What is Sinusitis?
Recurrent Rhinosinusitis or Chronic rhinosinusitis (sinusitis) causes the spaces inside the nose and head, known as sinuses, to become inflamed and swollen. This condition persists for as long as treatment is not instituted or given adequately.
This condition results in excessive and purulent mucus production in the nose. The nose becomes congested as the thick mucus remains trapped within the nose and sinuses, making breathing through the nose difficult. The area around the eyes might feel swollen and tender. Other symptoms include persistent headaches and facial pain, poor sense of smell, a bad smell within the nasal cavity, persistent post-nasal drip, coughing, and persistent coloured phlegm from the nose and throat. Nasal polyps are benign growth within the nasal cavity and may cause recurrent rhinosinusitis. The condition affects both adults and children.
Common Symptoms Of Sinusitis
The symptoms of acute sinusitis share similarities with a cold. However, the condition often worsens after 7 to 10 days. Symptoms include:
- Bad breath or loss of smell
- Cough
- Fatigue and general feeling of being ill
- Fever
- Headache
- Post Nasal drip
- Pressure-like pain
- Nasal discharge and stuffiness
- Sore throat
Symptoms of chronic sinusitis are similar. However, they tend to be milder and last longer than 12 weeks.
The Common Causes Of Sinusitis
Acute and chronic sinusitis can be caused by several factors, including:
Allergies
Allergies can irritate the nose and sinuses, leading to inflammation, swelling, and blocked sinuses. The result is acute and chronic sinusitis.
Deviated Septum
A deviated septum is a structural displacement of the nasal septum that can cause abnormal nasal discharge and breathing issues, contributing to frequent sinusitis.
Nasal Polyps
Tissue growths, otherwise known as polyps, can form and block the nasal passage or sinuses, resulting in sinusitis.
Respiratory Infections
Common respiratory infections caused by bacteria or viruses can cause the lining of the sinuses to become swollen, blocking mucus drainage and trapping infectious bacteria that can infect the sinuses, causing sinusitis.
How Sinusitis Is Diagnosed
If you suspect you might have sinusitis, please consult a healthcare provider. During the examination, the doctor will check for tenderness in the nose and face, as well as look out for any swelling inside the nose.
In addition to noting your medical history and symptoms, the doctor may also perform further tests to determine the cause of your sinusitis. These examinations include:
Nasal Endoscopy
The doctor will insert a flexible, thin tube with a fibre-optic light attached to inspect the insides of the nose and sinuses.
Imaging Tests
In some cases, the doctor may recommend an MRI or CT scan to detect any blockage or structural issues that could be causing sinusitis, such as a deviated septum or nasal polyps.
Allergy Testing
If you have chronic sinusitis, the doctor may test you for allergies that could be triggering the condition.
How Is Sinusitis Treated?
Medication
Over-the-counter (OTC) medication, such as ibuprofen and antihistamines, can help relieve symptoms of sinusitis. For bacterial sinus infections, antibiotic therapy may help eliminate the infection and prevent further complications. Nasal steroid sprays or nasal saline (saltwater) drops may also be prescribed to relieve short-term stuffiness.
Immunotherapy
If you have allergy-related sinusitis, the doctor may recommend allergy shots as a long-term treatment option to help reduce your body’s reaction to the allergen.
Surgery
Functional endoscopic sinus surgery (FESS) may be recommended for patients who do not respond well to medications and other treatments. The procedure is minimally invasive and performed internally through the nostrils. The doctor will insert an endoscopy tube into the nose to remove any nasal polyps or mucus that may be blocking the nasal passage.
Is Sinus Surgery Safe?
Risk and Complications Of Sinus Surgery
Like other surgical procedures, complications may occur during or after a sinus surgery. Some of the possible risks that patients may encounter during functional endoscopic sinus surgery include:
Breach Of The Skull Base
The brain is separated from the nasal sinuses by a thin layer of bone. If the surgeon does not have an unobstructed view of the area, they may breach this layer of bone, resulting in leakage of fluid surrounding the brain. As a result, further surgery may be needed to repair the breach. However, rest assured that the risk of this occurring is less than 1%.
Visual Disturbances
In addition to the brain, the eyes lie close to the nasal sinuses. While removing the bone between the nose and eye socket is generally harmless, patients may experience visual disturbances if vital structures in the eye socket are damaged. However, this is uncommon.
Bleeding From The Nose
Since part of the mucosal lining and bone in the nose will be removed during surgery, some degree of bleeding from the operative site is expected.
The surgeon will often use a nasal pack or sponge to stop the bleeding, which will be left in the nose for 24 to 48 hours. Once the packs are removed, some blood-stained mucus discharge and occasionally some clots can be expected.
