Specialists in Allergy, Sinus, & Asthma

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Sinus/Nasal Problems

What is a sinus or nasal problem?

Sinus and nasal problems are caused by an inflammation of the mucous membranes of the nose and sinus, creating a condition referred to as rhinosinusitis. It is one of the most common conditions in the United States affecting about 100 million people. Rhinitis refers to inflammation in the nose. Sinusitis refers to inflammation in the sinuses. Since the nose and sinuses are connected, the inflammation in one is commonly associated with inflammation in the other, hence the term rhinosinusitis.

Sinus and nasal inflammation can be caused by allergies, air pollution and viral infections. Viral-triggered rhinitis or sinusitis will persist as long as the body is invaded by the virus, usually five to seven days. Other forms of rhinitis and sinusitis such as those triggered by allergies are more long-lived and can be chronic in nature. When the source is an allergy, rhinsinusitis often coexists with hay fever, asthma or eczema. Some forms of stuffiness or congestion in the nose and sinuses are due to structural problems and are not forms of rhinitis or sinusitis at all.

There are two general types of rhinitis and sinusitis problems: allergic rhinosinusitis and non-allergic rhinosinusitis. Allergic rhinosinusitis, an allergy that affects the nose and sinuses, is one of the most common allergic conditions in the United States, affecting about 50 million people. It is important to treat allergic rhinosinusitis because it can contribute to other conditions such as sleep disorders, fatigue and learning problems.

Allergic Rhinosinusitis

Allergic rhinosinusitis is caused by substances called allergens. Allergens are often common, usually harmless substances that can cause an allergic reaction in some people. When allergic rhinosinusitis is caused by common outdoor allergens, such as airborne tree, grass and weed pollens or mold, it is called seasonal allergic rhinosinusitis, or hay fever.  Allergic rhinosinusitis can also be triggered by common indoor allergens, such as animal dander (dried skin flakes and saliva), indoor mold or droppings from cockroaches, birds, or dust mites. This is called perennial allergic rhinosinusitis.

Symptoms include some or all of the following:

  • Sneezing
  • Congestion
  • Runny nose
  • Itchiness in the nose, roof of the mouth, throat, eyes and ears
  • Sinus pain/pressure
Non-allergic Rhinosinusitis

Non-allergic rhinosinusitis takes many forms, usually afflicting adults and causing year-round symptoms, particularly nasal congestion (stuffiness) and headaches. These kinds of reactions differ from allergic rhinosinusitis in that they are usually the same all year-round, are not associated with any itching, and skin and RAST tests are usually negative. Generally, rhinosinusitis of this form is triggered by strong smells, pollution, dust or smoke in the air, and other irritants. The key point is that this type of rhinosinusitis is not triggered by an atmospheric allergen and cannot be treated with immunizations. Symptoms of non-allergic rhinosinusitis may also occur as a result of pregnancy, thyroid disorders, or as a side effect of certain blood pressure or topical OTC decongestant medications. When the symptoms are traced to a deficiency of thyroid hormone, thyroid medication can help. The following are other types of non-allergic rhinosinusitis your allergy and immunology specialist may diagnose:

  • Eosinophilic non-allergic rhinosinusitis, is named after the blood cell (the eosinophil) that distinguishes it from other forms of non-allergic rhinosinusitis. This type of rhinosinusitis behaves like allergic rhinosinusitis in that it causes frequent, recurrent bouts of sneezing, sometimes itching and runny nose. This disorder, which may seem to appear from out of the blue, can be provoked by changes in the environment, such as air pressure variations or weather shifts. Allergy skin tests are often negative with this type of rhinosinusitis, but not always. Growths in the nose, called nasal polyps (described below), are a common complication. Medications such as antihistamines, decongestants and topical cromolyn may be beneficial, but topical nasal and oral corticosteroids and leukotriene inhibitors provide the best relief for most patients.
  • Rhinitis medicamentosa occurs when non-prescription topical decongestants (over-the-counter nose sprays) are used in excess, often for more than three consecutive days. This form of rhinitis causes severe nasal congestion and is best treated by stopping use of the offending nasal spray. This often leads to temporary severe congestion, which can be helped by topical or oral corticosteroids.
  • Structural rhinosinusitis is caused by structural abnormalities in the nasal septum, nasal filtering structures called turbinates, or in the sinus drainage tracts. These abnormalities can be the result of an injury, such as a broken nose, or something that the person was born with, such as small or crooked nasal passages. Structural rhinosinusitis may produce year-round congestion that usually affects one side of the nose more than the other and commonly leads to both congestion and inflammation because the nose and sinuses simply don’t work right. Surgery can commonly correct this type of abnormality.
  • Nasal Polyps are growths on the mucus membrane of the nose that can cause congestion and loss of sense of smell. They provoke symptoms year-round and usually begin between the ages of 20 and 40. Nasal polyps may be associated with aspirin sensitivity and asthma, and may cause recurrent sinusitis. Decongestants or corticosteroid nasal sprays or pills may provide temporary relief. Nasal polyps can be surgically reduced, but they cannot be removed and they have a tendency to recur.
  • Sinusitis is inflammation of a sinus or sinuses. This may be caused by any one of the allergic or nonallergic problems listed above or can occur from common viral infections, occupational pollution, smoking, or even dental procedures. Your sinuses are hollow air spaces in your skull surrounding your face. When people say, “I’m having a sinus attack,” they are usually referring to pain or congestion within these air spaces. Your allergy and immunology specialist is especially trained in determining the causes of sinus disease and directing the most effective treatment.
  • Structurally-based Nasal Congestion is actually not a result of any inflammation in the nose or sinuses but still represents a cause of stuffiness or sinus pain. As long as the nose and sinuses are allowed to function properly, there will be only symptoms of stuffiness in the nose and pressure/pain sensations in the sinuses, if structurally based nose congestion or partial sinus blockage exists.

