It is not uncommon to hear people saying that they have a sinus problem. But what exactly do they mean? If you suffer from nasal itchiness, running nose, sneezing and nasal blockage, which is worse in the mornings, then you are likely suffering from allergic rhinitis rather than sinusitis. Allergic rhinitis occurs when your nasal passages react to allergens (pollen, dust or molds). The passages become swollen and secrete mucus. This causes nasal congestion and running nose. Certain chemicals called histamines are also released causing itchiness and sneezing. You can also feel itchy in your throat, ears or eyes.
There are 2 kinds of allergic rhinitis; perennial and seasonal. Seasonal allergic rhinitis usually occurs in temperate climates where the symptoms are pronounced during spring and summer when there are lots of pollen in the air. Perennial allergic rhinitis is more common here and is usually caused by exposure to house dust mites. The first step in treatment is allergen avoidance. This involves keeping the home environment clear of dust. Vacuuming, regular cleansing of bedding materials, removal of pet hair and clearing of molds will help reduce exposure to these allergens. Oral medications (antihistamines) and nasal sprays (corticosteroids) will be prescribed if the symptoms are troublesome. Allergic rhinitis can never be ‘cured’. The disease various in severity. During severe exacerbation medication is used and is tapered off the symptoms improve. There is an alternative treatment called sublingual immunotherapy which can significantly improve symptoms but needs to be taken daily for 1 to 3 years. It is especially useful if the symptoms are severe and allergy testing shows allergy to only one or two allergens. There are 4 pairs of air filled cavities in our face called sinuses. They communicate with the nose through tiny openings. When infection from the nose spreads into the sinuses, it will cause the mucous lining of the sinuses to swell and secrete excessive mucus or pus. This is known as sinusitis. The patients will usually complain of fever, facial pain, thick nasal and postnasal discharge, nasal obstruction and difficulty smelling, cough and headache. Usually this condition is treated with medication to reduce nasal congestion and allow the secretions to drain out of the sinuses. However, if the conditions worsen and the secretions become pus-like, then antibiotics may be added. If the condition does not resolve despite medication, a CT scan is required to visualize the sinuses. The CT scan will be able to show which sinuses are involved and if their drainage pathways are blocked. Functional endoscopic surgery can be done to open up and drain the obstructed sinuses and removed any diseased tissue or polyps. The surgery is performed under general anesthesia and requires overnight hospitalization. Usually the condition will fully resolve a couple of weeks after surgery.
Dr Sreetharan Sivapatha Sundaram, Consultant Ear, Nose and Throat (ENT), Head & Neck Surgeon
Gleneagles Kota Kinabalu Hospital