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Doc, what can I do about my Sinus?

Good morning and TGIF! Welcome to another Dr Euan's ENT Blogpost!


Today's topic is on what options there are for treating sinusitis, more commonly known as sinus.


Sinusitis is very common in Singapore, so if you would like to know more about what you can do about it, please have a read!



Q: What is sinusitis?

Sinusitis is an inflammation or swelling of the tissue lining the sinuses. Sinuses are hollow spaces within the bones between your eyes, behind your cheekbones, and in your forehead. They make mucus, which keeps the inside of your nose moist. That, in turn, helps protect against dust, allergens, and pollutants.

Healthy sinuses are filled with air. But when they become blocked and filled with fluid, germs can grow and cause an infection and nasal blockages.


A Diagram to show the different areas of the sinus

Some conditions that cause sinus blockages can include:

  • The common cold

  • Allergic rhinitis, which is swelling of the lining of the nose caused by allergens

  • Small growths in the lining of the nose called nasal polyps

  • A deviated septum, which is a shift in the nasal cavity

If you would like to know more about these ENT Conditions, you can read Dr Euan's advice in his blogposts about Allergies, Nasal Polyps, and Deviated Nasal Septum.


Q: What can cause Sinusitis?

Types of Sinusitis:

You may hear your doctor use these terms:

  • Acute sinusitis usually starts with cold-like symptoms such as a runny, stuffy nose and facial pain. It may start suddenly and last 2 to 4 weeks.

  • Subacute sinusitis usually lasts 4 to 12 weeks.

  • Chronic sinusitis symptoms last 12 weeks or longer.

  • Recurrent sinusitis happens several times a year.

You can read more about Dr Euan's advice on Acute Sinusitis and Chronic Sinusitis here.


Who Gets Sinusitis?

Lots of people. About 35 million Americans have sinusitis at least once each year. You are more likely to experience sinusitis if you have:

  • Swelling inside the nose like from a common cold

  • Blocked drainage ducts

  • Structural differences that narrow those ducts

  • Nasal polyps

  • Immune system deficiencies or medications that suppress the immune system


Q: What are the common symptoms of Sinusitis?

1. Acute Sinusitis Symptoms

The main symptoms include:

  • Facial pain or pressure

  • "Stuffed-up" nose

  • Runny nose

  • Post nasal drip

  • Loss of smell

  • Cough or congestion

You may also have:

  • Fever

  • Bad breath

  • Fatigue

  • Dental pain

It may be acute sinusitis if you have two or more of such symptoms or thick, green, or yellow nasal discharge.


2. Chronic Sinusitis Symptoms

If you are suffering from chronic sinusitis, you may experience these symptoms for 12 weeks or more:

  • A feeling of congestion or fullness in your face

  • A nasal obstruction or nasal blockage

  • Pus in the nasal cavity

  • Fever

  • Runny nose or discoloured postnasal drainage

You may also have headaches, bad breath, and tooth pain. You may feel tired a lot.

Lots of things can cause symptoms like these. You'll need to see your doctor to find out if you have sinusitis.


Q: What are the available treatment options?

If you have a simple sinus infection, your doctor may recommend you use a decongestant and saline nasal washes. You shouldn’t use an over-the-counter decongestant for more than 3 days, though, because it can make you more congested. You can read more on Dr Euan's advice in his blogpost on Nasal Sprays.


If your doctor gives you antibiotics, you’ll probably take them for 10 to 14 days. The symptoms usually disappear with treatment. Warm, moist air may help if you have chronic sinusitis. You can use a vaporizer, or you can inhale steam from a pan of warm water. Make sure the water isn't too hot.


There are some other things you can do yourself to help with chronic sinusitis:

  • Warm compresses can ease pain in the nose and sinuses.

  • Drink plenty of fluids to keep mucus thin.

  • Saline nose drops are safe to use at home.

  • Over-the-counter decongestant drops or sprays can help. Don’t take them longer than recommended.

In some cases, your doctor may prescribe steroids along with antibiotics.


Treatments for chronic sinusitis include:

  • Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone, triamcinolone, budesonide, mometasone and beclomethasone. If the sprays aren't effective enough, your doctor might recommend rinsing with a solution of saline mixed with drops of budesonide or using a nasal mist of the solution.

  • Saline nasal irrigation, with nasal sprays or solutions, reduces drainage and rinses away irritants and allergies.

  • Oral or injected corticosteroids. These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Oral corticosteroids can cause serious side effects when used long-term, so they're used only to treat severe symptoms.

  • Allergy medications. If allergies are causing sinusitis, your doctor may recommend allergy medications.

  • Aspirin de-sensitization treatment, if you have reactions to aspirin that cause sinusitis and nasal polyps. Under medical supervision, you're gradually given larger doses of aspirin to increase your tolerance.

  • Anti-fungal treatment. If your infection is due to fungi, you may have antifungal treatment.

  • Medication to treat nasal polyps and chronic sinusitis. If you have nasal polyps and chronic sinusitis, your doctor may give you an injection of dupilumab or omalizumab to treat your condition. These medications may reduce the size of the nasal polyps and lessen congestion.

