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Symptoms of nose and sinus problems
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Symptoms of Sinusitis

Question: What symptoms are associated with sinusitis?
Factors Associated with the Diagnosis of Chronic Rhinosinusitis:

Major FactorsMinor Factors
Facial pain/pressure*Headache
Facial congestion/fullness Fever
Nasal obstruction/blockage Halitosis
Nasal discharge/purulence/discolored nasal drainageFatigue
Hyposmia/anosmia /td>Dental pain
Purulence in nasal cavity on examination Cough
Ear pressure/fullness
*Facial pain/pressure alone does not constitute a suggestive history for chronic rhinosinusitis in the absence of another major nasal symptom or sign

Question: Will you tell me more about facial pressure and pain in sinusitis?
The sinuses are hollow, air-filled cavities housed in the facial skeleton. The sinuses are lined by a mucous-producing lining. Mucous is typically swept out of the sinuses into the nasal cavity and then back into the throat where it is swallowed. In patients with sinusitis, the small openings ("ostia") through which the mucous from the sinuses drains are blocked – often by swelling of the sinus lining. When the openings are blocked, the mucous does not drain effectively and a “back-up” occurs. The sinuses then retain secretions and an environment is created where warm, wet, stagnant secretions pool, leading to an influx of inflammatory mediators. Patients with this pooling of mucous and swelling of the sinus lining typically complain of facial pain and pressure associated with the swelling (and, on occasion, infection) in the sinuses.

Question: Will you tell me more about nasal obstruction and congestion in sinusitis?
Nasal congestion and nasal blockage has many causes. It is useful to divide them into causes that are treated medically and causes that require surgical treatment.

  • Medical causes include the common cold (viral infection -- temporary cause), bacterial sinusitis, allergy, sensitivity to dust, smoke, pollution, and other irritants.
  • Other causes include anatomic abnormalities such as a deviated septum, nasal polyps, obstructed sinuses that do not improve with medication, over-enlarged turbinates, obstructing adenoids, and other causes. Sometimes scarring from trauma or prior nasal surgery can cause nasal obstruction. In rare cases, a sinus or nasal tumor can lead to blockage and obstruction. Chronic nasal obstruction must be evaluated by a specialist.

FIGURE 2. This otherwise healthy, non-smoking patient presented to clinic with a complaint of nasal obstruction. Clinic examination with a nasal endoscope revealed a nasal mass. Biopsy found squamous cell carcinoma. Because of early diagnosis and intervention, this tumor was caught in its early stages and the patient did well.

Question: Will you tell me more about postnasal drainage in sinusitis?
Postnasal drainage is a symptom that may result from rhinitis or sinusitis. Abnormal swelling of the nasal and sinus membranes causes them to produce thick, abnormal mucus, which can contribute to nasal blockage, and also can drain into the back of the throat and cause cough, sore throat, and so forth. Treatment of postnasal drainage includes treating rhinitis and sinusitis. Sometimes, the sensation of postnasal drainage may actually come from acid reflux. Acid from the stomach can travel in a retrograde direction -- up the esophagus -- and spill onto the voice box (larynx). The irritation to the larynx, and associated throat-clearing and felling of "something stuck in my throat," can contribute to the feeling of postnasal drainage.

An ear nose and throat doctor can quickly and easily evaluate you for this Laryngopharyngeal Acid Reflux with a quick clinic examination. In this case, as in most instances with the sinuses and throat, effective treatment depends on proper diagnosis.

Question: Will you tell me more about halitosis in sinusitis?
A common cause of halitosis (bad breath) is thick postnasal drip. This thick mucus can be white, yellow, or even green. If a patient has sinusitis, the mucus is stagnant in the sinuses and becomes foul-smelling, then it drips back into the throat to give bad breath. No mouthwash will take this bad breath away. The patient needs to see a sinus specialist. As part of the evaluation of postnasal drainage, the specialist will evaluate the nose and sinuses, as well as the throat.

Question: Will you tell me more about fatigue in sinusitis?
Patients who experience fatigue should see their primary doctor to evaluate the many possible causes. Thyroid dysfunction, for example, commonly manifests with fatigue. However, chronic sinusitis -- like any chronic illness -- can also take its toll on a patient. It can decrease energy levels and make the individual less productive. Several studies have confirmed that fatigue is a common presentation of patients with sinusitis. If a patient has sinusitis, this can be a contributing factor to fatigue.

