Sinusitis

Sinusitis VIDEO

Insight into sinus problems in adults and children

• How are sinusitis symptoms different from a cold or allergy?

• When does acute sinusitis become chronic?

• What treatments are available?

Have you ever had a cold or allergy attack that wouldn’t go away? If so, there’s a good chance you actually had sinusitis. Experts estimate that 37 million people are afflicted with sinusitis each year, making it one of the most common health conditions in America. That number may be significantly higher, since the symptoms of bacterial sinusitis often mimic those of colds or allergies, and many sufferers never see a doctor for proper diagnosis and treatment.

What is sinusitis?

Acute bacterial sinusitis is an infection of the sinus cavities caused by bacteria. It usually is preceded by a cold, allergy attack, or irritation by environmental pollutants. Unlike a cold, or allergy, bacterial sinusitis requires a physician’s diagnosis and treatment with an antibiotic to cure the infection and prevent future complications.

Normally, mucus collecting in the sinuses drains into the nasal passages. When you have a cold or allergy attack, your sinuses become inflamed and are unable to drain. This can lead to congestion and infection. Your doctor will diagnosis acute sinusitis if you have up to 4 weeks of purulent nasal drainage accompanied by nasal obstruction, facial pain-pressure-fullness, or both. The sinus infection is likely bacterial if it persists for 10 days or longer, or if the symptoms worsen after an initial improvement.

When does acute sinusitis become chronic?

When you have frequent sinusitis, or the infection lasts three months or more, it could be chronic sinusitis. Symptoms of chronic sinusitis may be less severe than those of acute; however, untreated chronic sinusitis can cause damage to the sinuses that sometimes requires surgery to repair.

What treatments are available?

Antibiotic therapy – Therapy for bacterial sinusitis may include an appropriate antibiotic. If you have three or more symptoms of sinusitis (see chart), be sure to see your doctor for diagnosis. An oral or nasal spray or drop decongestant may be recommended to relieve congestion, although you should avoid prolonged use of nonprescription nasal sprays or drops. Inhaling steam or using saline nasal sprays or drops can help relieve sinus discomfort.

Antibiotic resistance means that some infection-causing bacteria are immune to the effects of certain antibiotics prescribed by your doctor. Antibiotic resistance is making even common infections, such as sinusitis, challenging to treat. You can help prevent antibiotic resistance. One way is to wait up to 7 days before taking antibiotics for mild sinus infections, allowing time for your body to fight the infection naturally. If the doctor prescribes an antibiotic, it is important that you take all of the medication just as your doctor instructs, even if your symptoms are gone before the medicine runs out.

Intensive antibiotic therapy – If your doctor thinks you have chronic sinusitis, intensive antibiotic therapy may be prescribed. Surgery is sometimes necessary to remove physical obstructions that may contribute to sinusitis.

Sinus surgery – Surgery should be considered only if medical treatment fails or if there is a nasal obstruction that cannot be corrected with medications. The type of surgery is chosen to best suit the patient and the disease.

Functional endoscopic sinus surgery (FESS) is recommended for certain types of sinus disease. With the endoscope, the surgeon can look directly into the nose, while at the same time, removing diseased tissue and polyps and clearing the narrow channels between the sinuses. The decision whether to use local or general anesthesia will be made between you and your doctor, depending on your individual circumstances.

Before surgery, be sure that you have realistic expectations for the results, recovery, and postoperative care. Good results require not only good surgical techniques, but a cooperative effort between the patient and physician throughout the healing process. It is equally important for patients to follow pre- and postoperative instructions.

When should a doctor be consulted?

Because the symptoms of sinusitis sometimes mimic those of colds and allergies, you may not realize you need to see a doctor. If you suspect you have sinusitis, review these signs and symptoms. If you suffer from three or more, you should see your doctor.

What are the symptoms of sinusitis vs. a cold or allergy?

SIGN/ SYMPTOM

SINUSITIS

ALLERGY

COLD

Facial Pressure /Pain

Yes

Sometimes

Sometimes

Duration of Illness

Over 10-14 days

Varies

Under 10 days

Nasal Discharge

Whitish or colored

Clear, thin, watery

Thick, whitish or thin

Fever

Sometimes

No

Sometimes

Headache

Often

Sometimes

Sometimes

Pain in Upper Teeth

Sometimes

No

No

Bad Breath

Sometimes

No

No

Coughing

Sometimes

Sometimes

Yes

Nasal Congestion

Yes

Sometimes

Yes

Sneezing

No

Sometimes

Yes

Can children suffer from sinus infections?

Your child’s sinuses are not fully developed until age 20. However, children can still suffer from sinus infection. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Sinusitis is difficult to diagnose in children because respiratory infections are more frequent, and symptoms can be subtle. Unlike a cold or allergy, bacterial sinusitis requires a physician’s diagnosis and treatment with an antibiotic to prevent future complications.