Antibiotics

Antibiotics are sometimes necessary for sinusitis if your infection is caused by bacteria. If your doctor can't rule out an underlying infection, he or she might recommend an antibiotic, sometimes with other medications.


Immunotherapy

If allergies are contributing to your sinusitis, allergy treatment (sub-lingual immunotherapy) that helps reduce the body's reaction to specific allergens might improve the condition.


Surgery

Endoscopic sinus surgery

In cases resistant to treatment or medication, endoscopic sinus surgery might be an option. For this procedure, the doctor uses a thin, flexible tube with an attached light (endoscope) to explore your sinus passages.

Depending on the source of the blockage, the doctor might use various instruments to remove tissue or shave away a polyp that's causing nasal blockage. Enlarging a narrow sinus opening also may be an option to promote drainage.


Balloon Sinuplasty

This is a new / novel way of treating sinusitis, by employing balloons to dilate open the sinus openings and thus restore the natural ventilation routes of the air filled para-nasal sinuses.

There are also various catheters that can be used to effectively irrigate the interior of the sinuses.

Diagram explaining Balloon Sinuplasty procedure

This is a minimally invasive procedure that is now commonly done in the USA and Europe; In Singapore, we have been offering balloon sinuplasty for the past 20 to 15 years.


Other Treatment Options


It would be best if you also avoided any triggers linked to your sinusitis.

If you have allergies, your doctor may recommend an antihistamine.

If a fungus is to blame, you’ll get a prescription for an antifungal medicine. Some patients develop hypersensitive reactions to fungi and may suffer from Allergic Fungal Sinusitis.


If you have certain immune deficiencies, your doctor may give you immunoglobulin, which helps fight the things your body reacts to.


Can I Prevent Sinusitis?

There is no surefire way to prevent sinusitis. But there are some things that might help.

  • Don’t smoke, and avoid other people's smoke.

  • Wash your hands often, especially during cold and flu season, and try not to touch your face.

  • Stay away from things you know you’re allergic to. Talk to your doctor to see if you need prescription medicines, allergy shots, or other forms of immunotherapy.

If your sinus problems keep coming back, ask your doctor about the pros and cons of surgery to clean and drain the sinuses.


We hope this advice helps you to keep your sinuses clear so that you can smell the roses!


If you would like to make an inquiry or appointment about sinusitis treatment, please feel free to Contact Us at Euan's ENT Surgery & Clinic.


Thank you for reading! We wish you a blessed 2023 ahead!



REFERENCES:


[1] Aring AM,Chan MM, Current Concepts in Adult Acute Rhinosinusitis. American family physician. 2016 Jul 15; [PubMed PMID: 27419326]

[2] DeMuri G,Wald ER, Acute bacterial sinusitis in children. Pediatrics in review. 2013 Oct [PubMed PMID: 24085791]

[3] Rosenfeld RM,Piccirillo JF,Chandrasekhar SS,Brook I,Ashok Kumar K,Kramper M,Orlandi RR,Palmer JN,Patel ZM,Peters A,Walsh SA,Corrigan MD, Clinical practice guideline (update): adult sinusitis. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2015 Apr [PubMed PMID: 25832968]

[4] IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults., Chow AW,Benninger MS,Brook I,Brozek JL,Goldstein EJ,Hicks LA,Pankey GA,Seleznick M,Volturo G,Wald ER,File TM Jr,, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2012 Apr [PubMed PMID: 22438350]

[5] Berger G,Kattan A,Bernheim J,Ophir D,Finkelstein Y, Acute sinusitis: a histopathological and immunohistochemical study. The Laryngoscope. 2000 Dec; [PubMed PMID: 11129027]

[6] Wald ER,Applegate KE,Bordley C,Darrow DH,Glode MP,Marcy SM,Nelson CE,Rosenfeld RM,Shaikh N,Smith MJ,Williams PV,Weinberg ST, Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013 Jul; [PubMed PMID: 23796742]

[7] Rosenfeld RM, CLINICAL PRACTICE. Acute Sinusitis in Adults. The New England journal of medicine. 2016 Sep 8 [PubMed PMID: 27602668]

[8] Brook I, Acute sinusitis in children. Pediatric clinics of North America. 2013 Apr [PubMed PMID: 23481108]

[9] Boisselle C,Rowland K, PURLs: Rethinking antibiotics for sinusitis: again. The Journal of family practice. 2012 Oct [PubMed PMID: 23106063]

[10] Zalmanovici Trestioreanu A,Yaphe J, Intranasal steroids for acute sinusitis. The Cochrane database of systematic reviews. 2013 Dec 2 [PubMed PMID: 24293353]

[11] Dwyhalo KM,Donald C,Mendez A,Hoxworth J, Managing acute invasive fungal sinusitis. JAAPA : official journal of the American Academy of Physician Assistants. 2016 Jan [PubMed PMID: 26704655]

[12] Knipping S,Hirt J,Hirt R, [Management of Orbital Complications]. Laryngo- rhino- otologie. 2015 Dec [PubMed PMID: 26308141]

[13] Schubert MS, Allergic fungal sinusitis: pathophysiology, diagnosis and management. Medical mycology. 2009 [PubMed PMID: 19330659]

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