Allergy, Nose & Sinus
Thick mucous in your nose or phlegm? It may be coming from your sinuses! (WARNING – SOME GRAPHIC MEDICAL IMAGES & VIDEO)
February 10, 2020
Recently, Dr Gan saw a patient, Mr A who has been suffering from blocked nose, yellow-brown nose mucous and headaches for close to half a year. In addition, he also coughs out thick pieces of phlegm almost on a daily basis. He has seen many doctors and has been treated with multiple courses of antibiotics, nose washes and nose sprays which does relieve some of his symptoms. However, he was frustrated that he constantly spits out clumps of thick brown mucous and had persistent headaches despite these treatments. When he saw Dr Gan, a scope through his nose was performed in the clinic. His nose was congested but there were no signs of sinusitis such as pus, or swelling near the drainage pathway of the sinuses. However, in view of his clinical history, a CT scan (series of special X-rays) of his nose and sinuses was performed. It showed that he had infection of most of his sinuses, with the sinuses at the back of his nose known as the sphenoid sinuses completed filled with inspissated mucous (in a normal CT scan of the sinuses, the sinuses should be completely filled with air and appears black. In Mr A’s case, his sphenoid sinuses were completely grey – i.e. completely filled with mucous!)
A front on CT image of the sphenoid sinuses showing complete blockage
Mr A underwent sinus surgery to clear his infections. During surgery, inspissated mucous was found stuck in his sphenoid sinuses. This resulted in polyps and severe swelling in the sinuses. The consistency of this mucous is typical of “Allergic or Eosinophilic Mucin”. This is a subtype of sinusitis (either Eosinophilic Mucinous Rhinosinusitis or Allergic Fungal Rhinosinusitis) that is difficult to treat and often, a combination of sinus surgery and medication is required to keep the condition under control.
Thick mucous was found in the sphenoid sinus during surgery
It has been just over 6 weeks since Mr A’s sinus surgery. He no longer suffers from the nasal symptoms that used to impair his quality of life. His days of constant headaches and spitting out clumps of phlegm are over (hopefully forever! – fingers crossed). Although majority of sinusitis can be treated with medications, it is important to understand that if the sinusitis is recurrent, have failed medical treatments or is of a certain subtype (e.g fungal, allergic fungal or eosinophilic mucin rhinosinusitis), surgical intervention may be required in addition to medical treatments. Mr A has been advised to keep his disease under control with daily nasal steroid washes. Fluctuation in disease states and relapses can occur with this subtype of sinusitis. Hence, regular and long term surveillance is of paramount importance.