Tag: nose

Posted on

Pragmatic Approach to Treating Inflamed Nasal Passages and Sinuses

Alberta countryside. (Dr. Noorali Bharwani)
Alberta countryside. (Dr. Noorali Bharwani)

Sinusitis refers to inflammation of a sinus, while rhinitis is inflammation of the nasal passage. Anatomical closeness of the sinus cavities and the nasal passages lead to frequent simultaneous involvement of both structures. When both structures are involved the diagnosis is rhinosinusitis. The inflammation may be due to a virus or bacteria. The disease can be acute or chronic.

Rhinosinusitis is a frequently occurring disease. It has a big impact on the quality of life and health care spending. This also affects absenteeism and productivity. It is estimated that approximately six billion dollars is spent on 25 million individuals in the United States annually on therapy for rhinosinusitis. Rhinosinusitis probably affects more than 25 million Americans and 2.5 million Canadians.

As we know the quality of life of patients with chronic or recurrent sinusitis can be unpleasant. Antibiotics are prescribed for nearly all patients with sinusitis, but they are not always effective and increase the risk of antibiotic resistance.

A study published in the Canadian Medical Association Journal (CMAJ September 2, 2016) looks at the pragmatic approach to treating rhinosinusitis. The study involved adults age 18 to 65 years old with a history of chronic or recurrent sinusitis from 72 primary care practices in the United Kingdom. These individuals reported that the illness impacted their quality of life. They were randomly assigned to one of four strategies: usual care, daily nasal saline irrigation, daily steam inhalation, or combined treatment with both interventions. They were followed for three to six months.

The study concluded:

  1. Nasal irrigation: Nasal irrigation for chronic or recurrent symptoms was less effective than prior evidence suggested, but it resulted in reduced overall symptom burden, headache, use of over-the-counter medications and the perceived need to consult primary care physicians in future episodes.
  2. Steam inhalation: Steam inhalation had no consistent benefits. On a personal note – I have found steam inhalation done twice a day does provide temporary symptomatic relief by unblocking the nasal passages. You can try it. It may help but it will not hurt.

The common cold can lead to rhinosinusitis. Common cold is caused by a virus (rhinovirus), and in most cases the severity of symptoms peak by day three. However, the same virus can activate an inflammatory process leading to bronchitis, pharyngitis, and rhinosinusitis.

Rhinosinusitis caused by bacteria usually gets better in less than four weeks. Within this 4-week period, symptoms resolve either spontaneously or with appropriate treatment. There may be up to three episodes per year and full recovery in between episodes.

Harvard researchers found that sinusitis sufferers reported the highest levels of pain and the lowest levels of social functioning, as well as significant problems with work, energy, and mental health.

Mayo Clinic website says, “One of the simplest, cheapest, and most effective ways to prevent and treat sinus problems is nasal irrigation. Using a homemade solution, you can often relieve sinusitis symptoms, reduce reliance on nasal sprays and antibiotics, and improve your quality of life.”

Hope this information helps. Flu season is coming. Do not forget your flu shot!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Posted on

Nasal Polyps

Dear Dr. B: What is a polyp? I have polyps in my nose and they bleed occasionally. Could they turn into cancer?

Answer: A polyp is a growth or tumor protruding from the lining of an organ such as the nose, bladder, uterus, and intestine or from any organ of the body.

Nasal polyps are growths in the mucous secreting lining of the nose or sinuses. They are grape like, fleshy and usually inflammatory in nature. Most of the nasal polyps are benign (non-cancerous), and can be on one or both sides of the nose. Unlike polyps in the colon or bladder, most polyps in the nose are not true tumors and do not suggest an increased risk of cancer. They are merely a reflection of inflammation.

Certain types of nasal polyps have a predisposition to turn into cancer. If you have polyps and if they tend to bleed then you should have your problem fully assessed by your doctor and a specialist in ear, nose and throat surgery (otolaryngologist).

Nasal polyps are more common in adults. . Men are four times as likely to have nasal polyps as women. The most common cause of polyps is allergy, followed by chronic sinus infection. They are more common in people who have asthma or inflammation of the lining of the nose (rhinitis), and cystic fibrosis.

People with nasal polyps suffer from stuffy nose and have trouble breathing. They become mouth breathers. They have a poor sense of smell and taste. Sometimes they have runny nose.

If you have chronic symptoms of rhinitis and sinusitis then your physician will refer you to an
otolaryngologist for an endoscopy. Endoscopy uses a small, flexible, lighted scope (nasopharyngoscope) to examine your nasal passages. A nasal polyp can be visualized and diagnosed with this instrument. Also biopsy can be taken to check for cancer.

You may also have a CT scan if the number and size of the polyps cannot be assessed with an endoscope. Quite often you may have polyps in the sinuses as well.

Nasal polyps are treated with corticosteroid nasal spray or corticosteroid pills. Steroids help to slowly shrink the polyps. If you continue to take the medicine, it may prevent new polyps. If your polyps are large, you may need surgery to remove them. Nasal polyps can recur. You should discuss with your doctor how to stay on maintenance therapy to prevent recurrence of nasal polyps.

A lesson in science:

In a school science class four worms were placed into four separate jars.

The first worm was put into a jar of alcohol. The second worm was put into a jar of cigarette smoke. The third worm was put into a jar of sperms. The fourth worm was put into a jar of soil.

After one day, the first worm in alcohol died. The second worm in cigarette smoke died. The third worm in sperms died. The fourth worm in soil stayed alive.

So the science teacher asked the class – “What can you learn from this experiment?”

Little Johnny quickly raised his hand and said “As long as you drink, smoke and have sex, you won’t have worms.”

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!