Rhinitis and sinusitis: what they are and how they are treated

• Rhinitis and sinusitis are often triggered by allergies. They are also closely related, as chronic rhinitis often causes sinusitis.
• Both diseases have pharmacological treatment but the most effective, when we include the chronic factor in one of them, is surgical treatment.
• Surgical intervention to treat rhinitis is based on a radiofrequency operation to reduce the turbinates.

Rhinitis directly affects the nasal cavities. These nostrils are two cavities separated by the sagittal septum and located above our mouth. 

This structure has numerous functions, including: it is responsible for filtering the air we breathe and regulating the flow of air on inspiration in order to control humidity and temperature.

It also collects impure particles found in the air by means of cilia and mucus, helps us with voice phonation as it acts as a sounding board, and also has the capacity to perceive and differentiate odours and to warm the air so that it does not reach the lungs cold. 

These cavities are lined with a mucous membrane which, when inflamed for whatever reason, is known as rhinitis. This disease can be acute or chronic and, when we talk about chronic rhinitis, it can cause sinusitis.

Sinusitis affects the paranasal sinuses. When we are born there are only the two ethmoid sinuses, at the age of 20 the frontal sinuses develop, the maxillary sinuses appear with the wisdom teeth and the sphenoid sinuses are the ones that take the longest to appear. The paranasal sinuses and the paranasal fossae are connected.

The sinuses are four pairs of nasal cavities that lie between the facial bones and the head. The function of the sinuses is to drain the mucous fluid inside them, to distribute the air circulating in the airways and to lubricate the nose to keep it free of particles and bacteria. 

Thus, when the mucous tissue lining the sinuses becomes inflamed due to a blockage of the nasal passages, sinusitis generally occurs.

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Rhinitis and sinusitis are inflammations caused mainly by allergies, among others. They are diseases that affect the nasal and sinus structures. The first of these, rhinitis, affects the nose, the nasal passages and their mucosa. In the case of sinusitis, it is the sinuses that are affected by the disease.

In both cases, however, there is irritation, an inflammation process, and it can have various causes and symptoms. Sinusitis can be caused by a cold, it can be fungal, i.e. it can be caused by a fungus, nasal polyps or the contraction of rhinitis. In this way, rhinitis and sinusitis are closely linked, as the former is usually caused by the latter when it is chronic.

Although rhinitis and sinusitis tend to be more common in winter due to the low humidity, the low air temperature and contact with dust mites affect our breathing. However, it should be borne in mind that these problems can occur throughout the year. 

We will now explain a little more about each of these pathologies:

Rhinitis

Rhinitis is an inflammatory process of the nasal mucosa since it affects the nasal passages. The contagion of this disease is usually airborne or direct, through physical contact with those causing the disease, as well as with people who have already contracted it. 

In this case, we mention the so-called Pflüger's microdroplets to refer to this type of contact, which are the microdroplets of saliva that are generated and expelled when speaking.

Thus, there are a series of limitations in the functions of the nasal cavities in our organism, ranging from filtering the air and collecting impure particles in the air through the mucous membrane and cilia, to the ability to perceive and distinguish odours. The cavities of the nasal cavities are lined with mucus and when this becomes inflamed, for whatever reason, we are dealing with rhinitis. The disease can be chronic or acute and, in the case of chronic rhinitis, it can lead to sinusitis.

Types of rhinitis

Rhinitis is an inflammation of the nasal mucosa. Symptoms include sneezing, mucoid rhinorrhoea, i.e. a runny nose and nasal irritation and congestion. There are therefore two types of rhinitis: allergic and non-allergic.

• Allergic rhinitis occurs when our immune system is exposed to an excess of outside particles such as: plant pollen, fungi, dust mites, animal hair, chemicals such as smoking or contact with tobacco smoke, food, medicines and insect venom. Allergic rhinitis is to the nose what asthma is to the bronchi.