The following symptoms may indicate a sinus infection in your child:

• A “cold” lasting more than 10 to 14 days, sometimes with low-grade fever

• Thick yellow-green nasal drainage

• Post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting

• Headache, usually not before age 6

• Irritability or fatigue

• Swelling around the eyes

If these symptoms persist despite appropriate medical therapy, care should be taken to seek an underlying cause. The role of allergy and frequent upper respiratory infections should be considered.

Tips to prevent sinusitis

As always, an ounce of prevention is worth a pound of cure. To avoid developing sinusitis during a cold or allergy attack, keep your sinuses clear by:

• Using an oral decongestant or a short course of nasal spray decongestant

• Gently blowing your nose, blocking one nostril while blowing through the other

• Drinking plenty of fluids to keep nasal discharge thin

• Avoiding air travel. If you must fly, use a nasal spray decongestant before take-off to prevent blockage of the sinuses, allowing mucus to drain.

• If you have allergies, try to avoid contact with things that trigger attacks. If you cannot, use over-the-counter or prescription antihistamines and/or a prescription nasal spray to control allergy attacks.

Allergy testing, followed by appropriate allergy treatments, may increase your tolerance of allergy-causing substances. If you believe you may have sinusitis, see our tips for sinusitis sufferers.

Reprinted from http://www.entnet.org/HealthInformation/patients.cfm with permission of the American Academy of Otolaryngology – Head and Neck Surgery Foundation, copyright (C) 2009. All rights reserved.

Sinus Headaches

Not every headache is the consequence of sinus and nasal passage problems. For example, many patients visit an ear, nose, and throat specialist to seek treatment for a sinus headache and learn they actually have a migraine or tension headache. The confusion is common, a migraine can cause irritation of the trigeminal or fifth cranial nerve (with branches in the forehead, cheeks and jaw). This may produce pain at the lower-end branches of the nerve, in or near the sinus cavity.

Symptoms Of Sinusitis

Pain in the sinus area does not automatically mean that you have a sinus disorder. On the other hand, sinus and nasal passages can become inflamed leading to a headache. Headache is one of the key symptoms of patients diagnosed with acute or chronic sinusitis. In addition to a headache, sinusitis patients often complain of:

• Pain and pressure around the eyes, across the cheeks and the forehead

• Achy feeling in the upper teeth

• Fever and chills

• Facial swelling

• Nasal stuffiness

• Yellow or green discharge

However, it is important to note that there are some cases of headaches related to chronic sinusitis without other upper respiratory symptoms. This suggests that an examination for sinusitis be considered when treatment for a migraine or other headache disorder is unsuccessful.

Treatment For A Sinus Headache

Sinus headaches are associated with a swelling of the membranes lining the sinuses (spaces adjacent to the nasal passages). Pain occurs in the affected region – the result of air, pus, and mucus being trapped within the obstructed sinuses. The discomfort often occurs under the eye and in the upper teeth (disguised as a headache or toothache). Sinus headaches tend to worsen as you bend forward or lie down. The key to relieving the symptoms is to reduce sinus swelling and inflammation and facilitate mucous drainage from the sinuses.

There are several at-home steps that help prevent sinus headache or alleviate its pain. They include:

Breathe moist air: Relief for a sinus headache can be achieved by humidifying the dry air environment. This can be done by using a steam vaporizer or cool-mist humidifier, steam from a basin of hot water, or steam from a hot shower.

Alternate hot and cold compresses: Place a hot compress across your sinuses for three minutes, and then a cold compress for 30 seconds. Repeat this procedure three times per treatment, two to six times a day.

Nasal irrigation: Some believe that when nasal irrigation or rinse is performed, mucus, allergy creating particles and irritants such as pollens, dust particles, pollutants and bacteria are washed away, reducing the inflammation of the mucous membrane. Normal mucosa will fight infections and allergies better and will reduce the symptoms. Nasal irrigation helps shrink the sinus membranes and thus increases drainage. There are several over-the-counter nasal rinse products available. Consult your ear, nose, and throat specialist for directions on making a home nasal rinse or irrigation solution.

Over-the-counter medications: Some over-the-counter (OTC) drugs are highly effective in reducing sinus headache pain. The primary ingredient in most OTC pain relievers is aspirin, acetaminophen, ibuprofen, naproxen, or a combination of them. The best way to choose a pain reliever is by determining which of these ingredients works best for you.

Decongestants: Sinus pressure headaches caused by allergies are usually treated with decongestants and antihistamines. In difficult cases, nasal steroid sprays may be recommended.

