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Health Tips :: sinusitis , rhinitis, deviated nasal septum

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Do you suffer from frequent sneezing, congestion and an itchy or runny nose? If so, you may have rhinitis. Rhinitis is one of the most common chronic conditions, affecting 10% to 30% of adults and up to 40% of children in the United States. If this includes you, you don't have to suffer.
By learning more about rhinitis, you will have a better understanding of your symptoms. An ENT Surgeon, Dr. Tejal Shah in Ahmedabad, can make an accurate diagnosis and develop a treatment plan that works for you.

Allergic Rhinitis

There are two types of rhinitis: allergic rhinitis and non-allergic rhinitis. Let's talk first about allergic rhinitis.
Allergic rhinitis is caused by allergens in the air, which are usually harmless but can cause problems in certain people.
Allergy symptoms are the result of a chain reaction that starts in the immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to pollen, your immune system identifies pollen as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction with symptoms such as sneezing, stuffiness, a runny nose, itching and post-nasal drip.
People with rhinitis are prone to itchy, watery eyes (from allergic conjunctivitis), and they may be more sensitive to irritants such as smoke, perfume or cold, dry air. Rhinitis can contribute to other problems such as asthma, sinus or ear conditions or trouble sleeping.


When allergic rhinitis is caused by outdoor allergens such as tree, grass and weed pollen, it is called seasonal allergic rhinitis, or "hay fever." Rhinitis can also occur year-round because of indoor allergens from pets, mold, dust mites and cockroach droppings. This is called perennial allergic rhinitis. You can have either seasonal or perennial allergic rhinitis, or a combination of both.


Diagnosis and Treatment of Allergic Rhinitis

ENT Surgeon, Dr. Tejal Shah in Ahmedabad can help determine which allergens, if any, are causing your symptoms. He or she will take a detailed health history, perform a physical exam and then test you for allergies. Skin tests show the results within 20 minutes. These results, as well as how frequent and bad your symptoms are, will be considered when developing a treatment plan. Steps to manage your symptoms may include avoiding the allergens you are allergic to, medications and/or allergy shots (immunotherapy).



Some medications for allergic rhinitis are best used daily to control inflammation and prevent symptoms, while others are used only as needed to relieve symptoms. Nasal corticosteroid sprays can control inflammation and reduce all symptoms of allergic rhinitis, including itching, sneezing, runny nose and stuffiness. Antihistamines in the form of pills or nasal sprays block histamine and may relieve itching, sneezing and runny nose. But they may not be as effective in reducing nasal stuffiness. Anti-leukotrienes in the form of pills can reduce all the symptoms of allergic rhinitis. Decongestant pills or nasal sprays can be used as needed if nasal stuffiness is not relieved with other medications. Decongestant sprays should not be used for long periods of time because they can cause your congestion to return.

Immunotherapy, may be considered if your symptoms are constant, if you don't want to take medications or feel that they are not enough, or if you want long-term control of your allergies with less need for medications. This treatment involves receiving injections periodically-as determined by your allergist-over a period of three to five years. The end result is decreased sensitivity to allergens.

Non-Allergic Rhinitis

Some people with rhinitis symptoms do not have allergies. Non-allergic rhinitis usually begins in adults and causes year-round symptoms, especially a runny nose and nasal stuffiness.

Strong odors, pollution, smoke and other irritants may cause symptoms of non-allergic rhinitis. Non-allergic rhinitis symptoms can also develop as side effects of medications, including some blood pressure medicines, oral contraceptives or medications used for erectile dysfunction. The most common form of this type of non-allergic rhinitis is caused by nasal decongestant sprays such as oxymetazoline, when used for long periods of time. This type of medication-induced rhinitis is also called rhinitis medicamentosa.

Treatment of Non-Allergic Rhinitis

If there is inflammation in the nose, the treatment of choice is nasal corticosteroid sprays. Decongestant pills can be used as needed to relieve nasal stuffiness.

