Sniffing out nasal problems

When we wake up sniffling every morning, suffering from a blocked nose, we often blame our sinuses. “I have a problem with my sinuses,” we may say. But what are our sinuses, and are they really the causes of as many nasal conditions as we think?

Causes of acute and chronic sinusitis

According to Dr Dharambir S Sethi, senior consultant ear, nose and throat surgeon at Novena ENT – Head and Neck Surgery Specialist Centre, the sinuses are cavities around the nasal passages. “Paranasal sinuses are cavities or pockets of air around the nose,” he shares. “Normal healthy sinuses are completely sterile, but the nose is an organ that harbours quite a lot of bacteria. While there are natural barriers that keep the sinuses clean from the nasal cavity, there are times when the barrier breaks down and infection tracks into the sinuses.”

This is often the cause of sinusitis, one of the most common nasal problems. “Sinusitis is an inflammation of the sinuses, which may or may not be due to an infection,” Dr Sethi continues. “There are two types of sinusitis – acute sinusitis and chronic sinusitis. Acute sinusitis is usually caused by viral infections that track into the sinuses, and eventually become bacterial infections. Acute sinusitis often develops due to upper respiratory tract infections, and any flu that lasts more than 10 to 15 days predisposes the sinuses to infection,” he shares. Symptoms of acute sinusitis could include a stuffy nose, thick, coloured discharge from the nose, along with tenderness or swelling around the eyes, cheeks and nose.

When the inflammation of the sinuses lasts between four to six weeks, it continues to be considered acute sinusitis. But when the inflammation lasts more than 12 weeks, it is considered chronic sinusitis. “In chronic sinusitis, patients may not be suffering from an infection – their sinuses are just inflamed due to a variety of reasons,” he says. “These could include having allergies, structural problems with their nose like a deviated septum, nasal polyps or enlarged turbinates. It could also be due to fungus, which we all breathe in but only some are sensitive or allergic to.”

But the sinuses are often unfairly blamed as the cause for certain symptoms. “Patients often come into the clinic and say, ‘I have a sinus headache’, or even ‘my sinuses are killing me’. They use the word ‘sinus’ for a variety of reasons, even if their condition may be due to other conditions like nasal obstruction, nasal blockage or nasal discharge,” Dr Sethi shares. “The myth is that any pain in the head is caused by sinus or sinusitis – many patients seem to think that sinuses are responsible for every problem they have with the nose. But in reality, less than five percent of symptoms like headaches are due to sinusitis.”

How to treat sinusitis

The treatments for acute and chronic sinusitis differ. “For acute sinusitis, treatment is medical, with the prescription of antibiotics and supportive treatment. A majority of patients will respond to medical treatment,” Dr Sethi says. “But there are some situations where surgery may be required in acute sinusitis, for example when the sinus is full of pus that cannot be resolved with medical treatment, the pus has to be drained surgically.”
Surgery is more often indicated for chronic sinusitis. “Patients may have polyps and the removal of polyps may help them breathe better. Or they may have fungus inside the nose, and surgery to remove the fungus would help them. Surgery for chronic sinusitis doesn’t aim to completely eradicate the problem, but instead to decrease the inflammatory load within their sinuses to improve their quality of life,” Dr Sethi elaborates.

Thanks to technological advances, Dr Sethi often carries out endoscopic sinus surgery using a nasal endoscope. These days, endoscopic sinus surgery is also used to reach areas of the brain to remove tumours and to repair defects in the skull base, the thin wall of bone that separates the brain from the sinuses. “Endoscopes give us excellent visualisation, magnification and illumination within the nasal cavity, and allow us to widen sinus openings and remove pathology or any disease from within the sinuses,” Dr Sethi says. “Endoscopic sinus surgery means that we don’t have to make external incisions on the face to access the sinuses.”

Dr Dharambir S Sethi is an Ear, Nose, Throat (ENT) surgeon with over 25 years’ experience in the field, providing specialised care for patients with nose and sinus disorders. Prior to establishing his private practice, Dr Sethi was Senior Consultant of Otolaryngology at Singapore General Hospital, where he is still a visiting consultant.

Novena ENT - Head & Neck Surgery Specialist
Main Clinic:
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #04-21/22/34
Singapore 329563
Tel: (+65) 6933 0451

Satellite Clinic:
Parkway East Medical Centre
319 Joo Chiat Place #03-07
Singapore 427989
Tel: (+65) 6346 7761
Email: enquiry_peh@novena-ent.com

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