Conditions of the nose and the sinuses

(Ảnh minh họa)

Sinuses are bony cavities which drain into and are ventilated through the nose via small openings called meatus (below images of endoscopic view and CT scan).

There are 2 maxillary sinuses located beneath the eyes and just above the teeth, 2 ethmoid sinuses located between, 2 frontal sinuses located above, and 2 sphenoid sinuses located behind the eyes. Except for the maxillary sinus, all other sinuses are very close to the eyes and the brain.

The inside of the nose and the sinuses is lined by a mucous membrane called the mucosa. This mucosa is largely identical to the mucosa of the larynx and lungs which explains that when trying to identify a sinus condition we systematically look for any lung condition as well (i.e. asthma)

Nose Conditions

1. Common cold, called acute rhinitis: is often caused by a virus with symptoms of a stuffy and clear runny nose. If the discharge turns yellowish or greenish it is a sign of bacterial infection. Usually symptoms disappear within a couple of days. Treatment is always medical to improve breathing through the nose and decrease the amount of nasal secretions.
2. Chronic rhinitis: with this condition, symptoms may persist for several weeks or even months. Symptoms include stuffy nose, discharge, difficulty smelling things. In case of allergy you may also have an itchy nose and watery eyes.

An ENT examination with endoscopy of nose and sinuses is needed to confirm the diagnosis. Nasal blockage is caused by mucosal swelling, mostly of the turbinates. In 20% of cases it is due to allergies. The treatment consists of daily rinsing the nose with 0.9% sodium chloride and application of cortisone containing nose sprays. Treatment duration can be several weeks and even months, it is very effective and does not have the side effects known from cortisone taken by the mouth.

If medical treatment does not work for you and if nasal blockage is really uncomfortable, several surgical solutions are available. These procedures are done by endoscopy, which means that they are minimally invasive and can be done either under local or general anesthesia. The goal is to reduce the size of the turbinates and to improve nasal breathing.

Several techniques are available which usually only require one-day hospitalization:

• Cauterization of the turbinates,
• Partial resection of the inferior turbinate called turbinectomy (image below),

Sinus conditions

Sinusitis is an inflammation of the sinus mucosa, it can either be acute or chronic.

Acute sinusitis: is very common. The symptoms include pain over the affected sinus, often accompanied by runny and stuffy nose at the same side. It is always caused by an infection.

During the consultation your ENT doctor will perform an endoscopy of the nose. This is a very simple procedure and can help visualize pus at the sinus meatus level. Endoscopy usually suffices to make a diagnosis; in rare cases a CT scan may be necessary. It is important to rule out an infected tooth as the cause.

Under antibiotic and nasal vasoconstrictor (Otrivine) treatment together with nasal rinsing solutions, healing can usually be achieved within a couple of days. Seldom acute sinusitis may have complications, involving the eyes and/or the brain. In such cases a CT scan or MRI, hospitalization, and surgical treatment, by endoscopy, may be necessary.

Chronic sinusitis: is a recurrent or permanent sinusitis with symptoms of stuffy nose and decreased sense of smelling. Chronic sinusitis is mostly caused by an inflammation of the sinus mucosa without infection. Generally, the condition is not painful, except if there are complications.

In 20% of the cases chronic sinusitis is associated with conditions affecting the mucosa of the respiratory tract, such as asthma. It is therefore necessary to identify and treat any such condition.

Other causes for chronic sinusitis may include polyps in the nose or sinuses.

The treatment of chronic sinusitis is essentially medical through daily nose rinsing with 0.9% sodium chloride, and application of cortisone containing nose sprays. In 10% of cases, endoscopic surgery under general anesthesia may be required with the aim to widely open the passage from the sinuses to the nose.

The name of these surgeries refer to the sinus to be treated (below image) and usually require 1 day of hospitalization:

• meatotomy - maxillary sinus surgery,
• ethmoidectomy - ethmoid sinus
• sphenoidotomy - sphenoid sinus.

Your doctor will be able to explain the risks and benefits of all options and discuss the most suitable form of treatment for you.

Professor Pierre Verdalle is an ENT and Head & Neck Surgeon from France. He is part of the team of highly qualified French doctors who continuously provide their expertise and knowhow to the Hanoi French Hospital and all our patients.

If you have any questions or want to book an appointment with our doctors, please contact us at (84-24) 3577 1100 or send us an inquiry here.