Sinus Problems

• Do you suffer from sinus symptoms (blocked nose, congestion, facial pressure/ pains, headaches, nasal discharge, post-nasal drip, reduced sense of smell)?
• Are sinus problems affecting your work, family and social life?
• When you catch a cold/ flu are you unwell for weeks afterwards?
• Would you like to be free of sinus problems?

Read this page to find out how your sinus problems may be fixed

What causes sinus problems?

Sinus problems that last for 3 or more months are usually caused by a condition known as "Chronic Rhino-Sinusitis"

What else can cause sinus problems?

Although Chronic Rhino-Sinusitis is the commonest cause of sinus problems, there are many other less-common causes of sinus problems. These include:

• Acute Sinusitis (Infections lasting less than 3 months)
• Allergic rhinitis (Allergy/ Hayfever)
• Non-allergic rhinitis
• Auto-immune disorders/ blood disorders (rare)
• Tumours/ cancers (rare)
• Problems due to structures near the sinuses (eye, brain, mouth, adenoids, etc)
• Other rare causes (birth defects, objects stuck in the nose, etc)

What is Chronic Rhino-Sinusitis?

Chronic rhino-sinusitis is defined as follows:

• A condition lasting at least 3 months or more
• With at least 2 of the following symptoms:
  • Blockage of the nose (obstruction/ congestion)
  • Discharge from the nose
  • Facial pains/ pressure
  • Post-nasal drip
  • Reduced sense of smell

Chronic rhino-sinusitis is very common. It affects up to 15% of the Australian population (3 in every 20 people)

What causes Chronic Rhino-Sinusitis?

Chronic rhino-sinusitis is due to one or more of a number of conditions. Possible causes and triggers include:

• Anatomical problems:
  • Deviated septum
  • Narrow sinus openings
  • Enlarged Inferior turbinates
  • Polyps in the nose (Nasal polyps)
• Allergic Rhinitis (hayfever/ allergy)
• Infection
• Disorders of the lining of the nose and sinuses (Eosinophilic chronic rhino-sinusitis/ "Type 2" or "non-Type 2")
• Fungus/ Mould
• Pollutants in the atmosphere, at home or in the workplace
• Smoking
• Rare conditions (Cystic fibrosis, Sarcoidosis, Wegener's granulomatosis, etc)

How can I find out what is causing my sinus problems?

Always see your GP first. Your GP will look inside your nose and may order some tests or prescribe some medications. If your GP cannot fix your sinus problems, he or she will give you a referral to see Dr Singh.

What tests can my GP order?

Some tests that your GP may order include:

• CT scan - This can show the anatomy of your sinuses
• Skin prick tests - These can show if you have allergy (Allergic Rhinitis)
• Blood tests (Allergen-specific IgE/ RAST/ ImmunoCAP) - These can show if you have allergy (Allergic Rhinitis). Blood tests are not as accurate as skin prick tests but are easier to perform.

What if my GP can't find the cause of my sinus problems?

Ask your GP for a referral to see Dr Singh.

What treatments can my GP prescribe?

Some treatments that your GP may prescribe include:

• Nasal saline rinse - This washes out the inside of the nose and sinuses
• Nasal steroid sprays - These shrink the lining of the nose and sinuses. They are most useful in patients with allergy (Allergic rhinitis)
• Antihistamine tablets/ sprays - These can be useful in patients with allergy (Allergic rhinitis)
• Antibiotics - These can treat infection. In addition, certain antibiotics have special anti-inflammatory properties if taken for a long time at a low dose.
• Other tablets - Other strong medications are available that can help relieve sinus problems. However, they must be used with caution as they have potentially very serious side-effects. Talk to your GP or ask for a referral to see Dr Singh.

What if the treatment from my GP doesn't work?

Ask your GP for a referral to see Dr Singh.

How can Dr Singh find out what is causing my sinus problems?

Dr Singh is a nose and sinus specialist. Dr Singh uses special tests to find out exactly what is causing your sinus problems.

What tests can Dr Singh perform?

Dr Singh will examine your sinuses and nose using special instruments.

Dr Singh will pass a super-fine camera into your nose to look at the sinus openings, septum and turbinates (the nose is made numb first using a special numbing spray). You can watch the camera on a TV monitor and see the anatomy for yourself.

Dr Singh's in-house nurse can perform special tests to accurately measure the flow of air through your nose (Rhinomanometry and Acoustic Rhinometry) along with tests to see if you have allergy (Skin prick tests).

What other tests can be ordered?

