What are the common causes of chronic nasal and sinus symptoms in adults?

While numerous things can lead to longstanding nasal and sinus symptoms, the three most common causes are nasal passage deformities, allergic rhinitis and chronic sinusitis.

What are nasal passage deformities?

These are structural abnormalities inside the nose that physically block the air flow through your nasal cavity. One common example is a deviated septum. Your nasal septum divides your nose into right and left nasal passage. A deviated septum is when that divider is bent into one nostril rather than being straight and in the midline. Enlarged turbinates and nasal polyps are other examples of nasal passage deformities which can physically block nasal air flow.

How do I know if I have a nasal passage deformity?

The main symptom from a deviated septum and other nasal passage deformities is difficulty breathing through your nose. They typically do not cause symptoms such as excess drainage and sinus pain. Allergies and sinus infections can also cause nasal obstruction. Therefore, the key to determining if your nasal obstruction is due to nasal passage deformity is to be examined by a physician who is familiar with normal nasal anatomy and who has the equipment to do a proper and complete exam.

How are nasal passage structural deformities treated?

Medications such as decongestant pills may provide temporary relief; however, the only
thing that actually corrects a nasal passage deformity is surgery.

What are allergies?

Allergies, or allergic rhinitis, refers to nasal symptoms that occur as a result of being exposed to certain substances floating in the air. These substances which provoke allergy symptoms are called allergens. Allergens include pollens, dust mites, molds and animal dander. Allergens are harmless substances; however, the immune system of people with allergies mistakenly perceives the allergen as harmful and responds by trying to get rid of the allergen. For example, an allergic patient may develop a runny nose and sneezing in an attempt to remove the pollen or dust mite from his/her nose.

How do I know if I have allergies?

One way is based on your type of symptoms. Some allergy patients are "runners" in that they
get a wet, drippy nose. Other allergy patients are "blockers" in that their nose simply blocks up. Both types of patients may also have bouts of sneezing, itching in the nose and throat and itchy, watery eyes.

Another clue is the timing of symptoms. Patients with allergies tend to have a predictable pattern
to their nasal problems. Their symptoms may consistently be worse in certain environments because they are inhaling more of a particular allergen at that time. Situations which may influence the severity of allergy symptoms include different seasons, different locations, different activities and different weather.

One final factor that may suggest allergies is response of symptoms to allergy treatment.

Obviously, if the patient’s symptoms improve on allergy medications, then the likelihood of allergies being present is greater.

What is allergy testing?

Allergy testing determines the substances to which you are allergic as well as how sensitive you are to each allergen. Although a blood sample from you can be analyzed, our allergy testing technique more commonly involves injecting small amounts of various allergies into your skin. A positive skin reaction indicates that you are allergic to that particular substance; however, it does not mean that substance is causing your symptoms. We must always correlate your allergy test results with your type and timing of symptoms.

Does the allergy testing include food allergies?

The allergens tested for are substances that can be inhaled such as pollens, dust mites, molds and animal dander. Food allergies are not included because we believe they cannot reliably be determined by standard skin testing. We can provide you with additional information on food allergies if you suspect you have them.

What are the treatment options for allergies?

The three choices are avoidance (i.e. environmental control), medications and allergy shots (i.e. immunotherapy). We have a separate handout providing more detail on allergy treatment.

What is chronic sinusitis?

The paranasal sinuses are air-containing spaces within the facial bones. These sinuses are not
in the nose but connect to the inside of the nose by way of small openings. Swelling can develop within the sinus that blocks the opening between the sinus and the nose. As a result, bacteria may begin growing and cause an infection within the obstructed sinus. Antibiotics are then used to treat the infection. If the swelling at the opening of the sinus persists after completion of the antibiotics, that persistent blockage may lead to more infections and cause continued symptoms in between the infections.

How do you diagnose chronic sinusitis?

One clue is a frequent need for antibiotics. If you have been on antibiotics four or more times during the past year, there is an increased likelihood that you may have chronic sinusitis. That likelihood is even greater if the antibiotics were appropriately prescribed for bacterial sinusitis, not simply colds, and if you had at least temporary improvement while on antibiotics. Admittedly, not all patients with chronic sinusitis have this recurring infection pattern. Some patients simply have continuous nasal congestion with some discolored postnasal drainage, perhaps a poor sense of smell, and possibly fatigue.

Since it is difficult to make a diagnosis of chronic sinusitis based simply on symptoms, a
complete exam of your nasal cavity is important. Nasal endoscopes, which we have available in our office, are especially helpful. They allow us to see the type of secretions coming from the sinuses and detect problems inside the nasal cavity.

Another key component in diagnosing chronic sinusitis is a CT scan, also known as a CAT scan. We usually obtain the scan after a prolonged course of medical therapy or at your baseline (ie. on a typical day); however, sometimes we decide to obtain it during a flare-up. This x-ray study determines if there is swelling blocking the opening between the sinuses and the nasal cavity.

What is the treatment for chronic sinusitis?

We may prescribe medications to keep your chronic sinusitis symptoms under control, or we may recommend functional endoscopic sinus surgery. This surgery restores the normal function of the sinuses by removing the blockage at the sinus openings.

Are there other things besides nasal passage deformities, allergies and chronic sinusitis that can cause nasal and sinus symptoms?

Vasomotor rhinitis is when the nose is overly sensitive to certain irritants in the environment but not necessarily allergic to those substances. These patients typically experience a runny or congested nose while eating or when exposed to irritants such as smoke, perfume and chemicals.

Laryngopharyngeal reflux refers to stomach acid rising up the esophagus and into the throat area. These patients are bothered by the sensation of excess throat mucus or a lump in the throat. They may also be experiencing throat clearing, non-productive cough, intermittent hoarseness and difficulty swallowing. They assume that this "throat mucus" is drainage coming from the nose when actually it is acid coming up from the stomach. Surprisingly, 50% of these patients do not have heartburn.

Finally, some patients believe they are having sinus headaches when actually the pain is from another cause. Other causes of headaches may include jaw joint (TMJ) problems, tension headaches and migraine headaches.

Determining the cause of your chronic nasal and sinus symptoms can be challenging. By understanding the different conditions that can cause your symptoms, you can better provide the necessary information to guide your treatment plan. We are grateful for the opportunity to work with you.

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