Rhinosinusitis and Nasal Polyps

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 essentially swellings of the lining of the sinuses which prolapse into the nasal cavity and cause nasal 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 – obstruction of sinus drainage pathways can produce facial pain.  They may settle with medical treatment: often topical cortico-steroid drops and sometimes a trial of a short course of oral steroids.   If this is not successful endoscopic sinus surgery may be considered.  This is almost always performed under general anaesthesia and after a CT scan of the sinuses. A preliminary CT scan of paranasal sinuses indicates the extent of disease and the anatomy of the sinuses, increasing the success and safety of surgery.

Recurrent acute sinusitis may occur due to obstruction of the drainage pattern of the sinuses.  Typically the mucosae 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” 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.

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 diagnostic out-patient endoscopy and 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 viral or bacterial infection the mucosae can 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 becomes occluded.  Predisposing factors can include underlying allergies and structural problems of the very small bones involved in the sinus outflow tract or 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 with recurrent problems there may be a role for endoscopic sinus surgery.