The complete range of tests that Dr Singh or your GP may order include:

• CT scan - This can show the anatomy of your sinuses and nose. Unfortunately, many radiologist (Xray doctor) reports do not accurately describe the condition of the sinuses. The most accurate test is to have Dr Singh review your actual scans (not just the report) and examine the sinuses with a special camera.
• Skin prick tests - These can show if you have allergy (Allergic Rhinitis).
• Blood tests (Allergen-specific IgE/ RAST/ ImmunoCAP) - These can show if you have allergy (Allergic Rhinitis). Blood tests are not as accurate as skin prick tests but are easier to perform.
• Rhinomanometry and Acoustic Rhinometry - These scientifically measure the airflow through your nose.

Our office is unique as all of these tests can be performed on-site, in one appointment.

Despite all the tests and high-technology available, the single most accurate tool is your doctor’s skill, knowledge and experience!

Can my sinus problems be treated?

Yes.

In most people with sinus problems, the cause can be found and treated.

How are sinus problems treated?

The treatment used will depend on the cause.

Anatomical problems can be fixed with surgery. You will be asleep during the procedure (general anaesthetic). Please follow the links to find out more about each procedure:

• Narrow sinus openings: These are fixed with a FESS (Functional Endoscopic Sinus Surgery) operation
• Deviated septum: This is fixed with a Septoplasty operation
• Large Inferior Turbinates: These are fixed with a Turbinoplasty operation
• Nasal polyps: These are fixed with a Polypectomy operation

Are there any alternative treatments to surgery?

Yes. There are always options and it is always your choice as to whether to have surgery. In general, you can try other options first and choose surgery if nothing else works. Non-surgical options include:

1. Do Nothing. If your problem is not severe, you may choose not to have any treatment at all.
2. Simple treatments (Saline rinse). Try rinsing the nose 2-4 times a day with salty water from your pharmacy.
3. Medications. Try Nasal steroid sprays and antihistamine tablets/ sprays from your pharmacy or from your GP. They work best for people with allergy but may sometimes help people without allergy.
4. Strong Medications. These tablets require a prescription and can only be ordered by your GP or Dr Singh.

We recommend that you see your GP first and consider trying these non-surgical options. Then see Dr Singh when you are ready for surgery. There is a long waiting list to see Dr Singh and it is best if you see Dr Singh for surgery after the non-surgical treatments have failed. In general, Dr Singh will recommend a trial of strong medications for around 4-6 weeks. If, after 6 weeks, your symptoms are not controlled, surgery may be recommended, depending on Dr Singh's assessment.

• It is always your choice as to what treatment you would like to have.
• Some patients prefer to go straight to surgery as they have tried many medications already.
• Some patients prefer not to have surgery at all.
• The treatment you have will depend on your individual circumstances, Dr Singh's recommendation and your personal choice.

Are there any risks to surgery?

Yes. Everything we do in life has risks. Even something as simple as crossing the street has risks... but we still cross the street. Dr Singh will explain the risks of your operation and provide you with an information pamphlet that explains the risks in detail. If you have any questions about risks, ask Dr Singh during your consultation.

How are other causes treated?

The treatment used will depend on the cause. Please follow the links to find out more about each condition:

• Allergic rhinitis (Allergy/ Hayfever)
• Non-allergic rhinitis
• Acute Sinusitis
• Auto-immune disorders/ blood disorders (rare)
• Tumours/ cancers (rare)
• Problems due to structures near the sinuses (eye, brain, mouth, adenoids, etc)
• Other rare causes (birth defects, objects stuck in the nose)

What should I do next?

See your GP. If your GP is unable to fix your sinus problems, ask your GP for a referral to see Dr Singh

I have already seen a doctor - I was told nothing could be done for my sinus problems. What should I do?

Most people with sinus problems can be treated or improved. Dr Singh is a nose and sinus specialist and has expertise in difficult and complex cases.

Consider asking your GP for a referral to see Dr Singh.

I have already seen a surgeon and had an operation on my sinuses. It didn't work! What should I do?

Even patients who have undergone previous surgery can often be treated or improved.

Dr Singh is a nose and sinus specialist and has expertise in performing revision sinus surgery.

Dr Singh uses the most advanced and modern computer surgical navigation system available (Medtronic Fusion Electromagnetic at Lakeview Private and Westmead Private Hospitals) to perform revision sinus surgery with the utmost precision and safety.

We recommend that you return to see your original surgeon first. If nothing further can be done and you still have symptoms, consider asking your original surgeon or your GP for a referral to see Dr Singh. Dr Singh always works together with your GP and your other specialists to achieve your best health outcome.