Nose and Sinus Disorders Overview

Nose and sinus troubles drive more than 20 million outpatient visits a year in the US, researchers report. The bulk of those visits are for nasal congestion and a range of sinus problems, including pain, pressure, inflammation, and infection. Other common complaints include things like nosebleeds, hay fever, and nasal sores.

While treatment depends on the condition and its severity, many nose and sinus issues can be managed by a primary-care provider. Some situations, of course, call for specialty care from an ear, nose, and throat (ENT)-otolaryngologist, allergist, or pulmonologist.

What Is It?

Your nose and sinuses are designed to defend against germs and other irritants that can lead to inflammation or infection. But things can south when the mucous membranes lining those structures become inflamed or infected. Or when your nasal passages dry out and the delicate blood vessels within the nose burst and bleed. Or when noncancerous growths appear on the tissue lining the nose or sinuses. In short, there are lots of reasons why you might be experiencing a nose or sinus problem.

Here's how these parts of the upper respiratory system work:

• The nose consists of two passages separated by a strip of bone and cartilage called the septum. Behind the nose sits an empty chamber (aka the nasal cavity) through which air flows. It's lined with mucus-secreting membranes that warm and humidify the air you breathe. The nose also filters out particles that might otherwise travel to the lungs.
• The sinuses, or hollow spaces within the face and skull, make the mucus that keeps the nose moist and traps viruses, bacteria, and other small particles before they make their way to your lungs.

Types

Nose and sinus problems can be categorized in different ways. You might group these ailments by the structures impacted or their symptoms. For example, one of the most common problems is sinusitis, meaning inflammation of the nasal passages and sinuses.

Another way to describe nose and sinus conditions is by their duration. Some issues are short-lived (or "acute"), such as a case of sinusitis that can develop after you catch a cold. Others conditions are ongoing (or "chronic") and still others are somewhere in between (aka "subacute").

Common nose and sinus conditions include:

• Sinusitis (or what doctors call rhinosinusitis). It is defined as inflammation of the sinuses. Acute sinusitis, often the result of a cold, typically lasts 10-or-so days. Chronic sinusitis may be diagnosed when symptoms persist 12 weeks or longer.
• Nosebleeds. (The medical term is epistaxis.)
• Deviated septum, meaning the bone and cartilage separating each side of the nasal cavity is off-center.
• Nasal polyps, or soft growths of tissue, in the nasal passages or sinuses.

Symptoms

Sinusitis

This can cause all kinds of issues, such as:

• Nasal inflammation
• Thick, discolored discharge dripping from the nose
• Drainage down the back of the throat (or postnasal drip)
• Congested nose
• Pain, tenderness, and swelling around your eyes, cheeks, nose, or forehead

Nosebleeds

Usually, the only sign of nosebleed is when the bleeding occurs.

• Bleeding from one or both nostrils. This is a sign is an anterior nosebleed, the most common type. It's not typically serious and is most common in children.
• Bleeding in the back of the nose and down the throat. A posterior nosebleed begins in large blood vessels in the back of the nose, near the throat. It can be more serious and may require medical attention right away if the bleeding does not let up. It's also more common in adults than in children.

Deviated septum

A septum that's off center can lead to a number of symptoms. They include:

• Trouble breathing through one or both nostrils.
• Snoring, noisy breathing, or mouth breathing
• Nosebleeds
• Sinus infections

Nasal polyps

Whether or not you experience symptoms may depend on their size. Small polyps may produce a wide range of symptoms, including:

• Stuffy or runny nose
• Postnasal drip
• Sinus pressure
• Snoring

Larger polyps may lead to asthma attacks, sinus infections, sleep apena, or trouble breathing.

Causes

Here's why you may be having nose and sinus issues:

Sinusitis

When your sinuses are inflamed, viruses are usually to blame. If you've just recovered from a cold, sometimes that can lead to a sinus infection. But bacteria and fungi can also cause sinus swelling.

Other risk factors for sinusitis include:

• Seasonal allergies
• A weak immune system
• Structural abnormalities within the nose, such as a deviated septum or nasal polyps
• Smoking or exposure to secondhand smoke

Nosebleeds

Bloody noses can be caused by:

• Dry air
• Nose picking
• Injury or trauma
• Blood thinning medications, such as aspirin
• Deviated septum
• Nasal polyps
• Sinusitis
• Common cold

Deviated septum

Some people are born with a deviated septum; others develop it over time. It can also be the result of an injury.

Nasal polyps

While the exact cause isn't clear, anything that irritates or inflames the nasal cavity can encourage these painless growths. People with asthma, hay fever, chronic sinusitis, or repeated sinus infections tend to develop polyps.

Diagnosis

Doctors may firm up a nose or sinus diagnosis, and rule out other conditions, based on symptoms, patient history, physical exam, imaging, and/or other testing. The exact process varies by condition and symptom severity.

If nasal polyps are suspected, for example, your doctor may insert a flexible tube with a camera on the end (called an endoscope) to see inside your nose. In some cases, a small piece of tissue may be removed for analysis.

If your face is tender (and maybe even super painful), your doctor may take a sample from your nose, do a scan, or endoscopy. If your doctor suspects that the cause of all of the inflammation is hay fever or allergies, an allergy test to diagnose that may be performed too.

Treatment

There's no single solution for nose and sinus conditions. Again, it really depends on your diagnosis and the severity of symptoms. Some ailments require little more than self-care. Others may require medication or surgery.

Sinusitis

Antibiotics are not typically used to treat acute sinusitis because it's usually caused by a virus, and antibiotics only treat infections caused by bacteria. Some things you can do for relief:

• Take decongestants, this can help reduce some of the sniffling, stuffy nose symptoms, but be careful. Taking decongestants for me than a few days can cause something called "rebound congestion." This can make matters worse.
• To relieve the pain and tenderness typically associated with sinusitis, taking over-the-counter pain relievers like acetaminophen or ibuprofen may help.
• If it turns out that allergies are causing the sinusitis, your doctor may prescribe allergy medication.

The advice for chronic sinusitius depends on the underlying cause, symptoms, and other factors. Corticosteroids (in nasal spray, pill, or injectable form) may alleviate swelling. Allergy medicines may help people whose allegies are the culprit. Likewise, antifungal medicines may help people whose symptoms are the result of a fungal infection. When medication alone fails to provide relief, sinus surgery may be necessary.

Nosebleeds

Most nosebleeds are not serious and can be stopped simply by applying pressure to the nostrils for five to 10 minutes—or longer if bleeding continues. See a doctor if bleeding lasts more than 20 minutes. More serious bleeds may be treated by inserting gauze or an inflatable balloon to put pressure on the bleeding vessel or performing a procedure to seal off the vessel.

Deviated septum

As a first step, people bothered by breathing difficulties, recurrent infections, or other symptoms caused by a deviated septum may be prescribed decongestants, antihistamines, or nasal sprays to open up their nasal passages. But if those medicines don't provide relief, surgery may be an option.

Nasal polyps

Treatment begins with less invasive measures, like corticosteroid sprays to shrink these growths. If that doesn't work, your doctor may recommend surgery to remove your polyps.

Prevention

You can't always prevent nose and sinus conditions. But there are steps you can take that may reduce your risk:

• Manage underlying conditions, such as asthma and allergies
• Practice good hand hygiene
• Use a humidifier to keep the air in your home moist
• Irrigate your nasal passages with a saline solution
• Stop smoking
• Stay hydrated