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The nose has a crucial function in our health. It helps to warm, humidify, and filter the air we breath and also has a primary role of filtering the air we breath before it reaches the lungs. Mucous is an important part of the filter function of the nose. The problem occurs when too much mucous is produced and the nose runs. This can occur for a variety of reasons. The most common is a viral upper respiratory tract infection which will usually improve within 7-10 days. The secretions with a URI can be white, clear, yellow or green. More important is the time period that it occurs. Copious drainage from the nose that last longer than 10 days should be evaluated by a physician. Copious drainage that last longer than 10 days could indicate a sinus infection which requires antibiotics.
Another common cause of constant nasal discharge is allergies. The discharge from the nose with allergies is usually clear to white in color and may be associated with other symptoms such as sneezing, itchy eyes and cough. This can be treated with allergy medication to improve these symptoms. We can also do testing to investigate what may be causing allergies.
In children chronic nasal obstruction and discharge may be secondary to enlarged adenoids. Adenoids are the lymph tissue (like tonsils) which sit in the back of the nose. Adenoids are normal tissue but can swell in response to colds, allergies or recurrent infections. Symptoms of enlarged adenoids are mouth breathing, snoring and drooling in young children. Enlarged adenoids are common in children but rare in adults as they usually shrink and disappear by 15 years of age. We can evaluate children for adenoid enlargement in our office by using a special camera to view the back of the nose. An x-ray can also be performed to evaluate for adenoid enlargement.
The sinuses are a number of air filled spaces in the bones of the face that surround and drain into the inside of the nose. At birth these sinuses are very small. They continue to enlarge throughout childhood, and are not fully developed until late adolescence. No one knows what the purpose of the sinuses is, but they may help to make the head lighter (by replacing bone with air), improve the resonance of the voice, or provide a larger surface area for the lining of the nose to help with cleaning, warming and humidifying the air we breath.
There are four paired sets of sinuses. The maxillary sinuses are large spaces located behind the cheek between the upper teeth and the eyes. The ethmoid sinuses are a series of small cavities between the eyes. The maxillary and ethmoid sinuses are present at birth (but fairly small) and enlarge as the child grows. The sphenoid sinuses are deep inside the head, at the back of the nose. The frontal sinuses are in the forehead, and do not develop until the child is older.
Blockage of the nose can occur from several causes. The lining of the nose may become swollen due to recurrent viral or bacterial infections. There may also be anatomical reasons which make it difficult for an individual to breath through their nose. A deviated septum is not commonly seen in children and is more frequently the cause of one sided nasal blockage in adults . Other causes of nasal obstruction are nasal polyps. These are more commonly seen in adults and can be associated with significant allergies. An examination of the nose with a special camera is performed in our office to evaluate for nasal polyps and septal deviation. In children, evaluation of the adenoids is necessary to rule out adenoid enlargement as the cause for nasal blockage.
Sinusitis refers to an infection in the nose. Sinusitis means a bacterial infection and in most cases requires antibiotics. The symptoms of sinusitis are discolored nasal drainage that lasts for over 10 days and is not improving. Other symptoms include headache, cough, worsening of asthma, facial pain or pressure and in some cases pain behind the eyes.
An allergy is a condition in which the body responds to some foreign substance such as pollen or certain foods. The substance causing the allergic reaction is called an allergen. The reaction can be mild, for example, a stuffy nose or severe and life threatening, such as difficulty breathing. In nasal allergy, the nose responds to an inhaled allergen by increasing the normal output of mucus and by swelling internally. This results in a sensation of nasal obstruction and nasal drainage, similar to sinusitis. The symptoms of nasal allergies are different from sinusitis in that they may start suddenly after exposure to the allergen, the drainage is usually thin and clear, and there is generally no severe facial pain. Furthermore, people with allergies often have other symptoms such as watery eyes, itching, and sneezing.
The diagnosis of sinusitis is usually made on clinical grounds i.e. by performing a history and physical examination. The duration of the symptoms as well as the appearance of the lining of the nose are all indications of a bacterial infection of the nose. Sinus x-rays are in most cases not helpful and expose adults and children to a higher than acceptable level of radiation. ACAT Scan ( a computerized x-ray) may sometimes be suggested to better evaluate the severity of sinusitis and to evaluate the drainage pathways of the sinuses. In adults and older children a CAT Scan can be performed without sedation. In very young children who are unable to cooperate with the exam sedation may be recommended.
Sinusitis is most commonly treated with antibiotics. The duration and type of antibiotics used depends on the severity of the infection and how long it has been present. In children the exposure to more resistant bacteria such as those found in day care and school will also help to determine the type of antibiotic used.
If there is significant swelling of the lining of the nose nasal steroids may be prescribed. These are topical medications that are sprayed in the nose and help to decrease swelling and promote drainage. If there is an allergic component suspected as contributing to sinusitis, allergy medication may be recommended. We are careful with the use of allergy medication to assure that there is not over drying of the nose which can lead to thickened secretions and slower drainage of the sinuses.
One very effective and safe treatment for sinusitis is the use of humidification and nasal irrigation. Keeping the lining of the nose moist is important to the body's own natural defenses. Moisture also keeps the nasal secretions from drying out and blocking the natural sinus drainage pathways. Room humidifiers are helpful, but care must be taken to keep them clean, or they can grow colonies of bacteria and/or fungus. Nasal saline spray should also be used frequently.
In the vast majority of cases sinusitis can be controlled with medical therapy. There is a small percentage of patients who require surgery to drain the sinus and to widen the natural sinus drainage passages to help decrease the recurrence of sinus infections . A specialized x-ray called a CAT Scan is usually recommended prior to surgery to better evaluate if there is narrowing of the sinus drainage passages which may be predisposing to sinusitis and if there is evidence of long standing or severe sinus disease. In children and adults sinus surgery is performed under general anesthesia and usually takes 11/2 to 2 hours. Surgery is performed through the nostrils so there are no incisions on the face. The recovery time is 4-5 days and most adults and children may resume a fairly normal schedule though vigorous physical activity and travel ling are not permitted for the first 10 days after surgery. In a recent study I found that the vast majority of patients undergoing sinus surgery were significantly improved though only 33% felt that surgery cured all of their sinus problems.