Alternative medicine: Chinese herbalists use Magnolia Flower as a remedy for clogged sinus and nasal passages. In conjunction with other herbs, such as angelica, mint, and chrysanthemum, it is often recommended for upper respiratory tract infections and sinus headaches, although its effectiveness for these problems has not been scientifically confirmed.

If none of these preventative measures or treatments is effective, a visit to an ear, nose, and throat specialist may be warranted. During the examination, a CT scan of the sinuses may be ordered to determine the extent of blockage caused by chronic sinusitis. If no chronic sinusitis were found, treatment might then include allergy testing and desensitization (allergy shots). Acute sinusitis is treated with antibiotics and decongestants. If antibiotics fail to relieve the chronic sinusitis and accompanying headaches, endoscopic or image-guided surgery may be the recommended treatment.


Reprinted from http://www.entnet.org/HealthInformation/patients.cfm with permission of the American Academy of Otolaryngology – Head and Neck Surgery Foundation, copyright (C) 2009. All rights reserved.

Post-Nasal Drip

Insight into treating a runny nose

• What is post-nasal drip?

• How is swallowing affected?

• How is it treated?

• and more…

Glands in your nose and throat continually produce mucus (one to two quarts a day). Mucus moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. Although it is normally swallowed unconsciously, the feeling of it accumulating in the throat or dripping from the back of your nose is called post-nasal drip. This sensation can be caused by excessively thick secretions or by throat muscle and swallowing disorders.

What causes abnormal secretions?

Thin secretions:

Increased thin clear secretions can be due to colds and flu, allergies, cold temperatures, bright lights, certain foods/spices, pregnancy, and other hormonal changes. Various drugs (including birth control pills and high blood pressure medications) and structural abnormalities can also produce increased secretions. These abnormalities might include a deviated or irregular nasal septum (the cartilage and bony dividing wall that separates the two nostrils).

Thick secretions:

Increased thick secretions in the winter often result from dryness in heated buildings and homes. They can also result from sinus or nose infections and allergies, especially to foods such as dairy products. If thin secretions become thick, and turn green or yellow, it is likely that a bacterial sinus infection is developing. In children, thick secretions from one side of the nose can mean that something is stuck in the nose such as a bean, wadded paper, or piece of toy. If these symptoms are observed, seek a physician for examination.

How is swallowing affected?

Swallowing problems may result in accumulation of solids or liquids in the throat that may complicate or feel like post-nasal drip. When the nerves and muscles in the mouth, throat, and food passage (esophagus) aren’t interacting properly, overflow secretions can spill into the voice box (larynx) and breathing passages (trachea and bronchi), causing hoarseness, throat clearing, or coughing.

Several factors contribute to swallowing problems:

• With age, swallowing muscles often lose strength and coordination, making it difficult for even normal secretions to pass smoothly into the stomach.

• During sleep, swallowing occurs much less frequently, and secretions may gather. Coughing and vigorous throat clearing are often needed upon waking.

• When nervous or under stress, throat muscles can trigger spasms that make it feel as if there is a lump in the throat. Frequent throat clearing, which usually produces little or no mucus, can make the problem worse by increasing irritation.

• Growths or swelling in the food passage can slow or prevent the movement of liquids and/or solids.

Swallowing problems may also be caused by gastroesophageal reflux disease (GERD). This is when a backup of stomach contents and acid gets into the esophagus or throat. Heartburn, indigestion, and sore throat are common symptoms. GERD may be aggravated by lying down, especially following eating. Hiatal hernia, a pouch-like tissue mass where the esophagus meets the stomach, often contributes to the reflux.

How is the throat affected?

Post-nasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or a feeling that there is a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.

How is it treated?

A correct diagnosis requires a detailed ear, nose, and throat exam, and possibly laboratory, endoscopic (procedures that use a tube to look inside the body), and x-ray studies. Treatment varies according to the following causes:

• Bacterial infections are treated with antibiotics. These drugs may only provide temporary relief. In cases of chronic sinusitis, surgery to open the blocked sinuses may be required.

• Allergies are managed by avoiding the causes. Antihistamines and decongestants, cromolyn and steroid (cortisone type) nasal sprays, and other forms of steroids may offer relief. Immunotherapy, either by shots or sublingual (under the tongue drops) may also be helpful. However, some older, sedating antihistamines may dry and thicken post-nasal secretions even more; newer nonsedating antihistamines, available by prescription only, do not have this effect. Decongestants can aggravate high blood pressure, heart, and thyroid disease. Steroid sprays may be used safely under medical supervision. Oral and injectable steroids rarely produce serious complications in short-term use. Because significant side-effects can occur, steroids must be monitored carefully when used for more than one week.