How is a sinus or nasal problem diagnosed?

If you have symptoms of rhinitis, congestion, or sinusitis, your allergy and immunology specialist can help determine which specific problems listed above are triggering your reaction. Your allergy and immunology specialist will take a thorough health history, environmental history, and then test you to determine what the triggers are. If you have allergies, skin tests or blood (RAST) tests are the most common methods for determining your allergic triggers. Allergy and immunology specialists prefer skin tests since they are the most sensitive, accurate and least expensive way of diagnosing allergies and test for several kinds of allergic reactions. Blood tests are less sensitive and only test one kind of allergy. There are cases however, when blood tests are preferred or used as supplemental information. Your allergy and immunology specialist is best able to help you choose the most accurate and cost effective testing procedure. A careful exam of your nose and sinus passages will also be undertaken. Additional tests often needed to make a complete diagnosis are a screening sinus CAT scan and endoscopy of the nasal passage to get an accurate picture of your anatomy.

How is a sinus or nasal problem treated?

Treatment of rhinosinusitis depends on the triggers identified by your allergy and immunology specialist. If you have allergies, the avoidance measures mentioned earlier are important. Immunotherapy can also be prescribed by your allergy and immunology specialist to help cure your allergic disease. This treatment involves receiving injections periodically, as determined by your allergy and immunology specialist, over a period of three to five years. This helps your immune system to become more and more resistant to specific allergens, and lessens the need for future medications. Physicians also commonly prescribe allergy medications to decrease your rhinitis, congestion, and sinusitis symptoms depending on the exact diagnosis.

Sinus surgery is recommended if there are structural abnormalities in the nose and sinuses which are causing or aggravating your condition. These abnormalities can be the result of an injury, such as a broken nose, or something that the person was born with, such as small or crooked nasal passages or unusually large filtering areas of the nose called turbinates. Structural forms of rhinitis and sinusitis may produce year-round congestion that can affect one side of the nose more than the other. Surgery will commonly correct these problems as long as structure is the only cause of the nose stuffiness and other causes have been carefully ruled out. In cases of obstructed sinus passages that require surgery, your allergy and immunology specialist will refer you to an otorhinolaryngologist, or an ear-nose-throat physician (ENT) who specializes in this form of treatment. Sinus surgery re-establishes normal sinus drainage and is a very effective form of treatment when chosen carefully. It is important that a thorough diagnosis is made that obstructed breathing or sinus drainage is irreversible medically before surgery is performed to ensure a good surgical outcome.

Nasal irrigation is a very effective and natural treatment for all forms of rhinosinusitis. Nasal irrigation with a balanced salt solution, referred to as a saline rinse, often provides gratifying relief of many symptoms without the need of medications or injections.

Saline Rinse Recipe:

½ cup non-iodized salt
¼ cup baking soda

  1. Mix ingredients together well.
  2. Add ¼ tsp of mix to a rinse bottle and fill to the line with warm water.
  3. Gently rinse both nasal passageways, adjusting flow for comfort, using entire bottle.
  4. Rinse twice daily or as directed by your physician.

There are several nasal irrigation techniques available and your allergy and immunology specialist can go over the choices with you that best fit your needs.

How can a sinus or nasal problem be avoided?

Most rhinosinusitis problems that are not due to structure problems in the nose can be prevented by understanding how the nose works and caring for any problems your nose might have. For example, one of the most common preventable causes of sinus disease is allergy. Proper treatment of allergy before sinus disease develops is good preventive medicine. Also remember that the function of the nose is to warm, filter and humidify the air we breathe. If you work in a polluted environment, cleaning the nose with a salt-water rinse after work will be very healthful. In fact, washing your nose with a balanced salt solution is always healthful, just like brushing your teeth.

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