Sinus problems

Dr Francis Barnett, ear, nose and throat (ENT) specialist, said the paranasal sinuses (or just sinuses as they are commonly called) are air-filled spaces within the facial skeleton.

He said there are four groups of sinuses and they all open into the nasal cavity.

“These sinuses are a normal part of your body. As with any body part they may get sick. The commonest disease to affect the sinuses is sinusitis. This is an inflammation or infection of the sinuses,” Dr Barnett said.

He added that other diseases to affect the sinuses are tumours and cancers which are uncommon but “clearly have serious consequences”.

Below Dr Barnett explains some common symptoms of sinusitis:

1. Nasal congestion

More commonly known as the stuffy nose, Dr Barnett said a common misconception is that everyone with a stuffy nose has sinusitis. “This is not so, as several other conditions will cause this, such as the common cold and nasal polyps, among other things.”

2. Rhinorrhoea

This is what is referred to as a runny nose. “Again, other conditions such as allergies may cause this,” Dr Barnett said.

3. Post-nasal drip

According to Dr Barnett, this may be described as mucus draining to the back of the throat.

“It may be excessive and discoloured. Some drainage to the back of the throat is normal as this is the normal route by which mucus drains from the sinus and nasal cavity to ultimately reach the back of the throat,” he said.

4. Facial pain or pressure

The ENT specialist said pain or pressure may be felt in the mid-face especially around the nose and the middle of the forehead when one is affected by sinusitis.

5. Problems smelling

“This is when the ability to smell may be lost or reduced,” Dr Barnett said.

6. Headache

Dr Barnett said most patients with headaches during sinusitis have migraines.

7. Dental pain

“This affects the upper teeth. The roots of the upper dentition may be within the maxillary sinus. Dental infection may be a cause of maxillary sinusitis — the largest of the paranasal sinuses, beneath the cheek,” Dr Barnett said.

8. Cough

Dr Barnett said this may be due to irritation and drainage to the back of the throat.

“It may be especially noticeable in children who cannot describe this drainage,” he said.

Dr Barnett explained that a very common disease that may mimic sinusitis is allergic rhinitis.

“This is an allergic reaction of the lining of the nasal cavity. These patients get bouts of sneezing, itchy nose, runny nose and stuffy nose. It may be accompanied by itchy, red eyes. This is a different disease from sinusitis and so is managed differently,” he said.

Dr Barnett said that apart from the symptoms of sinusitis, there are complications that come with the disease.

“The sinuses are closely related to the brain and the eye, and so disease may spread from the sinuses into these areas,” he said.

“Intracranial infections such as meningitis and abscesses are life-threatening. Orbital complications such as orbital cellulitis and abscesses may lead to loss of vision. Severe headaches with vomiting, swelling and pain around the eye, double vision, pain on eye movement are worrying signs and one should seek medical attention immediately,” Dr Barnett said.

Before a sinus disease is treated, the ENT specialist explained that a procedure called a nasoendoscopy may be done by an ENT surgeon.

“In this procedure a camera is inserted into the nasal cavity. This will assist in identifying the cause of the sinus disease and help to identify growths such as polyps which may obstruct the sinuses. A CT scan may also assist in identifying the cause, extent, and the severity of the disease,” Dr Barnett said.

According to Dr Barnett, treatment may include antibiotics for bacterial infection, topical nasal steroids, which relieve inflammation and aids in opening the doorway to the sinuses so they can drain better, pain relievers, decongestants, nasal irrigation or flushing the nose and antihistamines, which are tailored for patients with an allergic component to their disease.

But when a patient fails to respond to medical treatment, Dr Barnett said surgery may be indicated.

“The surgery is done endoscopically through the nose with special cameras and instruments. The basic aim of the surgery is to widen the openings of the sinuses so that they can drain better and are better ventilated and to remove disease obstructing the sinus and disease within the sinus,” he said.


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