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Nasal and Sinus Congestion Treatment, Medication and Surgery

Rhinitis is the inflammation of the nasal passages while sinusitis is the inflammation of the paranasal sinuses, the hollow air-filled cavities in the skull that drain into the nasal cavity. Both rhinitis and sinusitis are often related since these structures have a similar type of mucosal epithelial lining and communicate with each other. Pathology in one part can therefore extend and involve the other. The treatments for both rhinitis and sinusitis, although largely depending on the cause, are similar. Congestion caused by swelling of the epithelial lining coupled with excessive mucus production is the hallmark of both rhinitis and sinusitis. In rhinitis this is usually isolated to nasal congestion, whereas in sinusitis the congestion of the sinuses also extends to the nasal cavity and passages.

Treatment for Rhinitis and Sinusitis

Both rhinitis and sinusitis may be due to a host of factors with the most common being allergic and infectious. Other causes are less common. Most infectious causes are due to viruses and bacteria and are more likely to occur in a person with allergic rhinitis or sinusitis.

Nasal Sprays

Nasal sprays, either unmedicated or medicated, are often among the first step in treatment. Unmedicated nasal sprays are mainly composed of saline, which simply is a water and salt solution, that is specially prepared for rinsing and moisturing the nasal cavity and sinuses. This is useful in both acute and chronic cases, although it may at times prove to be a short-term irritant to the passages. Neti pots are sometimes used to deliver the solution into the nasal and sinus passages in daily washouts.

Medicated nasal sprays are largely decongestants and corticosteroids. While decongestant sprays are useful in severe congestion particularly in acute cases, it should not be used long term without appropriate supervision. It is also available in oral form. Corticosteroid nasal sprays are only utilized in severe chronic cases that are largely unresponsive to other forms of treatment. It may also be useful in very severe acute cases and can also be administered orally. Long term use needs to be carefully monitored.

Antihistamines

Antihistamines are of greatest benefit in allergic cases but since it offers short term relief across the board, it is also used temporarily in acute infectious causes. These drugs, available in oral and nasal spray form, block the biochemical pathway that is associated with increased sensitivity of the lining and subsequently excessive mucus production. Ideally it should only be used for the short term during acute attacks but certain types are prescribed for the long term in chronic cases.

Pain Relievers

Severe congestion, particularly sinus congestion, causes facial pain and headaches. During the treatment period, pain relievers may be prescribed to manage the pain until the inflammation subsides and the excess mucus drains.

Antibiotics

Although most acute infectious cases are viral in origin and will resolve spontaneously, it may be followed by a secondary bacterial infection. Patients with chronic sinusitis and rhinitis are more prone to infections, both viral and bacterial. Antibiotics are essential to treat a bacterial infection. While in acute cases, particularly in a person without a chronic history, the infection may pass on its own or with minimal help from a nasal spray, antibiotics are often necessary to stop the infection and prevent it from infiltrating deeper lying tissue.

Surgery

Surgery is usually not necessary for rhinitis, whether acute or chronic, and acute sinusitis. However, with chronic sinusitis, particularly cases that do not respond to chronic management, surgery may be necessary. This should never be considered in haste until other non-invasive measures have been tried. A sinus washout was, and still is in many regions, the more commonly utilized procedure to ‘clean’ out the sinuses. It may have to be repeated many times in the life of a chronic sinusitis patient. A newer procedure known as functional endoscopic sinus surgery (FESS) is now the preferred procedure as it offers long term, or even permanent results. Chronic sinusitis may then be easier to manage after a FESS or even resolve almost completely without requiring any further therapy.


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