Question: Will you tell me more about facial pain and headache in sinusitis?
Facial pain and headache have many causes: tension headache, migraine headache, stress headache, cluster headaches, reflex sympathetic dystrophy, and more. Sinusitis does contribute to facial pressure and pain, and it can reduce resistance to other kinds of headaches -- that is, sinusitis can lower the threshold or make the patient more disposed to get another type of headache. While some patients develop headache, others may have pain, tenderness and swelling around the eyes, cheeks, nose or forehead.

The complete and thorough evaluation of headache includes evaluation by a neurologist and often an ENT specialist. If a patient's doctor feels that the individual's pain may be more sinus related, the doctor may want to start with a sinus specialist, who will examine the patient thoroughly and will search out all of the many causes of facial pain that can be treated. If the specialist doesn't find anything definitive, there may still be hope of other effective treatment, and a neurologist may also suggest treatments. In a rare patient, ENT and neurologic exams find no cause for the headache. In these cases, a pain management specialist is enlisted into the team, with frequent positive results that are usually a surprise to the patient.

Question: Will you tell me more about facial pain and pressure with airplane travel?
Nasal congestion, secondary to sinusitis and other conditions, is a relative contraindication to air travel. This means that patients prone to nasal congestive disorders should only travel by airplane if they have first consulted with their physician. The physician may determine that it is not safe to fly or may feel that the patient can fly with proper pretreatment. The risks of flying with nasal congestion include severe facial pain, damage to the eardrums including bleeding and perforation, dizziness or vertigo, sinus bleeding, and other even more serious conditions.

It is recommended that patients with nasal congestion take a systemic decongestant and also spray the nasal passages with a topical long-acting nasal decongestant before the flight and before the descent. Such patients should check with their doctors to make sure that they can take these medications...for instance, patients with high blood pressure may want to avoid these medications. Patients with allergies may also take an antihistamine under a doctor’s supervision. In some cases, a doctor may wish to prescribe other medications, such as oral prednisone, a few days prior to travel. Medical care should be available at the patient's destination in case sinusitis develops.

Air travelers with sinusitis are also advised to chew gum, swallow frequently, and learn how to perform the Valsalva maneuver to clear their ears. One way to perform this maneuver is to hold the nose and gently generate pressure against the closed mouth and glottis every 30 seconds.

Question: Will you tell me more about thick nasal discharge in sinusitis?
Some patients have recurrent infections with thick, sometimes discolored, nasal discharge. Sometimes this thick mucous drains down the back of the throat. The sinus specialist must find out why patients get recurrent infections and treat this problem. Some causes are unavoidable -- for instance, patients with small children in elementary school who bring home cold after cold will have to wait until their children grow older. (Actually, even in this situation the sinus specialist can often help with preventive medical treatment.) Patients with sinus blockage predisposing them to infections may find medical and/or surgical therapy to be helpful. The sinus specialist may need to check the function of the patient's immune status -- while this is usually normal, occasionally a patient has low immune defenses that can be helped.

Question: Will you tell me more about decreased sense of smell in sinusitis?
Smell and taste sensation go hand in hand. Patients who lose their sense of smell probably also find that food is bland or tasteless. Although annoying, this can actually be a more serious problem because the patient cannot tell if food is spoiled or if there is a household emergency such as fire, which they would not be able to detect. The nerves for smell are located in a very small area high in the nasal cavity. Even a small amount of blockage in this location can cause loss of sense of smell (which is why patients lose sense of smell when they have a cold, for instance).

Sinusitis is a common cause of loss of senses of smell and taste. However, there are a number of other problems that can cause a loss of sense of smell, including tumors, and this must be evaluated by an ENT specialist (FIGURE 3).

FIGURE 3. Nasal and sinus polyps, seen here on endoscopic view, can lead to decrease in sensation of smell and taste. The polyps and their associated inflammation often block the passage of olfactory molecules upwards toward the "smell nerves" housed in the roof of the nose.

Question: Will you tell me more about dental pain in sinusitis?
The maxillary (cheek) sinuses are located just above the teeth. In fact, the roof of the mouth (where the dental roots live) is the floor of the cheek sinuses. While it is not uncommon for dental problems to lead to infection in the cheek sinuses, an infected cheek sinus may also lead to dental pain. Once the maxillary sinuses are affected, infection can then spread to the adjacent sinuses.

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