Diseases of the Nose and Sinuses

Overview

Nose and sinus diseases are classified based on the symptoms and aliments by the structures impacted and other factors. 

Allergic Rhinitis 

Allergic rhinitis or hay fever is an allergic reaction to tiny particles in the air known as allergens. When you inhale allergens via your nose or mouth, your body reacts by discharging a natural chemical called histamine. 

Even though allergic rhinitis is also called hay fever, hay doesn’t cause hay fever, and most people don’t get a fever. Hay fever symptoms include nasal congestion, sneezing, nose, throat, mouth, and eye irritation.

Allergic rhinitis differs from infectious rhinitis, otherwise known as the common cold. Hay fever is not transmissible. Furthermore, not every rhinitis is allergic. People may suffer from non-allergic rhinitis with similar symptoms—inflammation results in rhinitis, not allergens or histamine release.

Cerebrospinal fluid (CSF) Leak

Cerebrospinal fluid (CSF) is a transparent liquid that circumvents the brain and spinal cord. It gives a cushion for fragile brain and spinal tissue. 

A CSF leak happens when the Cerebrospinal fluid evades via a tear or hole in the dura, the outermost layer of the meninges surrounding the brain. The dura mater can sustain injury or perforation as a result of cranial trauma or a surgical intervention involving the sinuses, brain, or spine.

Additionally, it can be harmed during a lumbar puncture procedure, such as a spinal tap, spinal anaesthesia, or myelogram. Spontaneous cerebrospinal fluid (CSF) leaks can happen due to increased intracranial pressure. This phenomenon is noticed in patients with occipital, defined by an accumulation of CSF within the cranium. Moreover, spontaneous leaks may crop up without a discernible cause.

Chronic Rhinosinusitis With Nasal Polyps

Chronic rhinosinusitis with nasal polyps is a medical condition that can result in distressing symptoms, ranging from sinus pain and nasal congestion to anosmia. Nasal polyps are growths that form in the nasal cavity or sinuses. 

Albeit they are not harmful, they can cause severe discomfort and disrupt your quality of life, making it hard to sleep. Treatment options available are nasal or oral medications, biologic injections, and surgical intervention. 

Nevertheless, there is a chance of polyp reappearance. You may required to consult with specialists, like an allergist and an otolaryngologist, who may even work together to treat your condition.

Chronic Rhinosinusitis Without Nasal Polyposis 

Chronic rhinosinusitis without nasal polyps (CRSsNP) is distinguished by at least two of four essential symptoms for 12 weeks or more. These symptoms include nasal obstruction, anterior or posterior nasal discharge, reduction or loss of smell, facial pain, pressure, or fullness.

Fungal Sinusitis

The fungus lives in our surroundings and the air we breathe via our nasal passages. It may be more widespread in specific environments that are moist and humid. The majority of individuals with an immune system do not exhibit any reaction to the presence of inhaled fungus daily. However, the fungus can lead to acute or chronic inflammation in the nasal passages and sinuses in sporadic cases.

Fungal sinusitis can manifest in various forms and is broadly categorised into invasive and non-invasive types:

Non-invasive: These types are not life-threatening and are often associated with specific environmental allergies. They are commonly linked to chronic sinusitis.

Invasive: These types can progress rapidly and pose a potential threat to life, necessitating hospitalisation, further testing, and treatments. These invasive infections are typically found in patients with uncontrolled diabetes or those undergoing chemotherapy for various blood-related tumours, such as leukaemia or lymphoma.

Inverted Papilloma

Inverted papillomas form in the nasal cavity and paranasal sinuses. It is a benign yet locally aggressive tumour. People with a history of sinonasal infections are more affected by it. Though the inverted papilloma is a benign tumour, there is a possibility of a benign tumour converting into a malignant tumour. 

About 5-12 percent of tumors can turn into malignant tumors. Malignant tumour cells grow and spread uncontrollably. 

The symptoms of Inverted papilloma are similar to chronic rhinosinusitis, including:

• Nasal congestion
• Drainage
• Headaches 
• Postnasal drip

Meningoencephalocele

Meninges are membranes that enclose the brain and spinal cord. Meningoencephalocele is an irregular sac of fluid, brain tissue and meninges that spreads through a defect in the skull. There are two types of meningoencephalocele: frontoethmoidal and occipital. 