• Gastroesophageal reflux is treated by elevating the head of the bed six to eight inches, avoiding foods and beverages for two to three hours before bedtime, and eliminating alcohol and caffeine from the daily diet. Antacids such as Maalox®, Mylanta®, Gaviscon®, and drugs that block stomach acid production such as Zantac®, Tagamet®, or Pepcid®) may be prescribed. If these are not successful, stronger medications can be prescribed. Trial treatments are usually suggested before x-rays and other diagnostic studies are performed.

General measures that allow mucus secretions to pass more easily may be recommended when it is not possible to determine the cause. Many people, especially older persons, need more fluids to thin out secretions. Drinking more water, eliminating caffeine, and avoiding diuretics (medications that increase urination) will help. Mucous-thinning agents such as guaifenesin (Humibid®, Robitussin®) may also thin secretions. Nasal irrigations may alleviate thickened secretions. These can be performed two to four times a day either with a nasal douche device or a Water Pik® with a nasal irrigation nozzle. Warm water with baking soda or salt (½ to 1 tsp. to the pint) or Alkalol®, a nonprescription irrigating solution (full strength or diluted by half warm water), may be helpful. Finally, use of simple saline (salt) nonprescription nasal sprays (e.g., Ocean®, Ayr®, or Nasal®) to moisten the nose is often very beneficial.

Sinus Conditions

Sinuses are air-filled cavities in the skull. They drain into the nose through small openings. Blockages in the openings from swelling due to colds, flu, or allergies may lead to acute sinus infection. A viral cold that persists for 10 days or more may have become a bacterial sinus infection. This infection may increase post-nasal drip. If you suspect that you have a sinus infection, you should see your physician to see if it needs antibiotic treatment.

Chronic sinusitis occurs when sinus blockages persist, causing the lining of the sinuses to swell further. Polyps (growths in the nose) may develop with chronic sinusitis. Patients with polyps tend to have irritating, persistent post-nasal drip. Evaluation by an otolaryngologist may include an exam of the interior of the nose with a fiberoptic scope and CAT scan x-rays. If medication does not relieve the problem, surgery may be recommended.

Vasomotor Rhinitis describes a nonallergic “hyperirritable nose” that feels congested, blocked, or wet.


Reprinted from http://www.entnet.org/HealthInformation/patients.cfm with permission of the American Academy of Otolaryngology – Head and Neck Surgery Foundation, copyright (C) 2009. All rights reserved.

Nose Bleeds

Insight into care and prevention of nosebleeds

• What is an anterior and posterior nosebleed?

• How do I stop a nosebleed?

• Tips to prevent a nosebleed

• and more…

The nose is an area of the body that contains many tiny blood vessels (or arterioles) that can break easily. In the United States, one of every seven people will develop a nosebleed some time in their lifetime. Nosebleeds can occur at any age but are most common in children aged 2-10 years and adults aged 50-80 years. Nosebleeds are divided into two types, depending on whether the bleeding is coming from the front or back of the nose.

What is an anterior nosebleed?

Most nosebleeds (or epistaxes) begin in the lower part of the septum, the semi-rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail. Nosebleeds coming from the front of the nose, (anterior nosebleeds) often begin with a flow of blood out one nostril when the patient is sitting or standing.

Anterior nosebleeds are common in dry climates or during the winter months when dry, heated indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented by placing a light coating of petroleum jelly or an antibiotic ointment on the end of a fingertip and then rubbing it inside the nose, especially on the middle portion of the nose (the septum).

How do I stop an anterior nosebleed?

• Stay calm, or help a young child stay calm. A person who is agitated may bleed more profusely than someone who’s been reassured and supported.

• Keep head higher than the level of the heart. Sit up.

• Lean slightly forward so the blood won’t drain in the back of the throat.

• Gently blow any clotted blood out of the nose. Spray a nasal decongestant in the nose.

• Using the thumb and index finger, pinch all the soft parts of the nose. Do not pack the inside of the nose with gauze or cotton.

• Hold the position for five minutes. If it’s still bleeding, hold it again for an additional 10 minutes.

What is a posterior nosebleed?

More rarely, a nosebleed can begin high and deep within the nose and flow down the back of the mouth and throat, even if the patient is sitting or standing.

Obviously, when lying down, even anterior (front of nasal cavity) nosebleeds may seem to flow toward the back of the throat, especially if coughing or blowing the nose. It is important to try to make the distinction between the anterior and posterior nosebleed, since posterior nosebleeds are often more severe and almost always require a physician’s care. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose or face.

What are the causes of recurring nosebleeds?

• Allergies, infections, or dryness that cause itching and lead to picking of the nose.

• Vigorous nose-blowing that ruptures superficial blood vessels.

• Clotting disorders that run in families or are due to medications.

• Drugs (such as anticoagulants or anti-inflammatories).

• Fractures of the nose or the base of the skull. Head injuries that cause nosebleeds should be regarded seriously.

