Keeping sinuses clear

Chronic sinusitis can be a serious annoyance in a person's life. Experts tell MYB what can be done about it

By Dhany Osman

If you sniffled endlessly and blew your nose several times while reading this article, you may be one of the many people here with chronic sinusitis.

Medically defined, sinusitis is an infection of the sinuses that can be due to bacteria, viruses or fungi.

About 3 to 5% of Singaporeans suffer from some degree of sinusitis

While acute cases are normally accompanied by a fever or flu and last only a few weeks, those with the chronic variety may have less severe but more prolonged symptoms.

These include a constantly blocked or runny nose, headaches, sore throats and coughs, all of which can severely inconvenience one's daily life.

'Sinusitis is very common in children, teenagers and young adults, who generally spend more time outdoors and are exposed to the environment,' said DrStephen Lee, a consultant ear, nose and throat (ENT) surgeon at Raffles Hospital.

Pollution and allergies, he added, may be contributory factors in the development of sinusitis.
While he does not know of the actual numbers, Dr Lee estimated that about 3 to 5 per cent of Singaporeans suffer from some degree of the condition.

Mind Your Body spoke to Dr Lee and other ENT experts on what sinusitis is and how it can be treated.

Where are the sinuses?

There are four sets of sinuses: the frontal (above the eyes), ethmoidal (between the eyes), maxillary (cheek) and sphenoid (back of the nose).

When in a healthy state, these sinus cavities are filled with air, and mucous produced by our sinuses should drain through openings into our nasal passages, said Dr Lau Chee Chong, an ENT doctor in private practice.

Why we have sinuses is still under debate but one notion is that they help to ease the relative weight of the front of our skulls.

Sinus cavities also affect how our voices resonate, which may explain why people sound nasal when their sinuses are blocked, Dr Lee said.

'Some patients feel that they sound very different after treatment and have to get used to the sound of their new voice,' he added.

What causes it?

Dr Lee described the insides of our sinuses as having a mucous membrane, or 'internal skin', that can get inflamed when infected and which may end up blocking a person's sinus passages.

Typically, a viral infection such as a flu or cold may block the sinus and the accumulated mucous becomes a breeding ground for bacteria, he added.

While acute sinusitis usually clears within a few weeks, poor sinus drainage can lead to the condition becoming chronic if the symptoms last for more than three months.

Structural problems - like naturally narrow sinus passages, deviated nasal septums - or if there are nasal polypses, can contribute to poor sinus drainage, said Dr Lau.

Such people are hence more prone to developing sinusitis, he added.

People with allergies, too, may often find their sinuses easily aggravated and blocked when exposed to their specific allergens.

Smoke or pollution can also be irrititants and block one's sinuses.

Dr Lau added that poor dental hygiene may lead to the infection of the cheek sinus, when bacteria pass through the roots of the upper teeth.

Symptoms

The most common symptoms are a stuffed nose, swelling of the nasal passages and excessive mucous production.

In more serious infections, the mucuous discharged can often be yellowish, greenish or brownish.
There may also be pain in the sinus regions, commonly known as a 'sinus headache'. This is often felt around the eyes and cheeks.

'The pain can hit you quite suddenly and can get quite severe, leaving you uncomfortable for the whole day,' said Dr Y. T. Pang, a private practice ENT doctor.

Sinusitis can also cause a post-nasal drip, as excess mucous accumulates in the throat.
This can lead to bad breath, sore or dry throats and even coughs.

'Many people may not realise that a long-standing cough may stem from sinusitis and they end up seeing the wrong doctors,' DrPang added.

'The prevention of sinusitis is very much like that for the common cold,' said Dr Lau.

Simple steps to take include staying in well-ventilated rooms and avoiding smoky and dusty places. He added that staying well-hydrated can help keep one's mucous thin and easier to drain.
'People with allergy-related sinusitis should also avoid allergens which they're susceptible to, such as inhalants or food,' he said.

Treatment

Acute sinusitis is commonly treated with antibiotics, decongestants and mucolytics (to thin the mucous).

Pain-relief medicines may also be prescribed, along with antihistamines for those with allergies.
Dr Lee added that simple home remedies like inhaling steam and flushing the nasal passages with salt water can help ease the symptoms. The latter technique can be applied by carefully using a small pump.

A more thorough version of this treatment can also be performed in clinics. Called an entral wash, it involves inserting a tube into a patient's sinus cavity to flush it out with saline solution, he said.

Dr Lau said for more serious cases of chronic or recurrent sinusitis, there may be a more permanent solution: a functional endoscopic sinus surgery (Fess) procedure.

A minimally-invasive operation, it involves the removal of inflamed and infected tissue, or the expansion of the sinus passages, to allow for better drainage.

'The surgery is done completely through the nostrils, without any external incisions,' said Dr Lau.
Another procedure that has emerged more recently is balloon sinusplasty. This makes use of a surgical balloon to expand narrow sinus passages.

Using a guide wire, the balloon is inserted through the nose and inflated when in the right position.

'With this procedure, there is no longer a need to remove tissue and the recovery rate is remarkable,' said Dr Pang.

'One other advantage is that I'm inclined to perform it on children, who may be more concerned about surgery.'

Source: The Mind Your body of The Straits Times dated 19 Feb 2009.