Thus, during an allergy attack, antibodies, more specifically immunoglobulin E (IgE), attach to mast cells, cells that release histamine, a compound that acts in the body as a hormone and neurotransmitter and plays an essential role in allergic reactions.

Antibodies, apart from attaching to mast cells, also attach to the lungs, skin and mucous membranes. When IgE makes contact with the mast cells, some chemicals are released, including histamine, causing the blood vessels to open and the skin to become red and swollen. All this occurs in the nose and causes sneezing and congestion.

There are two types of allergic rhinitis: seasonal and perennial.

• Seasonal allergic rhinitis, known as hay fever, occurs in late summer or with the arrival of spring. People sensitive to tree pollen usually develop symptoms of the disease in late March or early April, while people suffering from allergic reactions to mould spores develop symptoms in October and November due to leaf fall.
• On the other hand, perennial allergic rhinitis occurs throughout the year and can be caused by sensitivity to animal hair, mould, plants, carpets and upholstery. Air pollution, with emissions of toxic gases, can accentuate allergic rhinitis although bacteria are not the main cause but can create a condition that worsens allergies.
• Non-allergic rhinitis is not conditioned by the presence of IgE as it is not due to an allergic reaction. There is a clear relationship between sinusitis and non-allergic rhinitis as the former does not usually occur without chronic rhinitis. In addition, they share several symptoms such as nasal obstruction, loss of smell, swelling etc. Thus, it can be caused by cigarette smoke or smoking, cold, pollutants, etc.

The relationship between the two diseases is so strong that the preoperative test for endoscopic sinus surgery on computed tomography (CT or CAT) shows how the mucous membranes of the nose and sinuses are both involved in the common cold. 

Thus, in some cases, otolaryngologists who are aware of the relationship between the nasal passages and sinuses now refer to sinusitis as rhinosinusitis.

Sinusitis

Sinusitis affects the sinuses. The sinuses are air-filled cavities in the bones of the skull and are responsible for filtering the air we inhale, helping us with phonation and speech and giving us the ability to perceive and distinguish smells. As we have just said, sinusitis affects the paranasal sinuses and, therefore, the nasal cavities, thus causing limitations in these nasal sinus structures.

These limitations arise due to inflammation and infections caused by bacteria, fungi, viruses or recurrent allergies. This condition leads to nasal polyps and the accumulation of purulent mucus, which can make it difficult to breathe through the nose. In fact, due to the swelling in the eyes and face that this causes, it is common to feel discomfort in the face.

Types of sinusitis

There are two types of sinusitis, chronic sinusitis and acute sinusitis. We will talk about one or the other depending on the length of time it lasts in the person who contracts it. The difference that defines them, determined by time, is obvious, but they share other differences regarding their causes, symptoms and treatments.

• Acute sinusitis does not last more than four weeks. It is usually caused by a common cold or a bacterial infection, in the worst case. This type of illness usually resolves within a week and ten days. It is usually treated with drugs and even home remedies unless it persists for more than twelve weeks. If this is the case, it can cause serious infections and other complications and we would be dealing with a situation of chronic sinusitis.
• Symptoms of chronic sinusitis persist for more than three months. The disease is caused by infection, enlarged sinuses or a deviated nasal septum. In this type of sinusitis, bacteria are as present as fungi causing infections that are difficult to treat. The symptoms are presented by obstruction of the nasal passages, mucoid rhinorrhoea, i.e. runny nose, hyposmia, which is an olfactory disorder that affects the ability to perceive odours, etc. It can be treated with drugs, but if not resolved correctly or insufficiently, it may regress. Therefore, if medication does not make the symptoms disappear, we would be dealing with chronic sinusitis and the only definitive solution would be nasosinusal endoscopic surgery.

At Operarme, we offer sinusitis surgery, which is a minimally invasive surgical procedure that aims to restore the course of the sinus mucosa. This is carried out by eliminating infections and cleaning the sinuses in order to increase the patient's quality of life.

