Understanding Nose and Sinus Disorders

Millions of individuals suffer from nose and sinus disorders, which can result in pain, fatigue, headaches, breathing difficulties, and loss of smell. For instance, according to a study by the National Institute of Allergy and Infectious Diseases (NIAID), chronic sinusitis affects approximately 134 million Indians. However, you don’t have to endure the discomfort caused by these conditions, as they are easily treatable. This article delves into the symptoms, underlying causes, and treatment strategies for common nose and sinus disorders.

What are sinuses?

Sinuses are hollow spaces located in your skull. There are four pairs of sinuses, making a total of eight, and they are located in the following areas:

Above your eyes
Between your eyes
Behind your nose
Under your eyes, behind the cheeks

Why do we have sinuses?

In general, the sinuses help to clean the air inhaled through the nose. Several other theories are there regarding the functions of the sinuses, such as:

Reducing the weight of the skull
Enhancing the resonance of voice
Creating a protective buffer against trauma to the facial area
Insulating and protecting sensitive structures in the nasal cavity, for example, dental roots
Humidifying and warming inhaled air

What is sinusitis?

Sinusitis occurs when the mucosal layer, a very thin and moist pink lining of the sinuses, becomes inflamed. This mucosal lining typically has a thickness of less than 1 mm.

What are the types of sinusitis?

Common types of sinusitis include:

1. Acute Sinusitis:

Viral infections such as the common cold are the most common causes of acute sinusitis. Symptoms usually improve within 10 days but may persist for up to 4 weeks. You may experience the following symptoms:

Nasal congestion, or a stuffy nose, makes it difficult to breathe through your nose.
Thick yellow or green mucus drains from your nose as a runny nose or flows down the back of your throat, known as postnasal drip.
Pain, pressure, swelling, and tenderness around your nasal passages, which may worsen on bending over.
Headaches, pressure in your ear, a cough, and general discomfort.

2. Chronic Sinusitis:

Chronic sinusitis presents with symptoms that resemble those of acute sinusitis, but it tends to persist for a significantly longer duration. You will be diagnosed with chronic sinusitis if you have had symptoms lasting at least three months. There are many factors that can increase your risk, which may include:

Nasal polyps, or small growths in the nose
Deviated nasal septum, where the bone and cartilage that divide the nose get pushed to one side, often due to trauma
Allergies, or recurring respiratory infections
Diseases that impact the immune system, for instance, cystic fibrosis and HIV

3. Subacute Sinusitis:

Subacute sinusitis lies between acute and chronic sinusitis. A diagnosis of subacute sinusitis is made when symptoms persist for more than four weeks but less than 12 weeks in duration. However, your symptoms will be less severe as compared to acute sinusitis.

What are nose and sinus disorders?

Sinusitis is an extremely frequent condition, but many other problems related to the nose and sinuses need medical attention. Some of these include:

Nasal polyps
Aspirin-exacerbated respiratory disease (AERD)
Deviated nasal septum and nasal obstruction
Cerebrospinal fluid leaks
Loss of smell (anosmia)
Benign and malignant nasal tumours
Skull-base and pituitary tumours
Nasal fractures

What are some of the symptoms of nose and sinus disorders that I may experience?

These conditions can lead to challenging symptoms, including:

Facial pain
Frequent nosebleeds (epistaxis)
Headaches
Loss of smell (anosmia)
Persistent nasal congestion
Difficulty breathing

What are the common causes of nasal obstruction?

Nasal obstruction can lead to symptoms such as nasal congestion, nosebleeds, headaches, facial pain, postnasal drip, snoring, and sleep apnea. The most common causes resulting in nasal obstruction include:

1. Deviated Nasal Septum

The nasal cavity is separated by a structure composed of both cartilage and bone, named the nasal septum.
A deviated septum refers to a condition where the nasal septum is bent or misaligned. It can be either present at birth or caused by a nasal fracture.
Your doctor may recommend a septoplasty, a surgery usually performed on an outpatient basis in order to relieve symptoms. The procedure involves making incisions within the nasal cavity to remove the bone and cartilage causing the obstruction.

2. Nasal Turbinate Enlargement:

The nasal turbinates are structures that line the lateral walls of the nasal cavity. They help warm and moisten the air that enters the nose.
While doing so, the turbinates react by swelling and enlarging. This swelling can also occur as a reaction in response to irritants and allergens.
As a result, nasal obstruction can occur due to excessive enlargement of the turbinates.
Swelling can be reduced through the application of nasal sprays. When sprays don’t provide adequate relief, the turbinates can be surgically reduced, typically through an in-office procedure.

3. Nasal Polyps:

Nasal polyps can often lead to nasal obstruction. These are small, non-cancerous inflammatory tissue growths in the nasal cavity and sinuses.
Chronic sinus disease can occur when a polyp blocks the sinus drainage ducts.
Nasal polyps can be managed with steroid sprays in most cases, but in some instances, they need to be removed through endoscopic surgery.
Polyps are more common in individuals with allergies and/or asthma and have been found to be associated with a condition termed Samter’s syndrome.
Persons with Samter’s syndrome have a combination of nasal polyps, bronchial asthma, and severe allergic reactions to aspirin.

What causes nosebleeds?

Nosebleeds commonly result from:

Picking at the delicate nasal membranes. (Most common cause)
Very dry air which leads to the membranes drying out and becoming more fragile.
Allergies, infections, nasal fractures, or tumours.

How can a nosebleed be stopped?

You can stop most nosebleeds by following these steps:

Sit in an upright position and lean forward to avoid swallowing blood.
Pinch the soft parts of your nose between your thumb and index finger to close the nostrils. Breathe through your mouth and ensure your nostrils remain closed for about 5 to 10 minutes.
Place the cotton ball soaked with a decongestant nasal spray such as Afrin, Neo-Synephrine, or DuraVent inside the nostril, press the nostrils closed, and hold for approximately 5 minutes.
Apply ice to the nose and cheek area.

If your symptoms worsen or bleeding persists, call a doctor immediately.

How is sinusitis treated?

There are various treatment options for sinusitis, depending on the type and severity of your symptoms.

1. At-home treatments for a mild sinus infection:

Decongestants.
Over-the-counter (OTC) cold and allergy medications.
Nasal saline rinses.
Staying hydrated.

2. If you do not feel better after 10 days, your doctor may prescribe:

Antibiotics.
Oral or topical decongestants.
Prescription intranasal steroid sprays. Limit the use of nonprescription sprays or drops to no more than 3 to 5 days, as they can lead to increased congestion.

3. Providers treat chronic sinusitis by addressing the underlying conditions. Treatments may include:

Intranasal steroid sprays.
Topical antihistamine sprays or oral pills.
Leukotriene antagonists, such as montelukast.
Surgical intervention to treat structural abnormalities, polyps, or fungal infections.