Welcome to London ENT, your trusted provider of expert care for sinus-related issues. If you are struggling with sinusitis, our dedicated team, including leading sinus specialists in London, is here to offer comprehensive diagnosis and treatment options. Our goal is to help you breathe easier and improve your quality of life. Whether you are experiencing acute or chronic sinusitis, we have the expertise and advanced treatments to address your needs effectively. Explore our services to understand how we can support your journey to better sinus health.
What are the sinuses?
The sinuses are a set of air-filled spaces located within the bones of the face and skull. There are four pairs of sinuses, each playing a role that is still not entirely understood. Theories suggest that sinuses help control the temperature and humidity of air reaching the lungs, modify the tonal quality of voice production, and lighten the weight of the skull.
At birth, sinuses are tiny or nonexistent, gradually expanding throughout childhood and into young adulthood. Eventually, they become air-filled cavities lined with the same type of lining as the nose. Air enters the sinuses through small openings into the nose.
What do the sinuses do?
When functioning normally, the nose and sinuses produce about a pint and a half of mucus daily. This mucus traps irritant particles such as dust, pollen, bacteria, and other pollutants, which are then swept towards the back of the nose and throat by tiny hair-like structures called cilia. The mucus moves into the throat and is swallowed, a process that most people do not notice because it occurs gradually and continuously throughout the day.
Types of sinus infection:
The sinuses can get infected from time to time. Sinus infection occurs in two types:
- Acute sinusitis gives rise to severe symptoms but is usually short-lived. Acute sinusitis usually occurs following a cold or upper respiratory infection. The patient will typically notice a profuse green-yellow nasal discharge which can last a week or more after the onset of the cold. This is often associated with severe pain around the cheeks, eyes and/or forehead, a blocked nose, as well as an occasional swelling and a high fever.
- Chronic sinusitis is a form of sinusitis that continues for many weeks, usually in excess of 12 weeks. Chronic sinusitis may be triggered by an acute sinus infection which fails to resolve or as a result of an underlying allergy affecting the lining of the nose and sinuses. As the nose is almost always involved in the problem, the term chronic rhinosinusitis is now used as it more accurately describes the inflammatory and infective process than chronic sinusitis. Common symptoms include nasal obstruction, headache, nasal discharge, low grade fever, reduced sense of smell, facial pain, lethargy and halitosis.
What causes sinusitis?
Acute or chronic rhinosinusitis occurs when the sinus openings into the nose become blocked. These blockages may be caused by infections, irritants, allergies, structural abnormalities or a combination of these. It is worth mentioning that pain in the face may well be due to other causes such as tension headache, migraine, neuralgia and jaw dysfunction. This means that if facial pain is the main symptom, rhinosinusitis is unlikely particularly in the absence of any of the other cardinal symptoms usually associated with this condition.
- Upper respiratory tract Infections (the common cold or ‘flu): Most adults will get colds and upper respiratory tract infections up to three times a year. Children get them more frequently! The common cold is typically caused by a virus although secondary bacterial infections often follow. When this happens, the mucus changes from clear to yellow or green, indicating that the sinus openings are becoming blocked and more and more inflamed and infected. As the infection takes hold, this further slows down or even stops the normal proper sinus drainage and the infection develops even further.
- Irritants: This includes air pollution, diesel fumes, smoke, chemical irritants such as sprays containing pesticides, disinfectants and household detergents. If inhaled in sufficient quantities or in susceptible individuals, these irritants may cause swelling and blockage of the lining of the nose causing a narrowing of the drainage opening from the sinuses. This can once again lead to impairment of sinus drainage and subsequent infection.
- Allergies: The types of allergies that are associated with rhinosinusitis are those that can be inhaled through the nose. The commonest aeroallergens include tree and grass pollen, house dust mite, types of airborne fungi, cat and dog allergens and feathers. If you are allergic to one or more of these allergens, even a tiny quantity inhaled into the nose can cause considerable inflammation of the inner lining of the nose and sinuses. Common symptoms of an allergic reaction include nasal stuffiness, runny nose (which is initially watery and may become thicker later on), sneezing and itchy watery eyes.
- Structural problems: Occasionally structural problems within the nasal cavity can cause a narrowing, for example if there is a deviation of the nasal septum, excessive swelling of the inner nasal lining or the presence of nasal polyps (see separate information sheet). Some of these can be caused as a result of trauma while others may develop during the growth period. Occasionally the structural narrowing can be so severe that mucus builds up behind these areas of blockage giving rise to sinus infections.
Can my asthma get worse if I have rhino-sinusitis?
Chronic rhinosinusitis is sometimes associated with asthma. Allergies are responsible for asthma in some patients and may also cause nasal stuffiness making the asthma more difficult to control. This is because the nose serves an important function of warming, humidifying and filtering the air that we breathe in, meaning that the lungs receive a high consistent quality of air. If the nose is unable to achieve these improvements in air quality, the lungs receive poorer quality, dry air full of irritants and allergens which make the asthma worse.
Interestingly, if the rhinosinusitis and/or allergy are adequately treated with an intranasal steroid spray, there is good evidence that asthma can improve without the need for any inhaled asthma treatments. This further proves the link between inflammation in the nose and sinuses and the presence of asthma.
Diagnosis and treatment of rhinosinusitis
Acute sinusitis is usually treated with antibiotics and nasal decongestants which reduce the swelling of the nasal lining. This may be assisted by steam inhalations and/or salt water douches to cleanse the nose.
Chronic rhinosinusitis often requires longer term treatment. Medical therapies include antibiotics when required, decongestants and other treatments to reduce the swelling of the inner lining which usually revolve around the use of intranasal steroid sprays or drops. Antihistamines will have a place in patients with an underlying allergy. In the vast majority of cases, chronic rhinosinusitis can be managed effectively with medical treatment.
Occasionally, symptoms will persist despite the ongoing use of medications. In such cases, it may be necessary to consider surgery. If this occurs, your GP will probably refer you to an ENT specialist like London ENT who will assess your symptoms and examine your nose and sinuses with a nasal endoscope. You may require further investigations including allergy tests and possibly a CT scan of the sinuses, which will help your specialist decide if you need to proceed with surgery.
Sinus surgery
Surgery is normally only considered if medical treatment fails. When surgery is needed, there are a number of different options available depending on the severity of the sinus disease. Nowadays, the vast majority of sinus operations are performed entirely though the nose without the need for any external incisions.
The surgical options include functional endoscopic sinus surgery (FESS), sinus washouts (which are less commonly performed nowadays) and balloon sinuplasty, a non-invasive technique in which the sinus openings are dilated open with a balloon. Please see separate information sheets about these different options.
Sinus FAQs
What is a sinus specialist?
A sinus specialist is an ENT doctor who focuses on diagnosing and treating conditions related to the sinuses.
How can I prevent sinus infections?
Preventive measures include avoiding known allergens, maintaining good nasal hygiene, and managing underlying conditions like allergies and asthma.
What are the signs that I need to see a sinus specialist?
Persistent symptoms such as chronic nasal congestion, facial pain, headaches, and reduced sense of smell despite treatment are indicators to consult a sinus specialist in London.
What should I expect during a sinus consultation?
Your sinus specialist will review your medical history, perform a physical examination, and may use diagnostic tools like nasal endoscopy or imaging studies to assess your condition.
Is sinus surgery safe?
Sinus surgery is generally safe and performed with advanced techniques to minimise risks and improve outcomes.
Contact Us
If you are experiencing symptoms of sinusitis, contact London ENT to schedule a consultation with our sinus specialists. Call us at 0203 865 7225 today.