Rhinitis is a condition of the nasal passages. The two cavities separated by the nasal septum above the mouth become inflamed. The nasal passages have several functions and these are affected by the disease. 

These include filtering the air we breathe and regulating it to control humidity and temperature, collecting impurities by means of the cilia and mucous membrane and phonation for speech, as they act as a sounding board and give us the ability to perceive and distinguish smells.

These cavities are lined with mucus and when they become inflamed, for whatever reason, we speak of rhinitis. 

Rhinitis, like sinusitis, can be acute or chronic, and chronic rhinitis usually leads to sinusitis.

Rhinitis is an inflammation of the nasal passages, which causes nasal mucus, usually watery in the beginning and thicker as the process lengthens. This is usually typical of chronic rhinitis. 

Sneezing also occurs with rhinitis, especially in allergic rhinitis, as well as a blocked nose and, in some cases, itching in the nasal and eye area. We speak of hyposmia when it affects the ability to smell and reduces the perception of odours, and anosmia when it completely eliminates the ability to distinguish and perceive them.

There are two types of rhinitis treatment. We will attend to one or the other depending on the type of rhinitis we are talking about. Therefore, we will mention two ways of proceeding with the disease: with pharmacological treatment or surgical treatment.

However, it is worth highlighting some preventive measures to treat rhinitis and reduce its symptoms:

Preventive treatment

Avoid times and plans of the day when you are most exposed to pollen, for example:

• The early hours of the morning.
• Trips to the countryside.
• The times of the year when trees and flowers are in bloom.
• Travelling by car with the windows closed.
• Try to do as few outdoor activities as possible.
• Dust and vacuum houses with dogs.
• Avoid dusty objects such as curtains and carpets.

Having mentioned the measures that can prevent rhinitis, we now turn to the possible treatments for rhinitis.

Pharmacological treatment

The treatment of rhinitis involves good hydration to keep the mucous secretions fluid. It also accepts the use of nasal decongestants and apyretics to reduce fever, if present. The treatment of choice for allergic rhinitis is a combination of antihistamines and control to avoid exposure to the allergens that cause the disease.

In the case of dry rhinitis, the disease must be treated by moisturising with physiological saline solution and oily ointments in order to humidify the nasal passages. We therefore highlight the most common medicines to treat the disease in a preserved way:

• Nose sprays or saline washes.
• Antihistamines.
• Corticoids.
• Nasal decongestants.

In case of hypertrophy or nasal polyps, surgery is recommended. We therefore mention radiofrequency turbinate reduction surgery as a surgical treatment.

Surgical treatment with radiofrequency in turbinates

Initially, the treatment of rhinitis is based on the use of drugs, but there are some cases in which the disease continues to be present, even when a good treatment has been administered, for the necessary time. 

Rhinitis that persists over time can lead to enlargement of the nasal turbinates, affecting their functions, such as heating and humidifying the air we inhale.

Thus, the size of the turbinates can clog the nasal passages and, if there is no improvement and the symptoms continue, so that there are limitations to lead a normal life, surgery has a fundamental role to play in the definitive solution to rhinitis.

The surgery we are talking about is the radiofrequency turbinate reduction operation, also known as radiofrequency turbinoplasty. This surgery involves an intervention on the turbinates. But before explaining what the operation consists of, we will talk about the limitations that rhinitis imposes on this internal structure of our respiratory system.

The turbinates are a composition formed by bone, in its central part, covered by nasal mucosa and surrounded by multiple blood vessels. Therefore, the functions that are limited by their hypertrophy are as follows:

• Filtering the air, warming it and humidifying it.

Rhinitis, or turbinate hypertrophy, can be corrected with radiofrequency turbinate surgery, which consists of the following:

• Use a special needle and prick the nasal turbinates.
• This needle is connected to a device.
• The device produces a reduction in size.

