SINUS PROBLEMS

Possible reasons for your ‘runny nose’

Did you know that many people seeing an ENT doctor complaining about a sinus problem, actually have perfectly normal sinuses? How is that possible?

What are sinuses:

The sinuses are air-filled spaces within designated bones of the facial skeleton. They are not present at birth to any real degree and grow and develop in the first few years of life. To this very day, we have no real idea why we have sinuses! The confusion with patients and their sinuses is that there is an overlap between symptoms of the sinuses and symptoms of the nose and because of the anatomical relationship between these two, the brain (or the assessing doctor sometimes) makes the mistake in attributing the cause to the sinuses.

What is sinusitis?

What is sinusitis and what are the symptoms? The easiest way is to divide the types of sinus disease into two main categories: acute, which means it is of new onset, and chronic, which means it has been hanging around for more than three months.

1. Acute sinusitis is an active infection.

It could be viral or bacterial, but it is an illness related to the general feeling of also being unwell. You would have facial pain, a blocked and runny nose, a feeling of lethargy and may be running a fever. You have a cold or the feeling of something similar, but much worse.

2. Chronic sinusitis is a persistent inflammatory process.

It might have started from an infection but for whatever reason, the system is still irritated and reacting. It is unusual to have facial pain though you may feel pressure and a sense of heaviness, and it is unlikely that you will feel unwell or be actively sick. Instead you may be troubled by an altered sense of smell, a feeling of a blocked nose and congestion, and may have a persistent post-nasal drip.

What is allergic rhinitis?

It is not an infection and has no relationship to an infection. It is triggered usually by something in the air that the person has developed a sensitivity to.

The main problem patients have is that they erroneously call it ‘a sinus problem’ if they have ‘hay fever’ or ‘allergic rhinitis’ to use the medical terminology. With this condition, patients get variations of the theme of episodes of blocked and runny nose (clear mucus), sneezing, itching, facial pressure and fullness, irritated eyes, and may notice that their asthma plays up if they suffer also from this.

Treatments:

So, what can I do about my sinusitis problem? Firstly, ensure you receive the correct diagnosis.

1. Acute & chronic sinusitis:

If it is acute sinusitis, then using a combination of antibiotics and nasal sprays such as a decongestant, saline and steroid nasal medications may be necessary. If it is chronic, then this is more about using steroid nasal medications which could be as a spray or tablets.

2. Allergic rhinitis:

If it is an allergy, then again steroid nasal sprays may be needed, together with antihistamines. However, for this category, it is important to try and work out what is causing it. If you can do this, then you may be able to modify your exposure to the trigger and failing that may be a candidate for desensitisation. Desensitisation is also called immunotherapy and is prescribed by doctors trained in managing allergy problems.

Dr David McIntosh is a Paediatric ENT Specialist with a particular interest in airway obstruction, facial and dental development and its relationship to ENT airway problems and middle ear disease. He also specialises in sinus disease and provides opinions on the benefit of revision of previous sinus operations. Dr McIntosh can be contacted via this website.