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Know your Nose

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I used to have recurrent sinus infections, a miserable condition in which you wake to find that the dream you had about your head turning into a bowling ball actually happened. My mother used to get sinus infections too, and I seem to recall a time hers were so impervious to treatment, she needed some form of intervention involving anesthesia and scraping. Inspired to avoid that scenario at all costs, and on the recommendation of my GP who had exhausted his list of worthwhile antibiotics to prescribe, I dragged my bowling-ball head to an otolaryngologist, or ear, nose and throat (ENT) doctor to get checked out. Several negative nasal swabs and one unremarkable sinus series CT later, I found myself in the office of a neighborhood allergist, who was also very interested in my nose.

All of this was possible within walking distance from my Brooklyn apartment, since ENTs and allergists are fairly plentiful. The American Board of Medical Specialties tells me there are 12,000 ENTs and half as many allergists practicing in the US. Having seen one of each, I figured I had visited the most specialized of specialists. Turns out, no. Some ENTs spend another year or two in training, honing right in on the N to become “rhinologists”. To be clear, rhinology has nothing to do with scary African wildlife, and everything to do with the human nose, sinuses, and neighboring facial anatomy. The American Rhinologic Association website lists 26 fellowship training programs in the US and Canada available to board-eligible graduates of ENT residency programs. While, in the general sense, the study of the nose and its pathology has been around for a long while, rhinology as an organized, although not yet board certified, subspecialty is fairly new, gaining fellowship match status in 2006. And since few programs accept more than one candidate per year, there are only a handful of rhinology fellowship-trained rhinologists currently in practice.

As a group, rhinologists specialize in the advanced medical and surgical treatment of all things nasal, including chronic recurrent sinusitis, nasal obstruction, trauma, and tumors. Their zone of surgical expertise may extend to the orbit and skull base, and they may collaborate with ophthalmologists or neurosurgeons when they go there. With a lot of shared territory in the face, rhinologists are among several specialists, such as oral and maxillo-facial surgeons and plastic surgeons, who are capable of performing certain common procedures like rhinoplasty.

Although I have not suffered a sinus infection in years, knock wood, it’s comforting to know there are highly trained, nose-centric professionals out there who could wend their way around my troubled turbinates with ease, should I need one. What’s your take on the young and growing subspecialty of rhinology, and other nose-related clinical specialties? Feel free to leave a comment.

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