Sinus, Hay Fever, Sinusitis and Nasal Polyps

Nose and sinus conditions

Inflammation of the nasal mucous membrane is called rhinitis
The symptoms include sneezing and runny and/or itchy nose, caused by irritation and congestion in the nose
There are two types: allergic rhinitis and non-allergic rhinitis

Allergic rhinitis occurs when the body’s immune system over-responds to specific, non-infectious particles such as plant pollens, moulds, dust mites, animal hair, industrial chemicals (including tobacco smoke), foods, medicines, and insect venom
During an allergic attack, antibodies, primarily immunoglobin E (IgE), attach to mast cells (cells that release histamine) in the lungs, skin, and mucous membranes
Once IgE connects with the mast cells, a number of chemicals are released
One of the chemicals, histamine, opens the blood vessels and causes skin redness and swollen membranes
When this occurs in the nose, sneezing and congestion are the result

Seasonal allergic rhinitis or hay fever occurs in late summer or spring
Hypersensitivity to ragweed, not hay, is the primary cause of seasonal allergic rhinitis in 75% who suffer from this seasonal disorder
People with sensitivity to tree pollen have symptoms in late Spring and an allergic reaction to mould spores occurs in Autumn as a consequence of falling leaves

Perennial allergic rhinitis occurs year-round and can result from sensitivity to pet hair, mould on wallpaper, houseplants, carpeting, and upholstery
Some studies suggest that air pollution such as automobile engine emissions can aggravate allergic rhinitis
Although bacteria is not the cause of allergic rhinitis, one medical study found a significant number of the bacteria Staphylococcus aureus in the nasal passages of patients with year-round allergic rhinitis, concluding that the allergic condition may lead to higher bacterial levels, thereby creating a condition that worsens the allergies
Patients who suffer from recurring bouts of allergic rhinitis should observe their symptoms on a continuous basis
If facial pain or a greenish-yellow nasal discharge occurs, a qualified ear, nose, and throat specialist can provide appropriate sinusitis treatment

Non-allergic rhinitis does not depend on the presence of IgE and is not due to an allergic reaction
The symptoms can be triggered by cigarette smoke and other pollutants as well as strong odours, alcoholic beverages, and cold
Other causes may include blockages in the nose, a deviated septum, infections, and over-use of medications such as decongestants

Recent studies by otolaryngologist–head and neck surgeons have better defined the association between rhinitis and sinusitis
They have concluded that sinusitis is often preceded by rhinitis and rarely occurs without concurrent rhinitis
The symptoms, nasal obstruction/discharge and loss of smell, occur in both disorders
Most importantly CT scan findings have established that the mucosal linings of the nose and sinuses are simultaneously involved in the common cold (previously, thought to affect only the nasal passages)
Otolaryngologists, acknowledging the inter-relationship between the nasal and sinus passages, now refer to sinusitis as rhinosinusitis
The connection between rhinitis and sinusitis is thought to involve nose and sinus blockage, followed by bacterial colonization and infection leading to acute, recurrent, or chronic sinusitis
Chronic inflammation due to allergies can lead to obstruction and subsequent sinusitis
Other medical research has supported the close relationship between allergic rhinitis and sinusitis – a review of patients of all ages who had surgery to treat their chronic sinus conditions revealed that those with seasonal allergy and nasal polyps are more likely to experience a recurrence of their sinusitis

Nasal polyps are sac-like growths of inflamed tissue lining the nose (nasal mucosa) or sinuses
Nasal polyps typically start near the ethmoid sinuses (located at the top of the inside of the nose) and grow into the open areas
Large polyps can block the sinuses or nasal airway
People with the following conditions are more likely to also have nasal polyps:
- Aspirin sensitivity (wheezing)
- Asthma
- Chronic sinus infections
- Cystic fibrosis
- Hay fever (allergic rhinitis)

Medications help relieve symptoms but rarely cure nasal polyps
Nasal steroid sprays may help with nasal blockage or runny nose, but symptoms usually return once treatment is stopped
Corticosteroid tablets may also improve symptoms
Antibiotics should only be taken if there is a bacterial sinus infection
When medical treatment is unsuccessful then surgery, such as endoscopic sinus surgery (ESS) is usually required to remove the nasal polyps and clear the nasal passages

ENT – head and neck surgeons can provide a complete evaluation and treatment options regarding nose and sinus conditions
An otolaryngologist can receive up to 15 years of university and post-graduate training in plastic surgery, concentrating on ear, nose and throat procedures
Because they study the complex anatomy, physiology, and pathology of the entire head and neck, ENT specialists are uniquely qualified to manage allergic rhinitis, sinusitis and nasal polyps and perform procedures on the nose and sinuses