Rhinosinusitis: why it is different from rhinitis and how it is treated

Runny or stuffy nose, cough, headache, changes in the perception of odors, pain in the face, feeling of plugged ears. These are the most common symptoms of rhinosinusitis, an inflammatory condition that affects the mucous membrane of the nose and paranasal sinuses: “Patients often do confusion between rhinitis and rhinosinusitiswhich indicate instead two different conditions», Comments the doctor Fulvio Di Fulvio, otolaryngologist. “There rhinitis it is an inflammation of the nose, which in most cases is due to the viruses of the common cold, but sometimes it can also be triggered by an allergy. There rhinosinusitisinstead, it is his complication: if the rhinitis does not come

treated or badly treated, it can persist for days or even months, up to involving the paranasal sinuses, that is, those cavities of the cranial bones located above and below the eyes, between the eyes themselves and behind the nose ».

What is rhinosinusitis

This inflammation can be acute (when resolved within 30 days) or chronic (if it persists beyond three months). «In the middle, that is, between 30 and 90 days, there is rhinosinusitis subacute, although in most cases the other two cases prevail. While the acute one is much easier to diagnose, a chronic condition is decidedly complex to frame, because the symptoms can be blurred », warns the expert. For this reason, it is vital to seek medical attention when nasal congestion, cough or headache do not go away after 7-10 days.

As in any pathology, there is a predisposition: «More susceptible to rhinosinusitis are allergic subjects and those with some anatomical alterations in the nose, such as deviation of the nasal septum or concha bullosa, a sort of “swelling” of the middle turbinate that causes mechanical obstruction. They also predispose to the problem a weakness of the so-called muco-ciliary clearance, that complex system of “cilia” that covers the respiratory system and allows the mucus, containing viruses, bacteria and foreign particles, to move towards the mouth and subsequently be swallowed and digested: this condition of fragility is present in some hereditary pathologies, but it is also favored by tobacco smoke. Other predisposing factors for sinusitis are impaired immune system due, for example, to diabetes, cancer or debilitating treatments.

What are the symptoms of rhinosinusitis

«In the acute phase, rhinosinusitis is typically accompanied by a more or less intense headache. Depending on the location, the pain can be concentrated above, below or behind the eyes, sometimes accentuating with some movements of the body: for example, by lowering the head, the mucus or pus present in the paranasal sinuses descend downwards due to the force of gravity and make their weight “felt” », reports Dr. Di Fulvio.

Another a common symptom is nasal discharge, more or less abundant, often not felt by the patient: the drip, in fact, can take place directly in the pharynx (retro-nasal discharge), so the patient does not have a runny nose, but feels something going down the back of the throat, feeling the need to free it and therefore to swallow more than usual, or has a productive cough, especially upon awakening. “In the most serious cases, however, the secretion moves to the anterior area, so the nose begins to run and produces a transparent mucus or, more often, a greenish-yellow”. It can then be associated with a decrease (hyposmia) or even a zeroing (anosmia) of the sense of smell, for which there may be difficulty in perceiving odors or a total inability to grasp them or, perhaps, odors can be perceived but altered (dysosmia) . “When the sense of taste is also involved, however, this generally decreases but does not completely disappear”, specifies the expert.

How do you know you have rhinosinusitis

Given the symptoms, which can unite many other ENT conditions, it is important that a doctor makes the diagnosis. «First of all we need a thorough physical examination, during which the otorine exerts various pressures on the face to understand in which areas the pain is located, and a careful medical history to collect the patient’s clinical history and all useful information on the symptoms. This helps to understand if it really is rhinosinusitis or a simple rhinitis, but also if the picture is acute or chronic », explains Dr. Di Fulvio.

Sometimes it may be necessary to perform anasal endoscopy, a minimally invasive and painless examination in which a small optical fiber is introduced into the nose to observe the presence of anatomical changes or the presence of polyps. “Only in rare cases, when the other examinations leave a margin of uncertainty, is it necessary to subject the patient to a CT scan of the facial mass, which becomes mandatory instead in the case of polyposis, in order to be able to surgically intervene in a precise and targeted manner, as well as than in total safety “.

How to cure and how to get rid of mucus

In the first week, among the useful natural remedies there are nasal washes with a physiological or hypertonic solution, which help to clean the nasal cavities, especially if combined with local vasoconstrictors. But also the classic fumigations (with sulphurous thermal water or with menthol and eucalyptus preparations) are very valid.

What drugs are effective

Always in the acute phase, rhinosinusitis can be treated with local vasoconstrictorsthe classics decongestants sold in pharmacies to “free” from the feeling of stuffy nose, which must however be used for limited periods (4-5 days maximum) so as not to pave the way for chronic and potentially disabling rhinitis.

“If that’s not enough, it may be necessary to use antibiotics or steroids, by inhalation or to be taken systemically. In this way, in about three weeks, it is possible to solve at least 95 percent of acute situations », assures the expert. “The important thing is to intervene promptly, because rhinosinusitis can evolve, become chronic and result in one of the most frequent complications in adults, namely nasal polyposis, a pathology characterized by the presence of mucosal extroversions that obstruct the paranasal sinuses and nostrils »Concludes Dr. Di Fulvio. “Better to prevent, as our grandmothers always recommended.”

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