The frontoethmoidal type is situated at the frontal and ethmoid bones, and the occipital type is at the occipital bone. The names are assigned according to the location of the sac.

This condition is associated with occipital. occipital is an abnormality of the eyeball and tear duct. With this condition, few people may suffer from physical and intellectual disabilities, and few may have normal growth and abilities. 

This condition occurs at the time of birth, but there are cases where it develops in older individuals. The cause of the meningoencephalocele has not yet been found, but environmental factors have a significant role. 

Nasal Fracture

A crack or break in your nose is called a nasal fracture. The apparent reasons for broken nose or nasal fracture is physical fights, motor vehicle accidents, etc. The broken nose causes severe pain and bleeding, and the breathing process becomes complex.

Nasal and Paranasal Tumors

Healthy cells grow, increase and expand at a standard rate and die at a standard rate. Abnormal cells grow and multiply not at a standard rate but in an unruly manner. Nasal and paranasal tumours form by a genetic mutation. Genetic mutation converts normal cells into abnormal cells. 

There is a possibility of abnormal cells becoming cancerous cells. When the cells become cancerous, they may breach nearby tissues and detach from the first tumour to expand (Metastasize) to the rest of the body. 

Nosebleed

Many things can cause a nosebleed. The most conventional reasons are dry air, low-humidity climate and nose-picking. 

Other Causes

• Blowing your nose too hard frequently
• Injuries caused by a fall
• Side effects of medication

Asthma Triad 

Asthma triad, or Samter’s triad, is an aspirin-exacerbated respiratory disease. The disease consists of three conditions that happen together. They are Sinus inflammation with nasal polyps, asthma and aspirin sensitivity. 

Healthcare providers utilise various diagnostic tests to diagnose nose or sinus problems based on your symptoms. These tests help rule out other health conditions and determine your symptoms’ exact cause and severity.

Diagnostic tests commonly used by healthcare providers include:

Allergy testing: Skin tests generally identify the allergens that trigger allergic rhinitis symptoms.

Complete blood count (CBC): A blood test that can aid in diagnosing allergic rhinitis or identify the underlying cause of a nosebleed.

CT scan: An imaging test that provides a detailed view of the structure of your nose and sinuses. It can also assist in detecting nasal polyps.

Ciliary function test: This test assesses the effectiveness of cilia in eliminating germs and debris from your airways.

IgE RAST test: A blood test that checks for the existence of antibodies released by your body in response to an allergen.

Nasal endoscopy: A flexible tube with a camera on the end (endoscope) is injected into your nose to visualise the internal structures. A small tissue sample may be taken for further analysis in a few cases.

MRI: This imaging test is used to analyse your sinuses for fungal infections or tumours.

Prothrombin time (PT): It assesses the clotting time of your plasma.

Partial thromboplastin time (PTT): This test calculates the time it takes for blood to clot.

Toxicology screening: This test is conducted to check for substance use, which may contribute to nosebleeds.

Treatments

Following your nose or sinus disease diagnosis, your physician will create a personalised treatment plan. This plan may consist of various approaches, such as:

Medications

Balloon sinuplasty: This is an in-office procedure where a balloon is injected into the sinus passageway to expand and open it. By deflating the balloon, sinus drainage and function are improved.

Specialised head and neck surgical treatment: This may include minimally invasive nose or sinus surgery tailored to address your specific condition.

Inferior turbinate reduction: Another in-office procedure that involves reducing the size of the inferior turbinate passageway in the nose to improve nasal airflow.

Prevention

While preventing nose and sinus problems entirely may not be possible, you can adopt a few measures to reduce your risk.

• Receive an annual flu shot.
• Refrain from smoking or avoid starting altogether.
• Utilise a nasal spray.
• Effectively manage any underlying health conditions, such as allergy rhinitis and asthma.
• Reduce stress levels.
• Ensure proper hydration.
• Utilise a humidifier to maintain moisture in the air within your home.

Conclusion

Living with nose and sinus problems can be a challenging and uncomfortable experience. The pain, breathing difficulties, fatigue, and other symptoms can significantly impact your daily life. However, there is no need to suffer in silence. Some treatments can alleviate your discomfort and improve your overall well-being. 

FAQs