Sinus, Allergy and Nasal Disorders
The sinuses are small, hollow chambers inside the nose and head that reduce the weight of the facial bones, give the bones shape and support, assist in mucus drainage from the nose, and help the voice resonate. Healthy sinuses are filled with air. When their mucous membranes swell from allergies, the common cold, infection or another cause, the sinuses become blocked, the pressure inside them drops, and they can fill with fluid, which easily leads to bacterial infection (called sinusitis, or rhinosinusitis if the nasal tissues are also affected). Blocked, inflamed or infected sinuses can be very painful.
There are four groups of sinuses: maxillary, in the cheekbones; ethmoid, along the nose; frontal, above the eyes; and sphenoid, behind the ethmoids. Any or all of these may be involved in an allergy or sinus infection, so accordingly, discomfort may occur in many areas of the face and head, including the cheeks, eyes, forehead and teeth.
Sinusitis may be acute (short-term, as after a cold or flu) or chronic (more than 8-12 weeks). Acute sinusitis symptoms include thick yellow or green discharge from the nose, sharp pain, headache and fever. Symptoms of chronic sinusitis are less obvious and may include nasal blockage or congestion, post-nasal drip, reduced sense of smell, and malaise.
A diagnosis of sinusitis is made after a description of symptoms, a physical examination and potentially one or more imaging tests such as an x-ray, CT scan, or endoscopic examination under local anesthesia. Treatment may include a nasal spray, antibiotic, corticosteroid or antihistamine. In some cases the patient may wish to undergo surgery to clean the sinuses, improve drainage or realign a deviated septum.
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Allergies are a common cause of inflamed sinuses and headaches as well as runny or itchy nose, sneezing, itchy or watery eyes, blocked or itchy ears, rashes and wheezing. Allergies are in essence an overreaction by the body’s immune system to one or more objects in the environment, called allergens. Common allergens include dust, pollen, animal dander, mold and certain foods. Nasal endoscopy, blood tests or skin “scratch” tests are often all that is needed to determine the presence and cause of an allergy. Then the physician and patient can work together to plan treatment and management of symptoms.
The septum is made of bone and cartilage and spans the nasal cavity from the nostrils to the back of the throat. Ideally, the septum is straight and equally divides the two sides of the nasal cavity. However, in many people the septum has a slight bend, making one side of the cavity smaller than the other. In some cases the deviation is significant enough to cause problems such as congestion, sinusitis (inflammation of the sinuses), nosebleeds and breathing difficulties. Surgery to repair the deviation may be elected if symptoms are severe.
Perforations, or holes, in the septum can form after nasal surgery, injury, repeated picking of the nose, diseases or drug use. Symptoms include frequent nosebleeds, crusting around the nostrils and a whistling noise when breathing. These can be treated with Bacitracin and pinching the nose to stop bleeding; however, patients may choose to undergo surgery in which skin grafts or plastic membranes are used to repair the perforation(s).
Nasal polyps are small, soft, teardrop-shaped growths that form around the openings to the sinuses. They are not tumors or cancer (although the physician may study a sample to confirm the diagnosis) but merely indicate that the nose or sinuses are or have been inflamed. Symptoms that may occur along with polyps include congestion, drainage (runny nose), blockage and infection.
Nasal vestibulitis is caused by infection with the bacteria staphylococcus (the same organism that causes strep throat) in the area just inside the nostrils, otherwise known as the nasal vestibule. Typical symptoms are swelling, redness, tenderness, pimples around nasal hairs, or crusting. In most cases simple application of Bacitracin ointment and hot washcloths or a course of antibiotics are sufficient to treat the infection. Occasionally, though, infections can cause boils, spread beneath the skin (cellulitis), and rarely, spread through facial veins to the brain in a potentially fatal condition called cavernous sinus thrombosis. For this reason infections that persist should be examined by a physician.
Nosebleeds are quite common and hardly ever indicate the presence of a serious problem. Typical causes include nose picking, injury, dry air, and anticoagulant drugs such as aspirin. Thus many nosebleeds can be prevented by keeping fingers and other objects out of the nose, humidifying air in winter or moistening the front of the nostrils with petroleum jelly (e.g. Vaseline). If a bleed occurs, the best at-home treatment is to pinch the nose closed firmly for 5-10 minutes without letting go. This tends to be more effective than icing, placing tissue in the nose or tilting the head. Severe or frequent bleeds may be treated by a physician with a temporary sponge or nasal packing or with cauterization. More extensive care needs to be given in rare cases where bleeding originates in the back of the nose (posterior nosebleed).
