Acute sinusitis is usually short-lived and generally occurs after a common cold. A green or yellow nasal discharge occurs a week or more after the onset of the cold and this can be associated with severe pain around the cheeks, eyes and/or forehead. The nose is blocked, and there may be a fever and pain in the upper teeth.
Chronic sinusitis is sinusitis that continues for several months. Chronic sinusitis may be caused by an acute sinus infection, which fails to settle down. Common symptoms include nasal obstruction, nasal discharge and a reduced sense of smell. Facial pain or headache is less apparent and often absent in this type of sinusitis.
The diagnosis of sinusitis involves the use of a nasal endoscope, which is used to examine the sinus openings. This is not a painful procedure and takes only about 30 seconds to perform.
Acute sinusitis is treated with antibiotics and decongestants. Chronic sinusitis may need long courses of antibiotics together with steroid drops to reduce inflammation. Saline irrigations are also useful. In the vast majority of cases sinusitis can be managed effectively with medical treatment alone but sometimes symptoms will persist and surgery may be advised.
Sinus operations are performed under a general anaesthetic to put you to sleep and most patients go home the same day. There are usually no external incisions and operations are performed with specially designed instruments that are small enough to fit into your nostrils. I will ask for a scan of the sinuses to assist me with the planning of the operation. Sometimes I use a special machine called Image Guidance to navigate my way through the sinuses. This is useful in complex cases and revision surgery and makes the operation safer.
Sinuses are air-filled spaces in the bones of the face. Scientists do not really knows why we have sinuses. Some possible explanations are; to make the skull lighter, to act as crumple zones in case of trauma, to help resonate the voice or to kill germs that move through the nose. They are connected to the inside of the nose through small openings which can sometimes become blocked and cause symptoms.
Endoscopic Sinus Surgery is the name given to the operation to treat sinus problems, which have not improved with sprays and antibiotics. The operation is performed while the patient is asleep and requires no cuts on the face. It is performed using a small telescope (endoscope) and other instruments that fit inside the nostrils. Sometimes balloons are used to dilate and open the drainage channels.
Serious complications are extremely rare but can include damage to the eye or a leak of brain fluid through the nose.
A polyp is a swelling of the lining of the nose and is due to inflammation. The exact reason why some people develop them is uncertain but they are sometimes seen in patients with allergies and sinus infections. Late onset asthma, rather than childhood asthma, is also associated with nasal polyps and the underlying mechanism is very similar. I therefore often tell patients that having polyps is a little like having asthma in the nose.
Symptoms associated with nasal polyps are a blocked nose, runny nose, sneezing and a poor sense of smell and taste.
There is currently no cure for nasal polyps but most patient’s symptoms can be improved significantly with treatment. Polyps shrink when nasal sprays or drops containing steroids are used. Short courses of stronger tablet steroids can also be used a couple of times a year quite safely. Saline irrigation is also helpful.
Surgery unblocks the nose with immediate effect but more importantly it allows medical treatment to work better. The sinuses are opened and this reduces the surface area from where further polyps can arise and allows the steroid sprays to reach the site of the inflammation more easily
Sometimes the wall that separates the nose into right and left (nasal septum) is twisted. This can block the nose and can also make it bend. It may need to be corrected and this operation is called a Septorhinoplasty.
The operation can be performed either through the nostrils (closed approach) or by the use of a small incision under the nose (open approach). I prefer to use the open approach if the tip needs to be corrected.
The nasal septum is a thin piece of cartilage and bone inside the nose. It divides the left and right nostrils. Nobody has a completely straight septum but in some people the septum is significantly bent which can block the nose. Sometimes this is due to a previous injury but sometimes it just grows that way. An operation called a Septoplasty can straighten the septum and unblock the nose. This is performed with the patient asleep and most people go home the same day. I don’t usually put a removable pack inside the nose after surgery as removing it can be uncomfortable. It can take several weeks for the nose to become fully clear after surgery.
People can develop nasal symptoms because they are allergic to something in the environment. This is called allergic rhinitis. It can be intermittent at certain times of the year like hay fever, or persistent throughout the year like house dust mite allergy. Symptoms can include nasal blockage, congestion, sneezing, itching and a runny nose. Patients with asthma often have allergic rhinitis and it is important to treat both the lungs and the nose effectively at the same time. Not treating the nose will make the asthma worse and vice versa.
Allergy tests can be performed to look for specific causes. I use the skin prick test in clinic to look for common allergies. Sometimes a blood test can also be helpful.
Treatment includes avoiding the allergic substance if possible, which can be difficult, rinsing the nose regularly with saline to wash out the allergic substance and using steroid sprays and antihistamines to relieve symptoms. Sometimes surgery can help to relieve symptoms too.
Most people (including many doctors) often assume that facial pain is caused by sinusitis when in fact most causes are not due to sinus problems at all. This is especially true if you do not have any nasal symptoms such as a blocked nose, discoloured nasal discharge or a reduced sense of smell.
Acute sinusitis is often painful but tends to happen after a cold and does not usually last more than a week or two. Chronic sinus infections are much less likely to be painful and most patients will complain of nasal symptoms.
Common causes of facial pain and headache are tension headache and something called midfacial segment pain, which is like tension headache but it only affects the face. In both abnormal pain signals are sent to the brain and it usually improves with a tablet.
Other causes of facial pain include facial migraine, dental and jaw joint disorders, facial muscular pain and analgesic overuse headache amongst many others. By looking in your nose with an endoscope in clinic it will become clear to me if sinusitis is the cause of your pain.
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