However, uncontrolled bleeding may occur if there is damage to the blood vessels that run in or around the nose.
Tearing
When inserting the nose packs to stem the bleeding, they may block the opening of the tear duct and drain tears from the eye into the nose. As a result, the patient may experience tearing. However, this will resolve itself once the packs are removed.
Nasal Obstruction
After surgery, it is common for patients to feel like their nose is obstructed due to the packing material in the nose. Rest assured that this will improve after the packing is removed during outpatient followup and with nasal rinse.
What To Note After Functional Endoscopic Sinus Surgery
Nasal Packing
After surgery, the surgeon will generally place dressings in the sinus cavities to prevent unwanted scarring and minimise bleeding. These dressings are usually removed five to ten days after surgery. If necessary, the surgeon may also place nasal packs in the nasal cavity to minimise bleeding after surgery. These are usually removed after one or two days.
Bleeding
Please note that light red to clear discharge from the nose is normal three to seven days after surgery. A nasal gauze will be placed under the nose to collect any discharge leaking out. It will be removed before you are discharged from the hospital.
Recovery Period
Depending on the extent of surgery and the nature of your work, you can expect to return to work seven to ten days after surgery. During the recovery period, ensure you get plenty of rest and avoid strenuous physical activities for at least a month after surgery, as they may cause bleeding to reoccur.
Nasal Irrigation
After removing the nasal packs, a sinus specialist will instruct you on the correct nasal irrigation techniques to clear the sinus cavities and flush out mucus and debris from the nose and sinuses.
When should you see an ENT specialist in Singapore?
If you’re experiencing the following scenarios, please consult our ENT sinus specialist today:
- Chronic sinusitis – sinusitis that lasts for more than 12 weeks
- Cerebrospinal fluid leak
- Recurring episodes of sinusitis
- Recurring sinusitis despite previous sinus surgery
- Sinusitis accompanied by other complications, such as double vision, eye swelling, forehead swelling, meningitis, and severe headaches
- Unusual symptoms like excessive crusting and foul smell from the nose (cacosmia)
Assistant Professor Ker Liang has a passion for teaching and is an Assistant Professor with NUS Yong Loo Lin School of Medicine (YLLSOM). As the NUS-NUH Otolaryngology Department Undergraduate Medical Director, Dr Ker Liang supervises the training of medical students from YLLSOM, NUS. She is actively involved
in the training of postgraduate junior doctors and residents in the Head and Neck Surgery department. She was conferred with an Undergraduate Teaching Award by the National University Health System in 2016 for her outstanding efforts as an Otolaryngology educator.
Assistant Professor Ker Liang has a passion for teaching and is an Assistant Professor with NUS Yong Loo Lin School of Medicine (YLLSOM). As the NUS-NUH Otolaryngology Department Undergraduate Medical Director, Dr Ker Liang supervises the training of medical students from YLLSOM, NUS. She is actively involved
in the training of postgraduate junior doctors and residents in the Head and Neck Surgery department. She was conferred with an Undergraduate Teaching Award by the National University Health System in 2016 for her outstanding efforts as an Otolaryngology educator.
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FAQs About Sinusitis Treatment & Surgery
How Can I Relieve Sinus Congestion at Home?
Over-the-counter medications, nasal sprays, staying hydrated, and getting sufficient rest can help relieve sinus congestion. However, if the symptoms persist, please consult our ENT sinus specialist.
Is Sinus Surgery a Suitable Treatment for me?
Sinus surgery is recommended if you have chronic sinusitis and do not respond well to other conventional sinusitis treatments. Surgery should also be considered if you have structural abnormalities blocking your sinus passage, or if you still experience recurrent sinus infections despite medical management.
How Can I Prevent Sinusitis From Recurring?
In addition to your sinus medication, ensure you get sufficient rest and drink plenty of fluids. Placing a warm compress on the nose and forehead and adding moisture to the air with a humidifier can also help relieve symptoms of sinusitis.
However, these measures only offer temporary relief and may not prevent sinusitis from recurring. If your sinusitis keeps coming back, you may consider consulting our ENT sinus specialist to determine if surgery is a suitable option for you.
Will My Sinusitis Return After Surgery?
While surgery can help treat sinusitis, it is possible for the condition to resurface. Possible causes of recurrent sinusitis after surgery include:
- The original surgery may be limited.
- Poor healing or persistent infection following the first surgery may result in scarring that causes the sinuses to close off again.
- Nasal polyps returning after surgery.
- The sinusitis may be triggered by existing allergens, such as animal fur, dust, or pollen.