Is it sinusitis or allergy? How to tell the difference

By Vicky Wandawa

“I have sinuses,” is a commonly misused term you have perhaps heard over and again from people who persistently suffer nasal congestion and discharge.

However, Gregory Tumweheire, a senior ear, nose and throat (ENT) consultant at Mulago Referral hospital, says when someone says he has sinuses, it is similar to saying he has legs, arms, or ears; normally, every human being has sinuses.

Difference between sinuses and sinusitis

Julius Luyimbaazi, a doctor at Nyakibaale Hospital, explains that sinuses are air-filled spaces within the skull, which are in continuity with the nasal cavity.

However, these sinuses may get inflamed as a result of infection, allergy or abnormal reaction of the body’s immune system, a condition clinically known as sinusitis.

Therefore, people that often report to be suffering from sinuses are actually suffering from sinusitis. Because sinusitis inflames the sinuses, this interferes with drainage, leading to a build-up of mucus.

Tumweheire says this weakens the lining of the nose and sinuses, allowing bacteria to invade, hence the development of sinusitis. Blocked sinuses create a moist environment, making it easier for infection to arise.

Cause

Acute sinusitis is often triggered by an upper respiratory tract infection, whose cause may be; viral, bacterial and fungus. Viral sinusitis is the most common and usually resolves within 10 days. It mostly results from the common cold virus or flu.

“However, there are viruses which affect the rest of the body, hence the sinuses. For example, with measles, as the body skin is peeling off, the lining in the nose is also peeling off, so one experiences a bloody discharge,” Tumweheire explains. HIV can also cause inflammation of the nose and discharge, hence viral sinusitis. Ebola too may lead to viral sinusitis.

Luyimbaazi says sinusitis caused by fungus is common in the diabetics and those with immune deficiencies.

Symptoms and signs

The commonest symptom is headache, depending on the sinuses involved. The pain is felt where the affected sinus lies.

The frontal sinus lies on the frontal bone directly above the eyes. The maxillary sinus lies under the eyes, the ethmoid sinus lies behind the nose and sphenoid is behind the centre of the skull base.

So the patient suffers frontal headache, facial pain. “The headache is worse when the patient stoops because when upright, gravity decongests the head but does the reverse during stooping, because it congests the head.”

A patient suffering from sinusitis will also experience a postnasal discharge. Tumweheire notes that pus discharge from sinusitis is non-smelling. In the cases of bacterial sinusitis, the discharge is yellowish and could be blood stained.For fungal sinusitis, the discharge is clear and could also be blood stained, while viral, the discharge is usually clear with a lot of mucus but may also be blood-stained, may cause headache and itching. For bacterial and fungal, the itching may not be as pronounced.

Other signs and symptoms include:

• Pain and tenderness around the nose, cheeks, or eyelids
• Nasal congestion
• Persistent cough or pharyngeal irritation
• Facial pain
• Impaired smell sense
• Aching in upper jaw and teeth
• Reduced sense of smell and taste
• Cough

However, Luyimbaazi clarifies that not all cases of nasal congestion are caused by sinusitis.

                                        Keeping warm and foods rich in Vitamin C provide relief

The chronic phase

During the chronic phase, Tumweheire notes: “Some of the effects are reversed, for example blockage of nose, discharge, pain reduces and swelling reduces, et cetera.”

This, he notes, is after about four weeks when left untreated. With fewer effects, the urgency to seek treatment reduces. However, though the discharge flowing from the nose may have reduced, there is enough discharge to flow to the back of the nose, causing cough.

Therefore, some people with persistent cough actually have sinusitis. “The discharge causes throat irritation,  thus cough. The person keeps getting the urge to clear the throat.”

Tumweheire says the mucous may stick to the vocal cord and the voice becomes hoarse. So the cough may get better, but after some time it gets hoarse again.

At this point, though the person does not feel pain, there may be social discomfort, considering that one may continually have pus discharge from nose all the time and hence have to blow their noses often for relief.

One may also not talk for long without having to clear his voice since the mucous may make it hoarse.