• Hereditary hemorrhagic telangiectasia, a disorder involving a blood vessel growth similar to a birthmark in the back of the nose.

• Tumors, both malignant and nonmalignant, have to be considered, particularly in the older patient or in smokers.

When should an otolaryngologist be consulted?

If frequent nosebleeds are a problem, it is important to consult an otolaryngologist. An ear, nose, and throat specialist will carefully examine the nose using an endoscope, a tube with a light for seeing inside the nose, prior to making a treatment recommendation. Two of the most common treatments are cautery and packing the nose. Cautery is a technique in which the blood vessel is burned with an electric current, silver nitrate, or a laser. Sometimes, a doctor may just pack the nose with a special gauze or an inflatable latex balloon to put pressure on the blood vessel.

Tips to prevent a nosebleed

• Keep the lining of the nose moist by gently applying a light coating of petroleum jelly or an antibiotic ointment with a cotton swab three times daily, including at bedtime. Commonly used products include Bacitracin, A and D Ointment, Eucerin, Polysporin, and Vaseline.

• Keep children’s fingernails short to discourage nose-picking.

• Counteract the effects of dry air by using a humidifier.

• Use a saline nasal spray to moisten dry nasal membranes.

• Quit smoking. Smoking dries out the nose and irritates it.

Tips to prevent rebleeding after initial bleeding has stopped

• Do not pick or blow nose.

• Do not strain or bend down to lift anything heavy.

• Keep head higher than the heart.

If rebleeding occurs:

• Attempt to clear nose of all blood clots.

• Spray nose four times in the bleeding nostril(s) with a decongestant spray.

• Repeat the steps to stop an anterior nosebleed.

• Call a doctor if bleeding persists after 30 minutes or if nosebleed occurs after an injury to the head.


Reprinted from http://www.entnet.org/HealthInformation/patients.cfm with permission of the American Academy of Otolaryngology – Head and Neck Surgery Foundation, copyright (C) 2009. All rights reserved.

Nasal Fracture

Insight into diagnosis and treatment

• What is a nasal fracture?

• What are my treatment options?

• and more…

Projecting prominently from the central part of the face, it is no surprise that the nose is the most commonly broken bone on the head. A broken nose (nasal fracture) can significantly alter your appearance. It can also make it much harder to breathe through the nose.

What is a nasal fracture?

Getting struck on the nose, whether by another person, a door, or the floor is not pleasant. Your nose will hurt—usually a lot. You’ll likely have a nose bleed and soon find it difficult to breathe through your nose. Swelling develops both inside and outside the nose, and you may get dark bruises around your eyes (“black eyes”).

Nasal fractures can affect both bone and cartilage. A collection of blood (called a “septal hematoma”) can sometimes form on the nasal septum (a wall made of bone and cartilage inside the nose that separates the sides of the nose).

What causes a nasal fracture?

Nasal fractures, or broken noses, result from facial injuries in contact sports or falls. Injuries affecting the teeth and mouth may also affect the nose.

How can I prevent a broken nose?

• Wear protective gear to shield your face when participating in contact sports.

• Avoid fist fights.

When should I see a doctor?

If you’ve been struck in the nose, it’s important to see a physician to check for septal hematoma. Seeing your primary doctor or an emergency room physician is usually adequate to determine if you have a septal hematoma or other associated problems from your accident. If a septal hematoma is present, it must be treated promptly to prevent worse problems from developing in the nose. If you suspect your nose may be broken, see an otolaryngologist—head and neck surgeon within one week of the injury. If you are seen within one to two weeks, it may be possible to repair your nose immediately. If you wait longer than two weeks (one week for children) you will likely need to wait several months before your nose can be surgically straightened and fixed.

If left untreated, a broken nose can leave you with an undesirable appearance as well as permanent difficulty in trying to breathe.

How will my doctor determine if I have a broken nose?

Your doctor will ask you several questions and will examine your nose and face. You will be asked to explain how the fracture occurred, the state of your general health, and how your nose looked before the injury. The doctor will examine not only your nose, but also the surrounding areas including your eyes, jaw, and teeth, and will look for bruising, lacerations, and swelling.

Sometimes your physician will recommend an x-ray or computed tomography (CT) scan. These can help to identify other facial fractures but are not always helpful in determining if you have a broken nose. The best way to determine that your nose is broken is if it looks very different or is harder to breathe through.

What are my treatment options?

If your nose is broken but not out of position, you may need no treatment other than rest and being careful not to bump your nose.

If your nose is broken so badly that it needs to be repositioned, you have several options. You can have your nose repaired in the office in some situations. Your doctor can give you some local anesthesia, reposition the broken bones into place, and then hold them in the right location with a “cast” made of plastic, plaster, or metal. This cast will then stay in place for a week. In the first two weeks after the injury, your doctor may offer you this kind of repair, or a similar approach using general anesthesia in the operating room.

