Allergy, Nose & Sinus
Sinusitis: More Than Just Runny Nose
June 30, 2021
Sinuses are hollow cavities located within the skull and facial bones. We have four pairs of sinuses: sphenoid (beneath the nose), maxillary (cheeks), frontal (forehead), and ethmoid (between the eyes). Here are some important functions of our sinuses:
- Since they’re hollow cavities, sinuses make our facial bones less dense and lighter.
- They play an important role in shaping the quality of our voice production. Every person’s sinuses vary from others, and as such, we each have a unique voice characteristic.
- They produce mucus to moisturise the inside of our nose and trap pollutants like dust, as well as bacteria. Our sinuses also contain little hairs known as cilia that sweep the mucus, along with the trapped pollutants, irritants, and bacteria, to the back of the nose. Hence, when you suffer from a cold or sinus infection, you may feel a post-nasal drip draining into your throat, resulting in a cough.
Sinusitis is an inflammatory condition affecting the spaces behind the face that lead to the nasal cavity, also known as the paranasal sinuses. It is one of the most common conditions in Singapore, especially since we live in a tropical climate.
However, many people are unaware of what happens to their sinuses when they experience symptoms of sinusitis. As such, they are unsure of how their condition should be handled, and what warrants a visit to an Ear Nose Throat (ENT) Specialist in Singapore. Hence, in this article, we will provide a more in-depth guide to sinusitis.
Understanding What Sinusitis Is
Sinus infection, or sinusitis, occurs when inflamed and swollen sinuses block the tiny openings. As a result, mucus cannot flow into the nasal cavity through these openings. The mucus traps bacteria, viruses, and allergens. This excess buildup promotes the growth of germs which then leads to a sinus infection.
Excess buildup of mucus tends to be common in cases when you are suffering from a cold or allergies. While most colds or flus resolve on their own without the need for medication, it is best to see a doctor or an ENT Specialist in Singapore if your symptoms last for a period of longer than 10 days.
Sinusitis can be classified into two main types based on its duration:
1. Acute Sinusitis
The symptoms of a viral acute sinusitis last for a short amount of time and are most likely caused by a common cold. However, in the case of a bacterial infection, acute sinusitis usually lasts longer than 10 days and its symptoms can persist for up to a few weeks. Acute sinusitis can also be triggered by seasonal allergies.
2. Chronic sinusitis
Chronic sinusitis has symptoms that last for more than three months, and is usually the result of bacterial infection.
The Impact Of Chronic Sinusitis
While the symptoms of chronic sinusitis and the discomfort it causes are usually obvious, this condition has more severe consequences on the overall quality of your life. More than just a runny nose, chronic sinusitis can affect your work and leisure activities. These are three unexpected ways that chronic sinusitis, when left untreated, can affect you.
- Disrupted sleep
A common problem experienced by many people with chronic sinusitis is the reduced ability to sleep. Some are unable to get a full night’s rest and others notice their sleep quality declining significantly.
This is because the congestion associated with chronic sinusitis often makes it difficult to breathe and, thus, harder to drift off to sleep. In addition, there is also an increased risk of sleep apnoea amongst many who suffer from chronic sinusitis. Their breathing is often interrupted throughout sleep, hence they do not sleep as deeply as they should.
- Smell impairment
Chronic nasal congestion affects your sense of smell and taste. Whilst it may not seem like a big deal initially, over time, it has an impact on your ability to enjoy food. Since you cannot taste or smell what you eat, you may end up eating less than you should. Alternatively, you may also start gravitating towards unhealthy foods that are high in salt and sugar to boost your appetite.
- Lowers quality of life
It may be hard for you to concentrate at work or school when you’re dealing with a constant feeling of pain and pressure in the facial area. Brain fog is a common complaint received by many doctors at ENT clinics in Singapore – it refers to the feeling of the brain being surrounded by fog.
As a result of the many discomforts such as headache, giddiness, and fatigue, they tend to feel miserable and less likely to find joy in doing the things that they used to love. As such, sinusitis plays a role in lowering the overall quality of life.
- Noncancerous growths in the nose, also known as nasal polyps
- History of allergies
- Weakened immune system
- A deviated nasal septum (the wall of tissue running between your right and left nostrils displaces unevenly to one side)
- Recent upper respiratory tract infection
- Tobacco smoking
- Cystic fibrosis, causing thick mucus to build up in your lungs and other mucus membrane linings
The symptoms of acute and chronic sinusitis are similar. However, the main differences that tell the two conditions apart are the severity and length of symptoms. Generally, your doctor or ENT Specialist may diagnose you with sinusitis if you experience two or more of the symptoms listed below, accompanied by thick green, or yellow mucus discharge.
- Blocked nose
- Coloured (yellow, brown or green) or thick mucous from your nose, or in your phlegm
- Facial pain and headache due to increased sinus pressure
- Decreased sense of smell
Quite often, sinusitis can also cause postnasal drip, with a persistent cough and fatigue.
Other serious complications of sinusitis
You may think that your sinusitis will go away on its own or that it is easier to bear with it than seek medical attention from an ENT Specialist in Singapore. However, as our sinuses are close to other organs in our body, like the brain and the eyes, leaving it untreated may cause serious complications in the future.
