Many of my patients with chronic sinus problems are so used to their daily symptoms that they do not realise they have sinus problems, seeking treatment here instead for snoring, headache or bad breath.
What is sinusitis?
Sinusitis refers to an infection due to virus, bacteria or fungus; or inflammation from allergies or chemicals like smoke/drug abuse/ cocaine of these sinuses.
What are sinuses?
Many people think the sinuses are in the nose, but they are actually next to the nose. Sinuses are about 10 air cavities situated in our face next to, below, above and behind our eyes. There is actually a whole litre per day of mucus that is being continuously secreted by the sinuses. The mucus is swept imperceptibly into the nose, lungs and throat to protect against foreign particles and infection. When there is an infection or inflammation like in sinusitis, there is increased mucus production and the openings of the sinuses are narrowed or blocked.
What are the symptoms of sinusitis?
Common symptoms are fever, headache, facial/ear/eye/tooth pressure or pain, nose discharge, block nose, loss of smell and taste. Cough and sore throat are frequently due to a postnasal back drip from the sinuses. A Bloodstain is not unusual if there is repeated picking at the nose, heavy blowing of the nose, or severe infections. However, if blood-stained mucus persists; do see the ENT doctor as nasopharyngeal cancer must be excluded. Nasopharyngeal cancer has a higher incidence in Singapore compared to many other parts of the world.
In rare cases, there can be complications and emergency treatment must be sought – for example, eye swelling or visual changes, brain infection and invasive fungal infections especially for immunocompromised patients.
How do I know it is not a common cold or nose allergy?
Cold symptoms due to viruses usually continue throughout the day and last for a week or more. Sinusitis can last even longer, and patients are usually more ill. Chronic sinusitis may even result in polyps or infective bony changes around the sinuses that permanently narrow sinus openings. Inhalant airborne allergies of the nose usually happen at certain times of the day, e.g. house dust mites’ allergy is worse in the morning and night.
What will my ENT doctor check for in the clinic?
Your ENT doctor will examine the nose, ear and throat as these are usually affected together. It is important to consider related factors like whether this is a child, an adult, even the actual age ranges of a child, the ethnicity and occupational factors. For example, the frontal sinuses are not developed till 12 years old. Eye swelling may be the first sign of sinus disease in a young child who had never had nose issues. Cystic fibrosis sinusitis is more common in Caucasians and Middle Easterners.
A tiny noodle-like flexible fibre optic nose scope is passed through the nose and throat with the child or adult awake in the clinic after a decongestant nose spray. This may be ticklish but is not painful. We are looking out for redness, swelling, discharge, polyps, deviated nose bone and enlarged turbinate tissue.
I usually do a nasal swab for culture sensitivity testing so as to guide treatment, as there are increasingly antibiotic-resistant organisms and unusual infections due to increased global connectivity and travel. Sometimes, biopsies of polyps and tumours need to be done. Radiology investigations like CT and MRI scans are only needed if medical treatment fails, if complications are suspected or if surgery is planned.
What are the treatment options for sinusitis?
Treatment should be tailored for the individual.
1. Simple measures – Avoid smoking, use mask protection against fumes and dust, control diabetes and get flu vaccinations if needed. Do a simple skin prick test to identify allergens and treat allergies so that there is less progression to infective sinusitis. Nasal rinse should use cool boiled water, and one-way flow bottles for non-contamination.
2. Medications –These include antihistamines, nasal decongestants and steroid sprays. For bacterial infections, the correct antibiotic must be used at the appropriate dose and duration, best guided by updated local geographic bacteriology data and swab culture results.
3. Surgery – Fungal infections, chronic sinusitis and structural nose changes often require surgery. Balloon sinuplasty procedures may sometimes be considered for limited disease isolated to certain sinuses. Functional endoscopic sinus surgery (FESS) nowadays allow surgeons to do away with external incisions for the surgery, and has real-time CT scan image guidance intraoperatively and refined endoscopic instruments allowing precise surgery and increased safety to surrounding eyes and brain. Deviated nose bone septum and large obstructive nose turbinate structures may have to be addressed too if they are obstructing the sinus openings.