This surgery is relatively simple and has a very high success rate. It lasts between 15 and 20 minutes but this may vary depending on the case of each patient.

Operarme offers this operation with radiofrequency in turbinates for the solution of rhinitis and includes, in its final price of 3,990 €, everything necessary to be able to intervene in the safest and most effective way possible for the patient. 

You can request an assessment consultation for this operation by clicking below:

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Rhinitis and sinusitis are closely related, as chronic rhinitis leads to sinusitis. Sinusitis affects the paranasal sinuses, the air-filled hollows in the bones of our skull. They act as a filter for the air we breathe, play an important role in our voice when we speak and give us the ability to distinguish smells.

When the sinuses are affected by this disease, the nasal passages are also affected and a number of restrictions occur in these nasal sinus structures. Inflammation and infections caused by bacteria, fungi or persistent allergies lead to nasal polyps and excess mucus with pus. This can affect our ability to breathe, as it is often difficult to do so, and the swelling of the area can also cause discomfort to the face and eyes.

Before discussing treatments for sinusitis, we will mention some preventive measures that can avoid, as far as possible, the aggravation of some sinusitis symptoms.

Preventive treatment

Knowing that rhinitis and sinusitis are closely linked, we can consider some of the preventive measures for rhinitis, which allude to the avoidance of pollen, in order to effectively tackle allergies. 

Continuing with the advice, we will mention the most important ones:

• Moisturise the body and sinus passages through proper hydration of the body, especially by drinking water.
• Avoid smoking, tobacco smoke and places with high levels of pollution.
• Use decongestants if you have contracted a respiratory tract infection.

Thus, we refer to two types of treatment for sinusitis depending on the type of sinusitis, acute or chronic: pharmacological treatment or surgical treatment.

Pharmacological treatment

When sinusitis is acute, it is usually resolved with the passage of time and the correct medical measures, although it is true that it is normal to combine it with a two-week course of antibiotics. In turn, if the sinusitis is fungal, i.e. it has been caused by a fungus, it is necessary to follow a procedure for fungal infections.

Nasal sprays containing corticosteroids and antihistamines are used to reduce the size of the swelling caused by nasal polyps.

Chronic sinusitis is usually treated within three weeks to a month, but if it persists for more than three months, it can cause infections that are difficult to treat with medication, and surgical treatment, which involves endoscopic sinus surgery, is the only effective option.

Surgical treatment

If sinusitis symptoms persist for more than three months, this is a chronic disease. This can be diagnosed when symptoms are still present 90 days after starting drug treatment or when there are three or more repeated episodes of acute sinusitis per year. Therefore, as we have already mentioned, sinusitis surgery becomes the definitive solution to eliminate the disease.

This operation involves endoscopic sinus surgery, which involves opening and draining the sinuses to eliminate infections and clean them. 

Therefore, the procedure is as follows:

• Provide general anaesthesia
• Use a nasal decongestant to reduce swelling of the mucous membranes in the nasal passages.
• Perform dissection of the nasal wall with a fibreoptic scope. This is inserted through the nostril in order to obtain a direct view of the sinus opening.
• Removal of the abnormal or obstructive tissue.
• Finally, a check will be made of the bleeding points in order to tamponade the nose and prevent bleeding.

Operarme offers endoscopic sinus surgery to put a definitive end to sinusitis. This intervention requires the best conditions for the operation to be effective, which is why the price of €4,890 includes everything necessary to be able to perform it as safely and effectively as possible.

Before each surgery, we consider it necessary to make an appointment so that our specialists can assess you surgically and, in addition, get to know your case. In this way, we can decide, with more accuracy, what your situation is for a possible surgery. 

If so, and you would like to request a free consultation, you can do so by clicking below:

Do you need surgery to eliminate sinusitis?

Request a free and immediate appointment with our specialists in Otorhinolaryngology

Make an appointment