What if I need surgery?

If more than two weeks have passed since the time of your injury, you may need to wait a while before having your nose straightened surgically. It may be necessary to wait two to three months before a good repair can be done, by which time there will be less swelling and your nose will have begun to heal. Reduced swelling will allow the surgeon to get a more accurate picture of how your nose originally looked. This type of surgery is considered reconstructive plastic surgery, as its goal is to restore your appearance to the way it was prior to injury. If your repair is done within two weeks of the injury, restoring prior appearance is the only possible goal. If you have waited several months for the repair, it is often possible to change the appearance of your nose as you desire. Should you be interested in this kind of appearance change as well as repair, you can feel confident that your otolaryngologist is a specialist in all surgery of the nose. No other specialty has more training in surgery on the nose, and some otolaryngologists focus exclusively on plastic surgery of the face.


Reprinted from http://www.entnet.org/HealthInformation/patients.cfm with permission of the American Academy of Otolaryngology – Head and Neck Surgery Foundation, copyright (C) 2009. All rights reserved.

Nasal Congestion

Insight into the many causes of nasal congestion

• What are the causes of nasal congestion?

• Are there any risks when treating congestion?

• Where can I find out more?

Nasal congestion, stuffiness, or obstruction to nasal breathing is one of the oldest and most common human complaints. For some, it may only be a nuisance; for others, nasal congestion can be a source of considerable discomfort.

Medical writers have established four main causes of nasal obstruction: infection, structural abnormalities, allergic, and nonallercic (vasomotor) rhinitis. Patients often have a combination of these factors which vary from person to person.

What are the causes of nasal congestion?

Infection

An average adult suffers a “common cold” two to three times per year. These viral infections occur more often in childhood because immunity strengthens with age. A cold is caused by one of many different viruses, some of which are airborne, but most are transmitted by hand-to-nose contact. Once the virus is absorbed by the nose, it causes the body to release histamine, a chemical which dramatically increases blood flow to the nose and causes nasal tissue to swell. This inflames the nasal membranes which become congested with blood and produce excessive amounts of mucus that “stuffs up” the nasal airway. Antihistamines and decongestants help relieve the symptoms of a cold, but no medication can cure it. Ultimately, time is what is needed to get rid of the infection.

During a viral infection, the nose has poor resistance to bacteria, which is why infections of the nose and sinuses often follow a “cold.” When the nasal mucus turns from clear to yellow or green, it usually means that a bacterial infection has set in. In this case, a physician should be consulted.

Acute sinus infections produce nasal congestion and thick discharge. Pain may occur in cheeks and upper teeth, between and behind the eyes, or above the eyes and in the forehead, depending on which sinuses are involved.

Chronic sinus infections may or may not cause pain, but usually involve nasal obstruction and offensive nasal or postnasal discharge. Some people develop polyps (fleshy growths in the nose) from sinus infections, and the infection can spread to the lower airways, leading to a chronic cough, bronchitis, or asthma. Acute sinus infections generally respond to antibiotic treatment; chronic sinusitis may require surgery.

Structural abnormalities

These include deformities of the nose and nasal septum; the thin, flat cartilage and bone that divides the two sides of the nose and nostrils. These deformities are usually the result of an injury, sometimes having occurred in childhood. Seven percent of newborn babies suffer significant nasal injury in the birth process. Nasal injuries are common in both children and adults. If they obstruct breathing, surgical correction may be helpful.

One of the most common causes of nasal obstruction in children is enlargement of the adenoids. These are a tonsil-like tissue located in the back of the nose, behind the palate. Children with this problem may experience noisy breathing at night and may snore. Children who are chronic mouth breathers may develop a sagging face and dental deformities. In this case, surgery to remove the adenoids and/or tonsils may be advisable.

Other causes in this category include nasal tumors and foreign bodies. Children are often known to insert small objects into their noses. If a foul-smelling discharge is observed draining from one nostril, a physician should be consulted.

Allergies

Hay fever, rose fever, grass fever, and summertime colds are various names for allergic rhinitis. Allergy is an exaggerated inflammatory response to a substance which, in the case of a stuffy nose, is usually pollen, mold, animal dander, or some element in house dust. Pollen may cause problems during spring, summer, and fall, whereas house dust allergies are often most evident in the winter. Molds may cause symptoms year-round. In the allergic patient, the release of histamine and similar substances results in congestion and excess production of watery nasal mucus. Antihistamines help relieve the sneezing and runny nose of allergy. Typical antihistamines include Benadryl®, Chlortrimetron®, Claritin®, Teldrin®, Dimetane®, Hismanal®, Nolahist®, PBZ®, Polaramine®, Seldane®, Tavist®, Zyrtec®, Allegra®, and Alavert®, which are often available without a prescription and are available in several generic forms. Combinations of antihistamines with decongestants are also available.