Other forms of treatment may be considered if you have problems with the structure of your nose, such as narrow drainage passages, tumors or a shifted nasal septum (the bone and cartilage that separate the right from the left nostril). In these cases, an operation ( Septoplasty Surgery for DNS ) may be needed by an ENT Surgeon, Dr. Tejal Shah in Ahmedabad .

Healthy Tips

  • There are two forms of rhinitis: allergic and non-allergic. In order to control symptoms, it is important to have the right diagnosis.
  • Allergic rhinitis can be caused by outdoor allergens such as pollen (seasonal allergic rhinitis) or indoor allergens such as dust mites or pets (perennial allergic rhinitis).
  • Some people with symptoms of rhinitis don't have allergies. This is called non-allergic rhinitis and can develop as a side effect of certain medications.


Sinus infection, or sinusitis, is an inflammation of the sinuses and nasal passages. A sinus infection can cause a headache or pressure in the eyes, nose, cheek area, or on one side of the head. A person with a sinus infection may also have a cough, a fever, bad breath, and nasal congestion with thick nasal secretions. Sinusitis is categorized as acute (sudden onset) or chronic (long term, the most common type).
Anatomy of the sinuses (also called paranasal sinuses): The human skull contains 4 major pairs of hollow air-filled sacks called sinuses. These connect the space between the nostrils and the nasal passage. Sinuses help insulate the skull, reduce its weight, and allow the voice to resonate within it.
Frontal sinuses (in the forehead)
Maxillary sinuses (behind the cheek bones)
Ethmoid sinuses (between the eyes)
Sphenoid sinuses (behind the eyes)

Types and Causes of Sinusitis

The sinuses contain defenses against foreign bacteria (germs). If a disruption occurs that affects the normal host defenses inside the sinuses, those defenses may allow bacteria, which are normally present in the nasal passages, to enter any of the sinuses. Once there, the bacteria may stick to the lining cells and cause a sinus infection.
Acute sinusitis usually lasts less than 8 weeks or occurs no more than 3 times per year with each episode lasting no longer than 10 days. Medications are usually effective against acute sinusitis. Successful treatment counteracts damage done to the mucous lining of the sinuses and surrounding bone of the skull.
Chronic sinusitis lasts longer than 8 weeks or occurs more than 4 times per year with symptoms usually lasting more than 20 days.
These sinuses are covered with a mucus layer and cells that contain little hairs called cilia on their surface. These help trap and propel bacteria and pollutants outward. The ostiomeatal complex (OMC) connects the nasal passage to the paranasal sinuses.

Sinus Infection Causes

Acute sinusitis usually follows a viral infection in the upper respiratory tract, but allergens (allergy-causing substances) or pollutants may also trigger acute sinusitis. A viral infection causes damage to the cells of the sinus lining. This damage leads to inflammation. The lining thickens with fluid that obstructs the nasal passage. This passage connects to the sinuses. The obstruction disrupts the process that removes bacteria normally present in the nasal passages, and the bacteria begin to multiply and invade the lining of the sinus. This causes sinus infection symptoms. Allergens and pollutants produce a similar effect.
Bacteria that normally cause acute sinusitis are Streptococcuspneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. These microorganisms, along with Staphylococcus aureus and anaerobes (bacteria that live without oxygen), are involved in chronic sinusitis.
Fungi are also becoming an increasing cause of chronic sinusitis, especially in people with diseases that weaken the immune system, such as AIDS, leukemia, and diabetes.
Acute sinusitis is caused by an infection of the mucous membranes with a virus, bacterium or fungus. Most people with sinusitis have a viral infection such as the common cold.
The mucus that is produced by the mucous membranes in your sinuses normally drains into your nose through small holes called ostia. The ostia can become narrow or even blocked if the sinuses get infected and inflamed so the mucus cannot drain properly.
This can also happen if your membranes are irritated by something. Examples of irritants include:
  • airborne allergens such as grass and tree pollen
  • smoke and air pollution
  • sprays containing chemicals (eg household detergents)
  • nasal decongestants, if overused
  • chronic drug misuse (snorting substances such as cocaine)


