Many of the patients I see are bothered by nasal symptoms that are immediately labelled as "sinus problems". I believe that much of this comes from traditional advertising media that blames facial pain and pressure or nasal congestion as "sinus congestion" Unfortunately, this may lead to the over use of OTC medications, antibiotics and unhelpful and often unnecessary surgery.
To help people better understand their nasal and sinus symptoms, I have tried to best detail the what people may be experiencing!
Nasal blockage is a common complaint for many patients and can be due to swelling of the lining of the nose (mucous membranes), anatomic blockage (a deviated septum, external nasal deformity, inferior turbinate enlargement) or a combination of the anatomic factors and mucous membrane swelling.
Mucous membranes can swell because of viral infections, allergies and dryness (non-allergic rhinitis). Treatment with nasal steroids and saline rinses are the main therapies used to help with the swelling, plus avoiding nasal irritants and allergens.
If your symptoms improve when you’re in a humid environment but worsen or start when you’re in Calgary, increasing humidity in your nose with saline rinses and a humidifier in your bedroom can be helpful, but unfortunately, this is very difficult to treat and often made worse with surgery.
Anatomic factors such as a deviated nasal septum, external nasal deformity/ nasal valve collapse or turbinate enlargement, can be treated effectively with surgery and in-office procedures to improve nasal breathing.
NASAL BLOCKAGE WITH STUFFINESS AND A “PERMANENT COLD”
Chronic rhinosinusitis often presents as the “cold that never went away”. Symptoms of CRS include:
- loss or altered sense of smell
- thick nasal drainage
- facial pressure/ fullness when present with other nasal symptoms
CRS is a chronic inflammatory conditionwith many different causes. The mainstay of therapy is corticosteroids and saline rinses. Surgery improves drainage and ventilation of the sinuses plus increases penetration of medication into the sinuses. Sinus surgery is not a cure for CRS!
It is very rare for a person to see nasal polyps without the use of an endoscope and most often than not, when a family doctor looks into the nose and says that a patient has nasal polyps, they are likely seeing the inferior turbinate.
NASAL BLOCKAGE WITH PAIN AND THICK NASAL DRAINAGE
Pain and pressure in the face with thick nasal drainage typically means that you have a sinus infection, especially after you have had a cold!Pain and pressure that comes out of the blue without a preceding cold/ upper respiratory infection is rarely a sinus infection.
It typically takes 7-10 days for a cold to turn into an acute bacterial sinusitis and can last up to 12 weeks. Symptoms improve with saline rinses, nasal decongestants, nasal steroids and appropriately used antibiotics. Patients being treated with multiple courses of antibiotics without relief of facial pressure/ pain rarely have a sinus infection.
When our nose runs, it is typically a sign of irritation. This can be caused by many things including:
- non-allergic rhinitis (dry, runny nose with changes similar to eczema on the skin)
- septal deviation
- cocaine use / smoking (cigarettes and marijuana)
It is important to keep your nose moist and clean. Saline rinses can be helpful as can nasal gels. Most importantly, avoid nasal irritants!
There are multiple causes of facial pain and pressure. Studies show that approximately 95% of people presenting with a “sinus headaches” are actually suffering from migraine headaches. Muscle tension headaches are a typical cause of pressure in the head and face (often described as a band around the head and worsening in the late afternoon). Temporomandibular joint problems (TMJ) can be a common source of pain and pressure in the ears, cheek, forehead and around the eyes. Pain on the side of the head (temples) and neck is most often caused by muscle tension (there are no sinuses on the side or back of the head and neck!). Migraines can present with acute nasal obstruction and rhinorrhea and will most often present without an aura.
COUGH AND POST-NASAL DRIP/ PHLEGM
People produce and swallow up to 2 litres of mucous per day! Some people are more aware of the secretions that they swallow and complain of phlegm and post-nasal drip. The fact is is that the sinuses DO NOT DRIP INTO THE THROAT OR LUNGS!!!!Our nose and throat make mucous to help to warm, moisten and clean the air that we breathe in to make it safe for our lungs. Mucous can be made thicker for many reasons including:
- dryness of the air we breathe
- medications (blood pressure medications, anti-depressants, hormone medications)
- smoking (including second and third hand smoke)
- acid reflux or GERD (described as “Silent Reflux”, as patients rarely feel burning in the chest or throat, and may often occur at night when sleeping)
Patients may develop a sensitive throat after an infection and are “hyper-aware”of the secretions in their throat. This causes them to cough and clear the throat, causing more irritation. This continues to cycle of an irritated throat. Patients may gain relief by sipping on ice-water to desensitize the throat, a medication called Elavil or cough suppressants to help break the cough cycle.
Sinusitis is a rare cause of cough and typically presents with a history of asthma.
In general, there is NO CURE for post-nasal drip or phlegm and nasal and throat symptoms would be much worse without mucous.
Nose bleeds are common due to our dry environment as the mucous membranes will dry and crack, exposing the small blood vessels that run throughout the nose. It is normal to have a small amount of blood on Kleenex if one aggressively blows or rubs their nose - especially in the winter time! Patients who use blood thinners are at a higher risk for nose bleeds (remember, herbal supplements and vitamins can act as blood thinners). Patients with a deviated septum can be more prone to nose bleeds too. Patients using nasal steroids can have nose bleeds if the tip of the spray bottle traumatizes the nasal septum.
If nose bleeds are an issue, it is important to have a physician look inside your nose. Generally, nasal lubricants/ gels and saline rinses or sprays can help dry mucous membranes and reduce bleeding. Cautery can be helpful to stop bleeding from larger vessels.
Our nose and sinuses work to humidify, clean and moisten the air we breathe in. In general, we need to live with a relative humidity above 50% to function normally. When the relative humidity is lower than this, it can cause our nose and sinuses to dry out, causing the mucous we make to become thicker and thee membranes to dry and crack. When this happens, we will build up mucous in the nose, causing people to blow and pick at their nose, worsening the irritation. Nasal lubricants and saline rinses can be helpful for this.
Patients who smoke, or are exposed to smoke, can have greater irritation in the nose. Smoking causes people to make more and thicker mucous. As well, the cells that move the mucous out of the nose to the throat (called Hair Cells) become paralyzed when exposed to smoke. When this happens, patients make more and thicker mucous that doesn’t drain properly.
People who have used cocaine are at risk for destroying the normal function of the nose as the talc mixed in the cocaine embeds in the nasal tissue and essentially changes the normal mucous membranes into skin. This can happen with as little as one use and can present decades after exposure.
As you can see, many of the symptoms that people are bothered by are not related to actual sinus disease. Congesiton, post nasal drainage, crusty nose, etc may be a result of your environment, medications or may even be a normal physiologic process. Using a nasal care solution like Rhinoclear Rhinorinse works to clear the nasal passages of dried mucous and irritants and help you feel better overall!