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Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.
Q What are the functions of the nose and sinuses?
1 Ventilation(main function)
2 Conditioning of air (humidification, heating, filtration)
3 Defence/ immune function-due to healthy mucous and it natural clearance pathways
4 Sense of smell
5 sensation of airflow
7 Mechanical (lightening of skull, absorption of shock to the face)
8 Speech -aids in resonance of speech
Therefore sinusitis or rhinitis disrupts the above natural functions of the sinuses.
Q What is Sinusitis and What is Rhinitis ?
If the nose is considered a corridor the sinuses are the rooms on either sides of the corridor. Rhino means nose, hence rhinitis means inflammation or swelling contained to the nose. Sinusitis means when the infection involves not only the nose, but also the sinus chambers on the sides.
Rhinitis (nose inflammation) gives rise to nasal congestion, clear drip, clear mucous running to the back of the throat. In addition allergic type will give rise to sneezing.
Sinusitis gives rise to nasal congestion, yellow drip, yellow drip at the back of the throat, loss of smell, facial pain. It also may give rise to chronic cough, smell.
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| Nose is the corridor Sinuses are the rooms on either side corridor needs to be straight and uncluttered (by a prcedure called septoplasty/ turbinoplasty) If sinuses infected: the doorways in the rooms need to be widened (sinus surgery) |
Q What are the different types of rhinitis
Important subtypes of rhinitis
1 allergic rhinitisThis leads to a runny, blocked nose as well as sneezing- commonly known as hay fever. Usually affects the younger population.
2 Vasomotor rhinitis
Nose has two types of nerve innervations. One which makes the nose wet and the other which makes the nose dry. When there is an imbalance between the two the nose can get congested, runny without associated sneezing. This called Vasomotor Rhinitis. This affects elderly population.
3 Rhinitis due to excessive use of decongestants.
Over the counter decongestants should not be used long term. If used longer term, nose becomes dependant on them to keep dry and the condition worsens leading to a runny nose. This will eventually settle after stopping these medications.
4 Hormonal
Pregnant and pre menopausal women may develop a runny nose due to hormonal changes.
5 Chemicals
Due to direct irritation
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| Note the corridor is congested, but the rooms on the sides are black i.e full of air |
Q What are the different types of sinusitis.
1 Acute sinusitis
This is when If symptoms are short lived ie 4-8 weeks, usually after a viral infection. Though short lived some people get significantly affected due to recurring infections.
2 Chronic Rhino Sinusitis (CRS)
This usually due to layers of bacteria that infect sinuses continuously. Symptoms lasts for 3 months or longer.
3 CRS with polyps
Polyps are peeled grape like swellings that arise from the sinus chambers. It is thought that a severe reaction of our bodies against a foreign material (such as a fungus or a bacteria) cause sufficient damage to the sinus lining give rise to polyps.
4 Fungal Sinus Infections
These are rare. Some may develop a fungal ball. Immune compromised people can develop severe invasive forms
5 There are other rare types due to chronic multi organ conditions.
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| Note the rooms have grey: ie infection hence sinusitis |
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| Note the grey polyps in the sinuses and the nose |
Q What will your specialist do during the first visit.
You will asked about the symptoms in detail and how long you have had them. Further questions will be asked about what treatment you have been on to ensure that you have trialled medical treatment sufficiently. Thereafter a nasal endoscopic examination will be done to see if there is limited swelling of the nose, pus in the nose, polyps in the nose or any sinister findings in the nose.
By end of the consultation and the examination the following will be decided by your surgeon
1) If you suffer rhinitis or sinusitis and which type it is likely to be
2) If you have had adequate targeted medical treatment of your likely condition
3) Review your CT if not organise a CT scan to view the sinuses
4) Discuss non surgical options including maximum medical treatment with long term rinses, if you had not been consistent with these before.
5) Discuss the role of immune therapy if you wish to trail this. This is keeping in mind that surgery can help about 80% of the patients with one singe treatment.
Once the surgeon is satisfied that you have tried medical options and wish to pursuit surgery he will decide the extent of surgery which is likely to help you and discuss these in detail.
Q What surgical options are available?
1) Those who have rhinitis with no sinusitis confirmed on CT
This group will benefit from improving the nasal passage without the need to open the sinus chambers. Therefore the corridor will be made straighter by a procedure called septoplasty or septo -rhinoplasty and turbinoplasty.
2) Those who have limited sinus disease
These patients will need a straighter corridor (septoplasty/ turbinoplasty) and larger opening to the rooms on the sides of the corridor. With regards to sinus surgery: these patients only need their cheek sinuses and the sinus along the eyes opened up (mini FESS) . The sinuses at the front (frontal sinuses) and the once at the back (sphenoid sinuses) do not need opening.
3) Those who have severe sinus disease/ polyps
They need a straighter corridor (septoplasty/ turbinoplasty) as well as opening of all the sinuses (FESS)
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