Untreated sinusitis can spread the infection to the eyes, causing redness, swelling, reduced vision, and even blindness. Eye complications from sinusitis can range from orbital cellulitis (infection of the eyes without accumulation of pus), orbital abscess (infection of the eyes with accumulation of pus) to a potentially life-threatening, but rare condition known as cavernous sinus thrombosis (infection leading to a blocked venous system in the middle of the brain with important nerves and vessels). As the sinuses are also close to the brain, severe sinus infections can spread to the brain, leading to life-threatening conditions such as meningitis or brain abscess.
Although such complications are rare, it is still important to monitor your symptoms should you suspect that you have a sinus infection.
Difference Between A Cold And Sinusitis
As the symptoms of sinusitis and common cold are usually similar, such as runny nose, headache, and fatigue, most people tend to confuse the two conditions. However, there are some differences that can help you determine the condition you are suffering from and seek appropriate treatment options.
The duration of symptoms is the main difference between a common cold and sinusitis. According to a guideline by the Ministry of Health (MOH), a common cold is characterised by a sore throat, a general feeling of discomfort, and a low-grade fever. These symptoms tend to resolve within a few days and are followed by a blocked nose, runny nose, and cough. Most of us tend to visit a doctor for relief when we experience the second set of symptoms. After the seventh day, the symptoms will start resolving, allowing you to feel better again.
Here are some symptoms you may experience when you are suffering from the common cold:
- Blocked nose
- Runny nose
- Low-grade fever
- Mucus dripping down your throat, also known as post-nasal drip
- Clear or light mucus discharge
Unlike the symptoms of a cold that peak and resolve, sinus infections tend to last for more than 10 days with no signs of improvement. These are some of the symptoms that may set sinusitis apart from the common cold:
- Pain and pressure in the face
- Thick yellow or green mucus
Hence, if you notice that your symptoms do not improve or are worsening as the days go by, you could be suffering from sinusitis. It is always advisable to seek medical attention from an ENT Specialist in Singapore so that they can provide the best treatment.
Difference Between Sensitive Nose And Sinusitis
Should you be suffering from a blocked nose for a prolonged period, it’s highly likely that you are down with either a sinus infection or allergic rhinitis. Whilst they share similar symptoms, they are triggered by different factors. Allergic rhinitis, or sensitive nose, occurs when the body comes into contact with an allergen. The body defends itself by releasing a natural chemical called histamine, resulting in symptoms such as runny nose or sneezing.
These are some of the common symptoms of allergic rhinitis:
- A runny nose
- An itchy nose
- A blocked nose
- Itchy and/or watery eyes
- Eczema or hives
Read more: Allergic Rhinitis
Even though sinusitis and allergic rhinitis share similar symptoms, the factors that trigger the condition vary significantly between the two. In the case of allergic rhinitis, the passages of your nose and sinuses swell as a result of your immune system reacting to inhaled allergens like pollen, dust mites, mould, and pet dander.
On the other hand, sinusitis tends to occur as a result of allergic rhinitis. This is attributed to the prolonged swelling inside of your nose and sinuses when you come into contact with allergens.
Another main difference between sinusitis and allergic rhinitis is the onset of symptoms.
The onset of sinusitis usually occurs after a cold or allergic rhinitis. Hence, you will notice certain symptoms such as a blocked nose even after you’ve moved away from the trigger, or after your cold has gone away.
Unlike sinusitis, you’ll start feeling the symptoms of allergic rhinitis soon after you come into contact with the allergen. These symptoms usually persist until you’re away from the triggers. As allergies can happen at any time throughout the year, it is best to identify your triggers to minimise the risks of allergic rhinitis.
Visit Dr Gan, an ENT Specialist in Singapore, or your doctor about possible allergies if your symptoms of rhinitis last for a prolonged period and do not seem to be improving.
To diagnose your condition, the ENT doctor may feel for tenderness and pressure in your nose as well as face by gently pressing a finger over your sinuses. As mentioned earlier, some of the causes of sinusitis can include allergies and infections, hence, the doctor may also use other methods to diagnose sinusitis and rule out other conditions.
- Nasal endoscopy
A thin flexible tube with a fibre-optic light, called the endoscope, will be inserted through your nose. This is a relatively painless procedure that is done in the clinic under local anaesthesia (nasal spray used to numb the nose). This allows your doctor to visually inspect the inside of your sinuses to identify inflammation, nasal polyps, or other abnormalities.
- Imaging tests
A CT scan (a series of special X-rays) of your sinuses may be required to assess your sinuses. This is usually performed in:
- Patients whose sinus infection has failed to respond to medical treatment, and surgery may be required.
- Patients whose diagnosis of sinusitis is not clear.
- Patients whose sinus infection is severe and resulted in complications in the eyes or brain.
- Nasal and sinus samples
If your infection is persistent and there is pus in your nasal cavity, your ENT Specialist may take a sample of the pus to identify the bacteria involved. This will help your doctor in choosing the right antibiotics to treat your infection.