To diagnose sinusitis, an allergist will take a detailed history and perform a physical examination. He or she may also order tests. These tests can include allergy testing, sinus CT scans (which take exact images of the sinus cavities) or a sample of your nasal secretions or lining.
Your physician may also perform an endoscopic examination. This involves inserting a narrow, flexible endoscope (a device with a light attached) into the nasal cavity through the nostrils after local anesthesia. This allows your physician to view the area where your sinuses drain into your nose in an easy, painless manner.


Sinus infections generally require a mix of therapies. Your physician may prescribe a medication to reduce blockage or control allergies, which helps keep the sinus passages open. This medicine may be a decongestant, a mucus-thinning medicine or a steroid nasal spray. If bacterial sinusitis is present, your physician may prescribe an antibiotic. For people with allergies, long-term treatment to control and reduce allergic symptoms can also help in preventing sinusitis.

Several non-drug treatments can also be helpful. These include breathing in hot, moist air and washing the nasal cavities with salt water. If you need surgery to fix the structure of your nose, consult Dr. Tejal Shah – your otorhinolaryngologist, or an ear-nose-throat physician (ENT).
Most people with acute sinusitis get better without treatment. However, you may find that home treatments and over-the-counter medicines provide some relief.
Some people find that breathing in steam from a bowl of hot (but not boiling) water containing a few drops of menthol oil provides some relief from the symptoms. However, this isn't scientifically proven. Another method is to sit in the bathroom with the hot shower running and inhale steam this way. Some people find that applying a warm compress on the areas of the face that are painful and sleeping with their head and shoulders propped up with pillows provides relief but again there is no scientific evidence that this works.
You can take the painkiller you usually take for a headache to relieve pain and lower your temperature if you have a fever.
Decongestant tablets, such as pseudoephedrine, may reduce swelling in your nose and allow your sinuses to drain. Decongestant nasal sprays are also available but you should not use them for more than a week, as prolonged use can actually make nasal blockage worse in the long run. Always read the patient information leaflet that comes with your medicine and ask your pharmacist or doctor for advice.
If your symptoms continue for more than a week you may wish to see your ENT specialist Dr. Tejal Shah. If the sinusitis is thought to have been caused by a bacterial infection, your ENT specialist Dr. Tejal Shah may prescribe antibiotics.

Things To Remember

  • Sinusitis is a swelling of the nose and sinuses.
  • Acute sinusitis occurs when symptoms last less than four weeks.
  • Chronic sinusitis occurs when symptoms last more than three months.
  • People with allergies are at greater risk of getting sinus infections.
  • Treatment for sinusitis is available. See an allergist for help managing your symptoms.


There are a number of things you can do to help prevent sinusitis developing such as:
  • taking a short course (usually no longer than seven days) of decongestant medicine when you have a cold
  • having a flu vaccination each year
  • staying well hydrated by drinking plenty of fluids
  • not smoking
  • staying away from smoky environments
  • keeping your allergy symptoms under control - ask your doctor or pharmacist for advice
  • maintaining good general health by eating healthily and taking regular exercise

Sinusitis OR Rhinitis ??

Symptoms of sinusitis and rhinitis are very similar. Rhinitis is a swelling of the mucous membranes of the nose while sinusitis includes swelling of the sinuses in addition to the nasal passages. For this reason, sinusitis is often called rhinosinusitis.

Rhinitis may be allergic or non-allergic. Allergic rhinitis is caused by allergens in the air, which are usually harmless but can cause problems in allergic people. Symptoms of allergic rhinitis often are a runny nose, sneezing, nasal congestion and itchy eyes, nose, throat and ears. People with non-allergic rhinitis usually just have a stuffy nose. It may be caused by irritants such as smoke, changes in barometric pressure or temperature or overuse of over-the-counter decongestant nasal sprays.

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