Rhinitis and sinusitis
- Rhinitis is inflammation of the lining in the nose.
- Sinusitis is inflammation of the lining of the sinuses.
The linings of the nose and of the sinuses are continuous with each other, and mucous from the sinuses drains into the nose via channels made up of tiny nooks and crannies only 2–3 mm wide. Swelling of the lining of these drainage channels (resulting from inflammation) may cause them to stick together, so that mucous from the sinuses does not drain properly into the nose. It can therefore stagnate, and sinus infections may result from this inability of the sinuses to clear themselves.
This can cause symptoms of nasal blockage, poor smell, discharge, facial pain and headache.
Because rhinitis and sinusitis frequently co-exist, they are often referred to by the blanket term rhinosinusitis.
The cause of inflammation in the nose and sinuses falls into a few main groups:
- Allergy (especially in people with aspirin allergy and asthma and/or eczema).
- Long-standing nasal infection.
- Structural abnormalities causing narrowing of the sinus drainage channels (such as congenital narrowing of the sinus openings, or a twisted nasal septum).
- Congenital (inherited) diseases, such as cystic fibrosis and Young’s disease, where the mucous in the nose is abnormal.
- An ‘other’ group of various poorly understood factors, such as environmental (pollution) and occupational (workplace) triggers.
A combination of factors may be present in the same patient.
Nasal allergy
The main symptoms of nasal allergy are a blocked nose, excess (usually watery) mucus production, irritation of the nose and eyes, and sneezing. You may also feel an itchy throat and palate at the back of your mouth, and crackling in the ears or muffled hearing, due to the connection of the ears to the back of the nose via the Eustachian tube. Patients with associated asthma may notice that they are more wheezy and need their ‘reliever’ inhaler more often. These symptoms arise due to irritation of the lining of the nose and throat by airborne particles (aeroallergens) breathed in through the nose and mouth.
Nasal allergy may be seasonal (worse at certain times of year) or perennial (present all year round). The commonest cause of perennial nasal allergy is house dust mite, or possibly allergy to pets or animals in those with regular exposure. Common causes of seasonal allergy are tree pollen (February to May), grass pollen (June and July, commonly referred to as hay fever) and moulds (August to October).
We work with consultant respiratory physician colleagues and allergy specialists, which allows us to fully diagnose the likely cause and treat your nasal allergy and any associated chest symptoms, through thorough examination of your nose and sinuses and by blood tests.
In the light of these findings we are able to instigate appropriate and rapid advice and treatment. The mainstays of treatment are measures to avoid exposure to the relevant aeroallergen, as well as antihistamines and steroid nasal sprays. We can offer you all the latest treatments and medications used in this scenario. Occasionally, if nasal symptoms are the predominant problem, surgery to optimise the nose and sinuses may be appropriate, and we will guide you on this.
Nasal polyps
In some cases, long-standing inflammation of the nasal and sinus lining (rhinosinusitis) causes the lining of the ethmoid sinuses in particular to balloon out and hang down into the nose as polyps — like small grapes, visible with an endoscope (camera) up the nose.
Left untreated, polyps can grow to such a size that they cause increasing blockage of the nose, and may even become visible with the naked eye inside the nostrils. The size of polyps varies from person to person, as does the rate at which they regrow after surgery.
Nasal polyps are more common and aggressive in patients with certain other conditions such as asthma, allergy (particularly to non-steroidal drugs such as aspirin) and other long-standing chest diseases. Patients with the combination of asthma, aspirin sensitivity and nasal polyps have a condition called Samter’s triad, or aspirin-exacerbated respiratory disease (AERD).
Nasal drops & sprays
Nasal steroids are safe. They are strongest (and most effective) in tablet form, but can also be used as drops and sprays. They are the best treatment to help control nasal and sinus inflammation, both in the short and long term, and we will usually try a course of treatment with them before considering surgery. We may give a short course of antibiotics and steroid tablets prior to surgery to make the nasal lining healthier, and the surgery easier and therefore more effective. They are often required long-term after surgery in spray and drop form, especially if you have nasal polyps.
Lastly, it is important to realise that long-term observation, repeated examination and adjustment of medication is necessary for optimal control of rhinosinusitis, particularly when you have nasal polyps. There is no quick fix. Patients who have been treated by colleagues in the past will often tell us ‘my polyps have always come back before!’ Our belief and experience is that if a collaborative treatment pathway is followed — with thorough and targeted surgery, careful long-term follow-up, and use of the medications we suggest even when symptoms feel completely under control — then control of this condition is achievable.
We take great pride in offering only the best service in the management of chronic rhinosinusitis in our private practice. We audit our results and present them to colleagues locally and nationally for peer review, and we teach both junior surgeons and colleagues the surgical techniques we employ in the treatment of this condition.