The sinuses are four pairs of air-filled cavities around the eyes and nose (Source of photo:123rf.com)

No one wants to be sneezing, coughing and having a blocked nose or headache constantly.

It’s annoying, especially when you have to go to work and your “noises” start bothering colleagues around you.

These are classic symptoms of a medical condition called sinusitis, or inflammation of the tissue in the sinuses.

A lot of people tend to pass off these symptoms as “oh, it’s just my sinus” when they could actually be suffering from a sensitive nose or rhinitis.

Rhinitis is the inflammation and swelling of the mucous membrane of the nose, caused by allergens such as dust mites or certain foods.

Sinusitis and rhinitis are two different conditions, but they may overlap due to similar triggers and because the nose and sinuses are physically connected.

Rhinitis though, is more common and affects a large portion of the population, both young and old.

“Some patients may have both because when there is an allergy component, the opening of the sinuses can get blocked.

“So you can start off with rhinitis and end up with sinusitis.

“Or others may not have any rhinitis, but can have one or more episodes of sinusitis,” points out consultant ENT (ear, nose and throat), head and neck surgeon Dr Muthu Kumar.

Air-filled spaces

The sinuses are four pairs of cavities (spaces) in the skull, with narrow passages connecting them.

They are filled with air and contain a thin mucous layer and tiny hairs that warm and humidify the air you breathe before it reaches your lungs.

These cavities can become blocked when exposed to allergens, viruses, bacteria or fungi.

Dr Muthu explains: “This sinus cavity is like a room with a tiny window that lets air in and out.

“Now this room also has a carpet, which produces mucus daily.

“If you breathe well and the sinus is open, air goes in and dries up the mucus, and you feel light or normal.

“But when you have a bad flu or allergy or infection, the opening of the sinus gets blocked and mucus starts accumulating.”

This can lead to inflammation, congestion, excess mucus, pain, postnasal drip, and swelling around your eyes, cheeks, nose or forehead.

With a bad infection, you can even have a fever.

Sometimes, these symptoms go away on their own as you recover; at other times, they linger or get better, then recur.

When your sinuses are infected or inflamed for over a week, there is a likely chance of developing sinusitis.

Diagnosis is based on symptoms and physical examination, such as facial tenderness, which is an indication of mucus accumulation.

An ENT specialist can also insert a tiny camera into the nose (i.e. a nasal endoscope) to see whether there is mucus or pus flowing out from the cavities.

“Sometimes, we may do a CT (computed tomography) scan of the face to confirm if it is indeed sinusitis.

“For a normal person, the scan will come out black because air looks black on the scan, but for patients with sinusitis, the scan will appear grey.

“Of course, we don’t do a scan immediately as everyone who has suffered a bad flu will have some evidence of sinusitis,” he says.

The first line of treatment for sinusitis is usually medications such as antibiotics if there is bacterial infection, plus adjuvant therapies like nasal sprays to open up the blocked nose, and antihistamines if there is an allergic component.

Dr Muthu says: “If they get better, we never see them again.

“If they keep coming back with five or six episodes a year, then we investigate further.

“Sometimes, the patient may have anatomical abnormalities such as a deviated septum (crooked wall between the nostrils), so medicines won’t work and we need to ventilate the nose (via surgery).

“Or after severe rhinitis, they may develop nasal polyps, so again, these medications won’t work.”

Dr Muthu examining a patient with a nasal endoscope to check for sinusitis.

Inflating a balloon

Should medications fail to solve chronic sinusitis, the surgeon might try to flush the sinus out first before recommending surgery to widen the blocked passageways.

“Originally, we inserted surgical instruments into the nose to drill a hole to widen the opening, but there are potential complications to this.

“If you’re not well trained, you could injure the nearby structures, such as the eye.

“The instruments eventually got better with time and we still use them when required.

“But treatment then evolved into balloon sinuplasty, which is similar to a coronary balloon angioplasty,” says Dr Muthu.

The procedure involves inserting a flexible balloon catheter through the nose and into the opening of the sinuses.

“We inflate the balloon to widen and unblock the pathway, and we leave it there for 30 seconds to a minute before deflating it and pulling it out.

“Unlike the cardiac stents which are left in the body, this balloon is removed,” he explains.

Without any cuts, the complication rate is much lower and recovery is faster.

In most countries, this minimally-invasive technique is carried out as a daycare procedure under local anaesthesia.

Dr Muthu, however, only allows those who live near the hospital to go home on the same day.

The patient can return to daily activity in a day or two, compared to the traditional surgical methods, where the patient can only resume normal activities after two weeks.

Potential setbacks

Dr Muthu cautions that balloon sinuplasty may not be successful in every case as the opening can close up again.

“The normal size of a sinus opening is 1.2 millimetres; even with a bit of swelling, it may close up, so we need to widen it to triple the size.

“If that happens (i.e. closure of the opening), I have to find out why and since the patient is already under anaesthesia and I have taken his consent, I will either revert to the traditional surgery immediately or do a revision balloon.”

Thus far, he’s only had to do this in 5-15% of his patients.

For patients with bony deformities, traditional surgery is their only option to relieve their symptoms.

Incidentally, he has picked up numerous patients who were treated for asthma when it was actually sinusitis that was contributing to their so-called asthmatic symptoms.

Again, Dr Muthu gives this analogy: “Imagine the nose is the roof of the house and the lungs are the carpet in your living area.

“If your carpet is wet and you keep drying it, but the roof is constantly leaking, you’re not going to get better.

“But if you repair the roof (i.e. clear your sinus) and prevent mucus from dripping onto the carpet (i.e. the lungs), the asthma is then well controlled.

“You drain the top to help the bottom.”

He reckons roughly 30% of those with chronic sinusitis need surgery.

Balloon sinuplasty costs between RM20,000 and RM25,000 at private hospitals.

Chronic cough

S. Nagarajan, 57, is among the thousands who have been suffering from chronic sinusitis over the past 30 years.

“It started after a flu episode in my 20s and I’d have these terrible headaches, sneezing and blocked nose.

“I even did surgery a few times, but the symptoms always come back.

“Recently, I had a cough for three weeks and swallowed medicines until my throat became inflamed!” he shares.

The dusty environment the logistics manager works in may have triggered his cough.

He says: “I had to wear masks, couldn’t sleep or eat, and was constantly on medical leave as my colleagues would complain about my coughing.

“That’s when I was recommended balloon sinuplasty.”

After the procedure three months ago, his cough immediately stopped.

Dr Muthu adds: “He has an allergy component, so whenever he is exposed to dust, the nose will produce mucus.

“When you cut too much, as in his previous surgeries, the lining of the nose becomes damaged and can contribute to recurrent attacks of sinusitis.

“What I did was widen the scar tissue that has grown on the (previous) cut to let the mucus drain out.”

Nagarajan is now back to his pre-sinusitis self and is hoping to stay this way for good.

Nagarajan uses a nasal spray to flush his nose whenever necesssary. - S.NAGARAJAN

How balloon sinuplasty works

In balloon sinuplasty, the flexible balloon is inserted into one nostril and up to the opening of the affected sinus.

The flexible balloon is inserted into one nostril and up to the opening of the affected sinus.

Once the passageway has been widened, the balloon is deflated and removed.

Source: The Star