Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon

Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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Rhinosinusitis and nasal polyps

Nasal polyps are “boggy” swellings of the lining of the sinuses which hang down into the nasal cavity and can cause complete blockage. This can be associated with anosmia, loss of sense of smell and significant rhinorrhoea, watering of the nose. Polypi can be associated with infection, allergy and anatomical problems in the nose. They may settle with medical treatment, often topical cortico-steroid drops and sometimes a trial of a short course of oral steroids and if this is not successful than endoscopic sinus surgery may be considered. This is most frequently performed under general anaesthesia and frequently now involves endoscopic sinus surgery after a CT scan of the sinuses to accurately delineate the extent of the polyposis. This improves the diagnosis and also makes the surgery safer by allowing better knowledge of the anatomy of the specific sinuses.

Recurrent acute sinusitis may occur due to obstruction of the drainage pattern of the sinuses. Typically the mucosa of the frontal, ethmoid, maxillary and sphenoid sinuses produces mucus which is actively moved into the nose by cilia, small hair cells lining the paranasal sinuses and nasal cavity. This mucus is then eventually swallowed and an excessive amount of this can give the symptom of heavy catarrh or a post-nasal drip. Particularly if there is blockage in the “osteomeatal complex” then there may be obstruction to drainage from the maxillary, ethmoid and frontal sinuses and endoscopic sinus surgery may be appropriate to improve this symptom. This can manifest as mid-facial pain, nasal blockage and a tendency for recurrent sinusitis. A preliminary CT scan of paranasal sinuses would similarly be necessary to assess the disease and the anatomy of the sinuses.

Facial pain, specifically mid-facial pain and frontal headaches, can occur as a result of sinusitis but there are other problems such as atypical facial pain due to migraine, jaw joint problems, neuralgia and tension and cluster headaches which can produce similar symptoms. A review by an ENT Surgeon, often with a CT scan of the sinuses, can be helpful to accurately diagnose any sinus contribution. Sinusitis can contribute by infection in the sinus cavity after there has been blockage of the drainage area. If there is a viral or bacterial infection, this can cause the mucosa to swell so that the narrow outflow passages, where there mucus should pass from the final drainage area of the sinuses via the osteomeatal complex, into the nose is occluded. Underlying allergies can be pre-disposing factors as, mentioned above, can be structural problems of the very small bones involved in the sinus outflow tract or even in the nasal cavity where significant septal deviation can also block the drainage. Anatomical factors in the lateral wall of the nose involving the middle turbinates can also contribute to a blockage and secondary sinus infection. Airborne pollution and irritants may also have an affect on the mucosa and compromise drainage. Individual attacks of sinusitis, if uncomplicated, will generally settle with combinations of antibiotic treatment and decongestants, but if there is a recurrent problem, there is a role for endoscopic sinus surgery as mentioned above and discussed in more detail more below.


© Vincent Cumberworth 2005