A stuffy nose, headache and facial pressure are common symptoms in the winter months but once resolved, sinusitis can be quickly forgotten. Maintaining sinus health on a daily basis helps protect this hardworking and vulnerable area of the body. According to Dr Mohammed Thandar, an ear, nose and throat (ENT) surgeon practising at Netcare St Augustine’s Hospital, apart from its unpleasant symptoms which can also include a post nasal drip, facial pain, congestion, coughing and fatigue, sinusitis can lead to serious complications if it is left for too long.

“Sinusitis can have varying causes. Most commonly at this time of year during cold and flu season, it is a viral infection such as influenza, rhinovirus, or respiratory syncytial virus. When the nasal passageways become swollen, obstructing the natural pathways for fluid drainage, a build-up of mucus occurs within the sinus, which can result in a secondary bacterial infection.

“Symptoms may persist for many weeks leading to chronic sinusitis and recurrent infections. Certain symptoms, such as a postnasal drip that tracks down the back of the throat into the chest can quite easily result in the development of bronchitis. It can also aggravate pre-existing conditions, such as asthma,” he says. “Furthermore, untreated acute sinusitis has been known to lead to orbital complications including eye pain, swelling of the eyelids, a bulging eye, visual changes and visual loss, as well as intracranial complications such as inflammation of the membranes and fluid surrounding the brain, resulting in severe headaches, a change in level of consciousness, seizures, and even coma. This can necessitate emergency surgery,” he notes. Dr Pradeep Soni, an ENT surgeon practising at Netcare uMhlanga Hospital adds that although such complications may not be common, sinusitis occurs in almost all people and incorporating nasal hygiene habits into your daily routine istherefore an important ongoing preventative care measure.  

Dr Soni recommends taking the following steps:

• Practice good hygiene by washing hands and avoiding contact with people who are sick
• Use a nasal saline rinse daily to help keep sinuses clear of infection
• Use a humidifier to prevent sinuses from drying out and becoming inflamed in dry, heated environments
• Address dental problems to prevent oral infections from spreading to the sinuses
• Quit smoking, as it irritates the sinuses and damages their normal drainage mechanism thereby increasing the risk of infections
• Avoid allergens. Allergies are a trigger of sinusitis for many people, and it is important to limit exposure to allergens – which may range from dust mites to pollens, animals, grass and others. Controlling allergies will also prove helpful.

“Cold and flu season is immediately followed by allergy season and springtime pollens – another leading cause of sinusitis. In addition to this, many people live in urban environments where pollutants and irritants are in the air we breathe and can also contribute towards sinusitis.

“People with weakened immune systems such as those with diabetes, HIV and cancer, are more susceptible to sinusitis but it is an extremely common condition among the entire population and affects millions of people globally. It is therefore advisable for everyone to practise good nasal hygiene all year round,” says Dr Soni.

“There are certain home remedies that may help to prevent sinusitis from worsening. Recommend to patients that they should use a nasal saline rinse twice daily to gently clear the passageways and help to reduce congestion, apply warm compresses to the face, as this can help to reduce facial pain, and drink plenty of fluids to thin the mucus and encourage better drainage.”

Dr Soni notes that if sinusitis continues or worsens then certain treatments should be prescribed to address the infection, such as a nasal decongestant spray or oral decongestant for short term use, antibiotics, nasal steroids to reduce inflammation, and in the case of allergies, antihistamines. “It can be the case that intervention is required to address any nasal abnormalities, such as a deviated septum or polyps, that may be causing blockages. In some cases endoscopic sinus surgery may be required to improve the drainage going forward,” he says. Dr Thandar suggests that doctors who have patients who suffer from sinusitis on an ongoing basis should investigate if there are any possible underlying causes such as structural issues in the nasal passageways or allergies in the home. “Allergy testing and treatment has come a very long way in recent times. Testing is done through skin tests or blood tests – once identified it can help with allergen avoidance and, where possible, modify the immune system to effectively cure the allergy.

“This is done with immunotherapy or desensitisation over a period of a few years. However, the way that this therapy is administered is much easier now than it was ten years ago, when patients used to be subjected to weekly injections with a risk of anaphylaxis, or shock.  Nowadays, it is simply done with a spray under the tongue at home and there is minimal risk.

“I strongly recommend that GPs with patients suffering ongoing sinusitis should look into finding a long-term solution, as this seemingly insignificant condition is not only uncomfortable to live with but can over time lead to bigger healthcare concerns,” he concludes.