- Allergy tests
This is usually done to rule out allergic rhinitis, or if your doctor suspects that your sinus infections are triggered by allergies. The doctor at your ENT clinic may recommend a skin prick test. The test is generally safe, quick, and effective in pointing out the cause of your nasal allergy.
Treatment Options For Sinusitis
1. Natural Remedies
Natural remedies for sinus infections are not able to fully cure your symptoms, but they can help to reduce them. Examples of these approaches include:
- Drinking plenty of water
Water helps to thin out mucus, making it easier to pass through your sinus passages.
- Eating well
Boost your immune system by eating foods that are rich in vitamins and antioxidants to fight the free radicals that contribute to chronic sinus infections.
- Using a neti pot
A neti pot is a small pot with a long spout. It can be used to rinse out the nose and keep the mucous membrane moist whilst relieving pressure in the sinuses. An important thing to note when using a neti pot is that it is ideal to use sterile or distilled water, and not tap water. However, if you are unable to get access to either, you can boil water and let it cool before using it to rinse out your nose.
- Steam inhalation and warm compresses
Steam inhalation is effective in opening the passages in your nose to relieve sinus pressure. You can do this easily at home using a large bowl of steaming, boiled water. Simply position your face directly above the water, cover your head with a towel, and breathe through your nose.
Alternatively, you can apply heat to the sinus area by laying a warm compress on your nose bridge and cheeks for a few minutes to relieve pressure.
- Reduce stress
Prolonged stress can weaken your immune system, making you more susceptible to falling ill. Stress-related infections can attack and break down the cilia in your nose. Without cilia to trap pollutants and bacteria, it increases the risks of your sinuses becoming infected.
Do regular exercise, eat healthily, use breathing techniques, and get sufficient sleep to reduce daily stress and improve your well-being.
2. Medical therapies
Your doctor or ENT Specialist in Singapore may prescribe medications to treat the underlying cause(s) and reduce inflammation within your sinus passage. Depending on the underlying cause of your sinus infections, medical therapies may include:
The first-line treatment for chronic sinusitis is usually intranasal corticosteroids. These are nasal sprays that you need to use regularly for a period of time to reduce inflammation within the nasal passages. They reduce swelling within the nasal passages so that mucus can exit the nose easily. As such, blocked noses are cleared to improve breathing.
Oral corticosteroids may be prescribed in patients with inflammatory polyps but are not generally recommended for chronic sinusitis without nasal polyps.
One of the main symptoms of sinus infections is a blocked nose. Hence, your doctor may prescribe decongestants to unblock the sinuses and reduce the symptoms of nasal congestion. There are two kinds of decongestants available: nasal sprays or oral medications.
However, it is not recommended to use nasal decongestant sprays for more than five consecutive days as it may cause rebound congestion and worsen your blocked nose.
In acute viral or early bacterial sinus infection, symptoms can go away on its own without antibiotics. However, if your symptoms worsen after 5 days or persist longer than 10 days, your ENT Specialist may prescribe antibiotics to treat your infection.
A common mistake made by many patients on antibiotics is that they stop taking them once they notice that their symptoms are improving. This is not recommended as it exacerbates the bacterial infection, preventing it from fully resolving.
- Saline irrigation
Saline irrigation, also known as sinus rinse, uses salt water or a saline solution to flush out the mucus in your nasal cavity and sinuses.
- Surgical procedures
Your ENT Specialist will recommend surgery only if your sinusitis does not improve with conservative treatment. In the past, sinus surgeries often required external cuts in the face. However, with the advancement of technology, less invasive surgical approaches can be carried out to enlarge sinus cavities and make breathing, as well as drainage easier.
1. Functional Endoscopic Sinus Surgery (FESS)
FESS is a surgical approach used to treat chronic sinusitis. In this procedure, you will be put under general anaesthesia, and a special tool with a lighted camera on the end is used to look at the inside of your nose. The ENT surgeon will then either remove anything that is obstructing the affected sinus, such as nasal polyps or bony partitions. This helps to widen your sinuses allowing you to breathe better.
Read more about FESS here: https://www.drganent.com/blog/functional-endoscopic-sinus-surgery/
2. Balloon Sinuplasty
In this surgical procedure, the ENT Specialist will insert a small, balloon-tipped catheter into your sinus passages. Through the use of imaging guidance, the catheter is shifted to the right location before the balloon is slowly inflated. The balloon inflation widens your sinus passages, and once this is complete, it is deflated and the catheter is removed. Since this surgical approach does not require any tissue to be cut-out, the recovery time is generally shorter.
This procedure is, however, not suitable for everyone with chronic sinusitis. Hence, it is always best to discuss your options with your ENT Specialist before deciding on the appropriate course of treatment for your condition.
Even though sinusitis is a nasal condition, it also has a big impact on other parts of your body. Hence it’s always recommended to seek medical attention from an ENT Specialist to better understand the condition you are facing.
Medically reviewed by Dr Gan
A Specialist Clinic for Sinus, Snoring & ENT is located at Mount Elizabeth Novena and is helmed by Dr Gan, an ENT Specialist in Singapore. Together, we work hard to determine the root cause of your sinus issues and provide treatments for lasting relief. Contact us today to find out more.