Sinusitis is a condition where there is inflammation in the nasal sinuses mainly due to a bacterial or viral infection. It causes congestion, facial pain, and discomfort. Sinusitis is a common ENT problem which decreases quality of life leading to missed work days. Treatment by an experienced ENT doctor can significantly improve your symptoms.  If you are in Singapore, Dr. Annabelle Leong is a leading sinus specialist at The ENT Clinic with over 18 years of experience providing comprehensive sinusitis treatment for both adults and children’s sinus disorders.

What are sinuses?

Our sinuses are located as four paired air spaces in the face which are connected by narrow drainage channels. Sinuses are air-filled pockets which link to the nasal cavity. These sinuses form thin mucus which drains out through the nose. This drainage helps in keeping the  nose clean. However, during an infection, these sinuses can get blocked or congested with fluid causing facial discomfort.

What causes sinusitis?

Any blockage which prevents the flow of air through the sinuses, causing difficulty in the drainage of the mucus, will lead to sinusitis. There are many reasons why your sinuses could get blocked. Having a chronic allergy is one of them. Sinusitis can be a temporary acute condition or a long lasting chronic condition.

An infection in the sinuses can lead to sinus congestion. In addition, an obstruction within the nasal cavity can lead to low drainage from sinuses, causing congestion and ultimately an increased chance for congestion. The following factors increase the risk of sinusitis:

• Upper respiratory tract infections
• Allergy and related conditions like asthma
• Nasal polyps (usually benign inflammatory growths which come from the nasal lining)
• Exposure to chemicals and air pollutants
• Variations in atmospheric pressure
• Dental infections
• Having a weak immune system
• Anatomical differences e.g. deviated nasal septum (crooked nasal bones)

What are the signs and symptoms of sinusitis?

The location from where the pain stems is important to understand which sinus is affected. In addition, sneezing, coughing and bending may worsen sinusitis symptoms. Acute sinusitis and chronic sinusitis depends on the duration of the symptoms.

Other signs to watch out for include:

• Nasal congestion which can interfere with breathing
• Green and yellow smelly nasal discharge causing congestion
• Sore throat
• Bad breath
• Post-nasal drainage
• Headache
• Ear pain
• Fatigue
• Fever
• Reduced sense of smell
• Facial pain and face fullness with fluffiness around the eyes

Can sinusitis bring complications?

Yes, there is a possibility of having reduced vision if the sinusitis spreads into the eye sockets. In very rare cases, it can even cause blindness. In addition, sinusitis may lead to meningitis. This occurs when there is inflammation surrounding membranes in the spinal cord or brain due to chronic sinusitis.

When to see a doctor for sinusitis?

If you have acute sinusitis, it may go away on its own, but at times this may not be the case. There may be instances where the sinus infection cannot be contained with self-care solutions and symptoms aggravate.  If the symptoms do not settle within a week, then it is best to see a sinus specialist. Dr Annabelle Leong has significant experience dealing with sinusitis and allergies in patients.

Some signs which show that your sinusitis is deteriorating is:

• Increasing facial pain
• Fever
• High nasal discharge

Recurrent sinusitis is troublesome and needs intervention to put an end to ongoing symptoms.

How is sinusitis diagnosed?

To diagnose the condition, the otolaryngologist  would enquire in more detail about the symptoms and undertake a physical examination of the nose and face. Some of the commonly used diagnostic methods include:

• Examining the sinuses: The doctor will use a fibre-optic light to see the inside of the nose to view the sinuses. It will help to see if there are polyps or a deviated septum.
• Imaging tests: An imaging test done using CT or MRI can help to see the sinuses in detail. It can help to identify inflammation or a physical blockage which is difficult to see through an endoscope.
• Allergy testing: If your ENT doctor feels that your chronic sinusitis is triggered by an allergy, then an allergy skin test would be performed. It is a simple and quick test which can easily detect the allergen causing the flare-up.
• Culture of nasal and sinus discharge: If the sinusitis is chronic, the ENT doctor may suggest having a culture of the sample to determine the type of bacteria or fungus. This is generally done when treatment is failing. Samples of mucous discharge are sent to the lab for culture.

What are the general treatment methods for sinusitis?

In case of chronic sinusitis, the following treatments may be considered by your doctor:

• Nasal corticosteroids: Corticosteroids help to prevent and relieve you from inflammation. Nasal membrane inflammation is a usual sign of sinusitis and corticosteroids help to avoid it.
• Saline wash: Use of a saline rinse in the nasal cavity may be recommended. It helps to reduce drainage and removes allergens and irritants.
• Oral medications: If one has severe sinusitis, then the doctor may recommend oral corticosteroids to reduce inflammation. Your doctor will determine the length of usage of corticosteroids as long term usage may pose side effects.
• Allergy treatment: If an allergy is the reason for sinusitis, then it is important to first treat the allergy with medication.
• Antifungal treatment: If there is a fungal infection, then an anti-fungal treatment will be used.
• Nasal polyp treatment: An injection of Dupilumab may be used to shrink the nasal polyp which helps to reduce the level of obstruction.
• Antibiotics: If the sinusitis is caused by a bacterial infection, then an antibiotic will be prescribed by the ENT doctor.
• Immunotherapy: This is a very good way to manage an allergy by injecting allergy shots to improve the allergy condition.
• Surgery: Nasal obstruction caused by a deviated septum or nasal polyps can be corrected through surgery. It will help to improve sinus drainage and open up a congested sinus opening.