Children, however, do not tend to get chronic, despite the fact that they suffer more upper respiratory infection than adults as a result of lower immunity. This is because they heal faster.

For chronic or recurring sinusitis, referral to an otolaryngologist specialist may be indicated, and treatment options may include nasal surgery.

Complications

Tumweheire warns that when one does not seek treatment and carry on with the chronic sinusitis for several months or years, depending on the individual, complications may arise.

He explains that when the pus stops draining itself into the nose, after sometime, that self-cleansing mechanism stops and once the pus builds up it starts affecting other areas.

Luyimbaazi warns that proximity of the sinuses to the orbit (the bony cavity in the skull containing the eyeball) often leads to spread of bacterial infection, hence eye infections.

Because some of the paranasal sinuses are in close proximity to the brain, bacterial invasion into the brain can occur resulting into meningitis, brain abscesses, comma, convulsions and even death.

What is more, the pus contains bacteria and as you breathe some of these bacteria will find its way to the lungs, causing bronchitis.

Home remedies, diagnosis, treatment

Home remedies include: Pain killers:

As one awaits medical advice, Tumweheire recommends pain killers to help with headaches, which are usually synonymous with sinusitis.

Keep warm:

He also advises that the patient keeps warm. “Being out in the cold is not for you if you are suffering from sinusitis. When you are warm, your nose is a bit open but with cold, it closes and only allows in a little air it can warm.

Subsequently, you have to breathe through your mouth, hence the discomfort of a nasal blockage.”

“When you open a cold shower and pick the courage to jump into the shower. Do you notice that you gasp and breathe through your mouth? Well, it is because the nose closes, so you must breathe through the mouth.” He describes the nose closure as a reflex so that one does not breathe cold air into the lungs.

Consequently, when a patient suffering from sinusitis keeps warm, the blockage of the nose is partly relieved.

Inhale steam:

This may help clear the nasal blockage. It is usually done with the patient covering their head and bending over a container of hot water, hence directing the steam to their face. “The danger with that though is you make a mistake and that water burns you, so we do not readily advise it,” Tumweheire warns.

Keep hydrated:

“When you breathe through the nose, you conserve moisture. Breathing through the mouth means you are losing moisture. So you need to keep drinking a lot.” What is more, you need to keep well hydrated because you do not want the mucous to thicken, as it will attract more bacteria.

Vitamin C

Vitamin C improves the immunity of the body, especially the lining of the respiratory system. Fruits such as oranges are rich in Vitamin C.

Herbs: Herbs such as menthol and eucalyptus usually have a soothing effect on the throat.

Tests, diagnosis and treatment

One of the common tests for sinusitis is an x-ray of the sinuses and nasal area because these may identify deep inflammation and fluid collection.

For treatment, nasal irrigation may help relieve the symptoms of chronic sinusitis while decongestant nasal sprays may relieve nasal congestion. Antibiotics may also be used.

Furthermore, because many people with allergy end up with sinusitis, treating sinusitis requires controlling the allergy, because allergy makes blockage of the nose prone to sinusitis.

Surgical treatment is reserved for cases of recurrent acute sinusitis and chronic sinusitis who fail to get appreciable relief from medical treatment. The surgery is done to drain pus and prevent it from accumulating.

In most cases people get away with it. They may not have to receive treatment for sinusitis. Tumweheire notes that sinusitis is not exactly a common condition and the majority of patients he sees who say they have sinusitis actually have allergy.

Prevention

Luyimbaazi advises avoidance of all environmental factors that precipitate allergic reactions such as pollen, dust and cold, formites (for those who are prone to allergies).

It is also advisable to minimise contact with people with flu symptoms. The infection is mostly air-borne through droplets. Other ways of prevention include:

• Avoidance of cigarette smoke (passive smoking is associated with chronic sinusitis).
• Prompt treatment of acute upper respiratory infection so that they do not progress into chronic sinusitis
• Practice good hygiene to avoid flu because sinusitis commonly starts with flu
• Good aeration
• Early treatment of colds
• Avoid extreme temperatures because they interfere with the way the nose operates.