Allergy shots are a specific and successful treatment method. SLIT skin tests and sometimes blood tests are used to make up vials of allergy-inducing substances specific to an individual patient’s profile. The physician determines the best concentration for the first treatment. Once injected, these treatments form blocking antibodies in the patient’s blood stream that interfere with the allergic reaction. Injections are typically given for a period of three to five years. Patients with allergies are more likely to need treatment for sinus infections.

Vasomotor Rhinitis

“Rhinitis” means inflammation of the nose and nasal membranes. “Vasomotor” means pertaining to the nerves that control the blood vessels. Membranes in the nose have an abundant supply of arteries, veins, and capillaries, which have the ability to expand and constrict. Normally these blood vessels are in a half-constricted or half-open state. But when a person exercises vigorously, hormone (adrenaline) levels increase. Adrenaline causes constriction of the nasal membranes so that the air passages open up and the person breathes freely.

The opposite takes place when an allergic attack or a cold develops. During a cold, blood vessels expand, membranes become congested, and the nose becomes stuffy, or blocked.

In addition to allergies and infections, certain circumstances can cause nasal blood vessels to expand, leading to vasomotor rhinitis. These include psychological stress, inadequate thyroid function, pregnancy, certain anti-high blood pressure drugs, prolonged overuse of decongesting nasal sprays, and exposure to irritants such as perfumes and tobacco smoke.

In the early stages of these disorders, nasal stuffiness is temporary and reversible. It usually improves when the primary cause is corrected. However, if the condition persists, the blood vessels lose their capacity to constrict, much like varicose veins. When the patient lies down on one side, the lower side becomes congested, which interferes with sleep. It is helpful to sleep with the head of the bed elevated two to four inches. Surgery is another option that can provide dramatic and long-time relief.

Are there any risks when treating congestion?

Patients who get sleepy from antihistamines should not drive an automobile or operate dangerous equipment after taking them. Decongestants increase pulse rate and elevate blood pressure and therefore should be avoided by those with high blood pressure, irregular heartbeat, glaucoma, or difficulty urinating.

Pregnant patients should consult their obstetricians before taking any medicine.

Cortisone-like drugs (corticosteriods) are powerful decongestants, administered as nasal sprays to minimize the risk of serious side effects associated with other dosage forms. Patients using steroid nasal sprays should follow instructions carefully, and consult a physician immediately if they develop nasal bleeding, crusting, pain, or vision changes.


Reprinted from http://www.entnet.org/HealthInformation/patients.cfm with permission of the American Academy of Otolaryngology – Head and Neck Surgery Foundation, copyright (C) 2009. All rights reserved.

Deviated Septum

Deviated Septum VIDEO

The shape of your nasal cavity could be the cause of chronic sinusitis. The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by skin that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size.

Estimates are that 80 percent of all nasal septums are off-center, a condition that is generally not noticed. A “deviated septum” occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections.

Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 18. Septal deviations commonly occur due to nasal trauma.

A deviated septum may cause one or more of the following:

• Blockage of one or both nostrils

• Nasal congestion, sometimes one-sided

• Frequent nosebleeds

• Frequent sinus infections

• At times, facial pain, headaches, postnasal drip

• Noisy breathing during sleep (in infants and young children)

In some cases, a person with a mildly deviated septum has symptoms only when he or she also has a “cold” (an upper respiratory tract infection). In these individuals, the respiratory infection triggers nasal inflammation that temporarily amplifies any mild airflow problems related to the deviated septum. Once the “cold” resolves, and the nasal inflammation subsides, symptoms of a deviated septum often resolve, too.

Diagnosis of A Deviated Septum: Patients with chronic sinusitis often have nasal congestion, and many have nasal septal deviations. However, for those with this debilitating condition, there may be additional reasons for the nasal airway obstruction. The problem may result from a septal deviation, reactive edema (swelling) from the infected areas, allergic problems, mucosal hypertrophy (increase in size), other anatomic abnormalities, or combinations thereof. A trained specialist in diagnosing and treating ear, nose, and throat disorders can determine the cause of your chronic sinusitis and nasal obstruction.

Your First Visit: After discussing your symptoms, the primary care physician or specialist will inquire if you have ever incurred severe trauma to your nose and if you have had previous nasal surgery. Next, an examination of the general appearance of your nose will occur, including the position of your nasal septum. This will entail the use of a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril.

Surgery may be the recommended treatment if the deviated septum is causing troublesome nosebleeds or recurrent sinus infections. Additional testing may be required in some circumstances.

