What really causes the constant snifﬂes and blocked nose that plague so many of us?
Waking up regularly with a leaky nose, a throbbing headache and nasal congestion is no fun. If you suffer from sinus problems, you’ve probably turned up at the ofﬁce with tissues shoved up your nostrils, feeling both miserable and uncomfortable. What’s causing your nasal woes and is there a way to get rid of them for good? We ask the experts.
Understanding Your “Sinus”
It’s common for people to refer to a persistent runny or blocked nose as “having sinus”. “Actually, the term ‘sinus’ refers to an air cavity around the nose,” explains Dr Dharambir S Sethi, an ear, nose and throat specialist at Mount Elizabeth Novena Hospital.
We have four pairs of these air cavities – in the forehead bone, cheek bones, between the eyes and at the back of the nose almost in the centre of the head. Your sinuses are lined with a membrane that produces mucus, which moistens the tissues in the nasal passages, and helps to trap and ﬂush out dirt and harmful microbes.
Sinusitis occurs when this mucous lining becomes inﬂamed. “The inﬂammation may be due to viral infection, bacterial infection, fungal infection, smoking or allergies,” says Dr Sethi.
Dr Ker Liang, head and neck surgeon at the department of otolaryngology, National University Hospital, adds: “Inﬂammation then leads to nasal obstruction.” The swelling membranes can block your sinuses, cause facial pain and produce coloured nasal discharge. Other symptoms include fever, persistent headache, chronic cough, ear pain and not being to smell properly.
Not Just One Kind Of Sinusitis
“If the infection lasts for less than four weeks, it is deﬁned as an acute infection. When it persists for more than 12 weeks, it’s considered a chronic infection,” says Dr Sethi. Most cases are acute and are commonly caused by bacterial or viral infections, such as the ﬂu virus. Up to 40 per cent of patients recover on their own within two weeks.
Dr Ker says: “If no improvement is seen after two weeks, patients will be given a course of antibiotic therapy to combat the infection.” Two or three courses may be required.
Chronic infections that last for more than 12 weeks are usually due to allergies, structural problems within the nose or issues relating to your immune system. The World Allergy Organization Journal says roughly one in 10 people suffer from chronic sinusitis.
Chronic sinusitis can result in fatigue, dental pain and cough, on top of the usual symptoms. Multiple courses of antibiotic therapy may be ineffective in this case. And if the infection worsens and spreads to the eye or the brain, surgery may be necessary.
Is It Really Sinusitis?
You may feel that your recurrent runny nose, nasal congestion and head pain are a result of chronic sinusitis but doctors say that more often than not, it’s not the case. “If you wake up regularly with a dripping or congested nose, it is more likely that you have allergic rhinitis,” Dr Ker says.
Allergic rhinitis refers to hypersensitivity of the nose to environmental allergens like dust mites, animal fur or haze – one in ﬁve people in Singapore have it.
The symptoms are similar to sinusitis, including nasal congestion, runny nose, nasal itch and sneezing. But unlike chronic sinusitis, there’s no facial pain or dysfunction in one’s sense of smell. Instead, eye irritations, such as eye itch, tearing and redness may plague you.
Dr Ker points to another distinction: “Patients with allergic rhinitis produce clear, dripping nasal discharge, while those with chronic sinusitis produce a thick, yellow or green nasal discharge.”
As allergic rhinitis causes the tissues in your nose to become inﬂamed, it can also cause your sinuses to become inﬂamed too, resulting in sinusitis. Your doctor can prescribe a nasal sinus wash, a saline solution used to ﬂush out mucus and allergens, as well as antihistamines and intra-nasal steroid sprays, which stop inﬂammation. SH
DR DHARAMBIR S SETHI, ear, nose and throat specialist, Mount Elizabeth Novena Hospital.
DR KER LIANG, head and neck surgeon, department of otolaryngology, National University Hospital.
THAT SINUS OP
Patients with chronic sinusitis that does not respond to antibiotics could have mucous cysts, benign tumours or nasal polyps, which are small non-cancerous growths, in the nose or sinuses, says Dr Sethi. Or, their sinusitis could be caused by a fungal infection, which cannot be treated with antibiotics. Surgery may be needed but it’s not as scary or agonising a procedure as you might think. Here’s what can be done.
1 FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS)
“The aim of FESS is to remove diseased mucosa and bone from the sinuses. This allows the mucus to clear and promotes healing of the mucous membrane,” says Dr Ker.
Performed under local or general anaesthesia, an endoscope is inserted into the nose so the surgeon can see the nasal tract and remove diseased tissues. No external cuts or incisions are made; any infected mucus in the sinuses is also ﬂushed out. Pain is minimal, says Dr Sethi. “But it can hurt more if the operation involves all the sinuses, and concurrent procedures.” The minimally invasive day surgery can cost anywhere between $620 and $8,465 at public hospitals.
2 BALLOON SINUSPLASTY
In this option, a balloon dilation catheter is inserted into the sinus and inﬂated. “The objective is to widen the outﬂow tract of the sinus without having to remove any tissue,” says Dr Sethi. While this is less painful and results in a quicker recovery, it is suitable only in some situations, such as when the cause of sinusitis is isolated within a single sinus.
3 SEPTOPLASTY AND TURBINOPLASTY
In septoplasty, the cartilage between your nostrils is realigned, and in turbinoplasty, parts of the walls in your nose are removed. These are done to improve airﬂow and relieve nasal obstruction, and may be more painful.
IS SURGERY WORTH IT?
Endoscopic sinus surgery is very safe and the risk of major complications, such as damage to the eyes or blood vessels, is extremely low, at about 2 per cent. But Dr Sethi notes that it is best avoided in children as there is evidence that it may interfere with the growth of the facial skeleton.
Recovery takes just one to two weeks. You can expect a few nose bleeds, crusting or scabs that form on the mucous membrane as it heals, and blood-stained saliva during this period.
For the next three to six weeks, doctors will monitor your healing closely and help you with post-operative care, such as sucking out blood clots or prescribing antibiotics to deal with any infections that may occur.
“But surgery does not immunise you against the recurrence of sinusitis,” says Dr Ker.
She adds: “Although, you are more likely to recover from future infections completely and quickly with medication.”