what is a 'sinus' problem?
Locally, it is very common to hear patients complain that they have ‘sinus’. Usually this means that they have symptoms of nasal stuffiness, a runny nose and itching at various times throughout the day that can disrupt their day to day activities.
so what truly is a 'sinus'? Do patients have 'Sinus'?
Yes and no, as the answer is slightly more complicated than that.
Medically, sinuses are hollow spaces in bone or other tissue. So truthfully, we all have sinuses, or
actually paranasal sinuses in this case.
As shown in the picture, paranasal sinuses are hollow cavities within the skull bones that
connect into the nose via several bony drainage pathways. Some may exist at birth while others
form over the course of childhood but everybody will have them.
So yes, everybody does have paranasal sinuses, but no, it itself is not a disease entity.
So if not 'sinus', what do these symptoms mean?
Broadly speaking these symptoms of nasal blockage, runny nose and associated conditions can either be due to allergies or hypersensitivity (allergic rhinitis) or true infections or inflammation of the paranasal sinuses (sinusitis). You may have one or the other, but a lot of times both conditions overlap.
We will now talk briefly about both conditions.
Nasal allergies are due to hypersensitivity of the nasal lining to inhaled allergens, for example dust. The exposure to the allergens will cause an allergic reaction with the nose with common symptoms such as:
Nasal obstruction: Allergen exposure causes the tissues within the nose to swell, leading to blockage and discomfort. This may disturb sleep and lead to dry mouth and throat.
Runny nose: Typically watery and clear, the lining of the nose becomes leaky and leads to frequent blowing or wiping to keep the nose clear.
Itching and sneezing: Itch is a very prominent symptom in allergic rhinitis as the allergic response releases histamine, which causes a lot of itching. This may be only in the nose or extend into the eyes, ears, throat or face.
Associated allergies: Often times allergic rhinitis will overlap with eczema or asthma. Poor control of any of these conditions can lead to the development of one of the others.
Sinusitis is an inflammation of the paranasal sinuses. As shown above, the paranasal sinuses are hollow spaces with the facial bones with openings that drain into the nasal cavity. In certain conditions, the lining of the drainage pathways can become swollen and blocked. This can occur in bad viral infections or dental infections.
Patients with allergic rhinitis are also at a high risk of developing sinusitis as they have a general background level of nasal lining swelling, which can extend into the paranasal sinuses.
The blocked drainage pathways will stop mucus from within the paranasal sinuses from draining out into the nose. The trapped mucus can then become infected or act as an irritant within the paranasal sinuses, giving symptoms such as:
Nasal obstruction: As with allergic rhinitis, patients with sinusitis may feel that their noses are blocked.
Nasal discharge: Usually thicker and less watery than in allergic rhinitis. Sometimes it may be green or yellow.
Facial pressure or pain: Patients with sinusitis typically feel that they have a sensation of pressure or aching over the cheeks, around the eyes or over the forehead. It is very commonly mistaken for migraines. The pain occurs due to built up pressure within a blocked sinus, similar to the discomfort of a blocked ear during flights, diving or altitude change.
Smell disturbances: Sinusitis patients may find that their sense of smell is affected, either being severely reduced, completely absent, or that they experience a foul odour in their noses that others are unable to smell.
I think i have
The diagnosis of allergic rhinitis and sinusitis requires a combination of a good history, a thorough and meticulous physical examination and sometimes further tests including scans or blood tests in some cases. This may include nasoendoscopy to examine the nasal cavity and paranasal sinus drainage pathways. It is advised to visit an ENT specialist (otorhinolaryngologist) in order to get the correct diagnosis.
Treatment itself can consist of either medicine for control and in some cases surgery. Not all patients require both and depending on the diagnosis and severity, this will be customised to suit you to give the best possible outcome.
can it be anything more severe?
Occasionally tumours and other growths within the nose or paranasal sinuses may give symptoms similar to sinus blockage. This is especially true in older patients or those with bloodstaining of their mucus or saliva. In patients that have persistent symptoms which do not improve or continue to get worse, it is advised to seek a consultation with a fully trained ENT specialist as soon as possible.