Septoplasty: Septoplasty is a surgical procedure performed entirely through the nostrils, accordingly, no bruising or external signs occur. The surgery might be combined with a rhinoplasty, in which case the external appearance of the nose is altered and swelling/bruising of the face is evident. Septoplasty may also be combined with sinus surgery.

The time required for the operation averages about one to one and a half hours, depending on the deviation. It can be done with a local or a general anesthetic, and is usually done on an outpatient basis. After the surgery, nasal packing is inserted to prevent excessive postoperative bleeding. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose.

If a deviated nasal septum is the sole cause for your chronic sinusitis, relief from this severe disorder will be achieved.


Reprinted from http://www.entnet.org/HealthInformation/patients.cfm with permission of the American Academy of Otolaryngology – Head and Neck Surgery Foundation, copyright (C) 2009. All rights reserved.

Allergic Rhinitis

Inflammation of the nasal mucous membrane is called rhinitis. The symptoms include sneezing and runny and/or itchy nose, caused by irritation and congestion in the nose. There are two types: allergic rhinitis and non-allergic rhinitis.

Allergic Rhinitis: This condition occurs when the body’s immune system over-responds to specific, non-infectious particles such as plant pollens, molds, dust mites, animal hair, industrial chemicals (including tobacco smoke), foods, medicines, and insect venom. During an allergic attack, antibodies, primarily immunoglobin E (IgE), attach to mast cells (cells that release histamine) in the lungs, skin, and mucous membranes. Once IgE connects with the mast cells, a number of chemicals are released. One of the chemicals, histamine, opens the blood vessels and causes skin redness and swollen membranes. When this occurs in the nose, sneezing and congestion are the result.

Seasonal allergic rhinitis or hayfever occurs in late summer or spring. Hypersensitivity to ragweed, not hay, is the primary cause of seasonal allergic rhinitis in 75 percent of all Americans who suffer from this seasonal disorder. People with sensitivity to tree pollen have symptoms in late March or early April; an allergic reaction to mold spores occurs in October and November as a consequence of falling leaves.

Perennial allergic rhinitis occurs year-round and can result from sensitivity to pet hair, mold on wallpaper, houseplants, carpeting, and upholstery. Some studies suggest that air pollution such as automobile engine emissions can aggravate allergic rhinitis. Although bacteria is not the cause of allergic rhinitis, one medical study found a significant number of the bacteria Staphylococcus aureus in the nasal passages of patients with year-round allergic rhinitis, concluding that the allergic condition may lead to higher bacterial levels, thereby creating a condition that worsens the allergies.

Patients who suffer from recurring bouts of allergic rhinitis should observe their symptoms on a continuous basis. If facial pain or a greenish-yellow nasal discharge occurs, a qualified ear, nose, and throat specialist can provide appropriate sinusitis treatment.

Non-Allergic Rhinitis: This form of rhinitis does not depend on the presence of IgE and is not due to an allergic reaction. The symptoms can be triggered by cigarette smoke and other pollutants as well as strong odors, alcoholic beverages, and cold. Other causes may include blockages in the nose, a deviated septum, infections, and over-use of medications such as decongestants.

Rhinosinusitis: Clarifying The Relationship Between The Sinuses And Rhinitis

Recent studies by otolaryngologist–head and neck surgeons have better defined the association between rhinitis and sinusitis. They have concluded that sinusitis is often preceded by rhinitis and rarely occurs without concurrent rhinitis. The symptoms, nasal obstruction/discharge and loss of smell, occur in both disorders. Most importantly, computed tomography (CT scan) findings have established that the mucosal linings of the nose and sinuses are simultaneously involved in the common cold (previously, thought to affect only the nasal passages). Otolaryngologists, acknowledging the inter-relationship between the nasal and sinus passages, now refer to sinusitis as rhinosinusitis.

The catalyst relating the two disorders is thought to involve nasal sinus overflow obstruction, followed by bacterial colonization and infection leading to acute, recurrent, or chronic sinusitis. Likewise, chronic inflammation due to allergies can lead to obstruction and subsequent sinusitis.

Other medical research has supported the close relationship between allergic rhinitis and sinusitis. In a retrospective study on sinus abnormalities in 1,120 patients (from two to 87 years of age), thickening of the sinus mucosa was more commonly found in sinusitis patients during July, August, September, and December, months in which pollen, mold, and viral epidemics are prominent. A review of patients (four to 83 years of age) who had surgery to treat their chronic sinus conditions revealed that those with seasonal allergy and nasal polyps are more likely to experience a recurrence of their sinusitis.


Reprinted from http://www.entnet.org/HealthInformation/patients.cfm with permission of the American Academy of Otolaryngology – Head and Neck Surgery Foundation, copyright (C) 2009. All rights reserved.