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A COLD BY ANOTHER NAME, THE SINISTER SINUSITIS

'Sinus'. Says the man, not his usual voluble self, and you notice the strain on the face, and in the eyes. "Made a mistake coming in to work... Caught the death of a cold," he adds, stubbing a thick wad of tissue to the nostrils.

You wonder if its contagious, and you give him that extra something space which on other normal days with other normal men you wouldn't have, not if the man was drowning.

Actually, it's called 'sinusitis'. A common condition that can usually be treated with medication and, on the face of it, not much different from a head cold, with blocked and stuffy or runny nose. It plays havoc with the routine, and it makes the eyes water - the bouts of sneezing a bother as well as relief from the blocked nose.

So, what's it really? "Sinusitis is a swelling of the inner lining of the sinuses. This swelling causes the openings of the sinuses to be blocked so that the mucus inside can no longer drain out. When this happens the pressure of the blocked fluid creates pain in the face and impairs breathing," says Dr Udaya Chand Das, specialist ENT surgeon, Zulekha Hospital, Dubai.

For most people, says Dr Das, sinusitis is a temporary condition that goes away with simple treatment. "If the symptoms continue for a significant period of time without responding to medication, or if the symptoms are especially severe, surgery may bring about permanent relief."

Sinusitis can be the result of:

A cold that lingers

A bacterial or viral infection

Swelling due to allergies

Having small sinus openings

Deviated Septum

The partition separating the left and right sides of the nose, called the septum, is sometimes crooked. This crooked condition is called a deviated septum. Some people are born with this abnormality, but sometimes it is the result of an injury.

"Very few people have a perfectly straight septum. Endoscopic sinus surgery is only recommended for those whose septum is crooked enough to cause significant sinus blockage leading to chronic sinusitis or repeated attacks of acute sinusitis that does not respond to medication. The surgery can then straighten the septum and improve breathing," says Dr Das.

So, what causes sinusitis? Dr Das lists them:

Virus, Bacteria, Fungus, Allergies, Asthma, Poor air quality,

Extremes of temperature and humidity, Dehydration, Excessive nose blowing,

Foreign objects placed in the nose, Stress, Diseased teeth, Hormonal imbalances,

Medication side effects, Low immune system, Deviated septum,

Small sinus openings, Polyps, Tumours etc.

The symptoms of sinusitis vary from person to person, but the most common are:

Stuffy or runny nose

Clear, thin discharge from the nose (as in chronic sinusitis), or thick yellow or green discharge from the nose, sometimes tinged with blood (as in acute sinusitis)

Sneezing and/or coughing

Pain over the bridge of the nose

Headache that is worse in the morning, when bending forward, or when riding an elevator

Post-nasal drip from the nose into the throat

Frequent throat clearing

Itchy eyes and/or nose

Impaired sense of smell and/or taste

Bad breath

Fever and chills

Pain in the roof of the mouth or teeth

Face and eye pain

Less common symptoms, says Dr Das, which may or may not be accompanied by a stuffy nose, include:

Earache, feeling of fullness in the ear, swelling, and tenderness behind the ear, and/or ear popping due to mucus in the eustachian tube of the ear

Sore throat and hoarse voice caused by infected post-nasal drip

Swelling of the eye area due to spread of infection from the sinuses to the eye

Severe headache with vomiting, a very rare symptom, indicates the possibility of meningitis or the spread of infection into the brain.

How does a doctor determine whether surgery is necessary?

"The first thing a doctor will do is take a detailed medical history and make note of all symptoms, as well as how long the symptoms have been present. The doctor will need to know any medications being taken, as well as any other conditions such as high blood pressure, eye diseases or bleeding disorders."

If there is another course of treatment besides surgery that has not yet been tried, the doctor may prescribe new medications.

"If surgery appears to be the best course of action, a CT scan, which is a special type of x-ray, is usually taken so that the doctor can see all of the sinuses prior to using the endoscope. The CT scan serves as a kind of road map for the endoscopic examination," says Dr Das.

Before the endoscopic examination, a nasal spray is used to shrink and anaesthetize sinus tissues. "The doctor will then insert the endoscope into the nostrils to determine what is causing the sinusitis symptoms, such as thick mucus, swelling, small openings, deviated septum, or polyps. The doctor will perform surgery only if the examination shows problems that can be surgically corrected."

What is the recovery period?

"The patient can start working after a week of the operation. This, of course, is a gradual process and varies from person to person," says Dr Das.