Rhinology (Allergy & Sinus) : Rhinology Conditions



Sinusitis, or rhinosinusitis, results from inflammation of the lining of the nasal passages and paranasal sinuses. The paranasal sinuses are air spaces that fill your cheeks, forehead, and areas between your eyes. While the bones of the face and forehead may feel solid, they are actually hollow. The hollow spaces are the sinuses. (See Figure) The anatomy of the sinuses and inflammation that occurs with sinusitis can help us to understand many of the symptoms that occur with sinusitis and similar conditions. Sinus “inflammation” refers to irritation and swelling in the sinuses.
Some symptoms are very common with sinusitis. Other symptoms occur less frequently. In addition, many symptoms that occur with sinusitis or sinus infections may also be seen with other nasal and sinus conditions. For example, viral upper respiratory infections (the common cold) or nasal allergies can lead to similar symptoms. This may cause confusion for the patient, and sometimes it make take a longer time to determine if you are experiencing sinusitis or another condition. Your Otolaryngologist (ENT physician) can help you identify the correct diagnosis and determine the best treatment for your condition.


Sinusitis is the inflammation of one or more of the sinuses that drain into the nose. Everyone has four sets of sinuses. In children, the maxillary and ethmoid sinuses are most commonly affected, as the frontal and sphenoid sinuses are still developing. In children, a common cold or viral infection is the most common event that may lead to a sinus infection. Also, foreign bodies such as a peanut, a raisin or a bead pushed into the nose may cause a nasal infection. When an infection begins, the lining of the sinuses may become swollen, blocking the passage where normal sinus mucus drains. This results in a backup of mucus which cannot get out. When this mucus remains in the sinus too long it can become infected.


Fungus is ubiquitous, present in all our surroundings and the air we inhale. Most healthy people do not react to the presence of fungus due to a functioning immune system. However, in rare instances, fungus may cause inflammation in the nose and the sinuses. Fungal sinusitis can come in many forms, differing in pathology, symptoms, course, severity and the treatment required. It is broadly classified into invasive and non-invasive types:
• A simplified classification of fungal sinusitis is as follows:
• Non-invasive fungal sinusitis
• Fungus ball
• Allergic fungal sinusitis
• Non-allergic fungal sinusitis
• Invasive fungal sinusitis
• Acute invasive fungal sinusitis
• Chronic invasive fungal sinusitis
• Granulomatous invasive fungal sinusitis


Allergic rhinitis and asthma are both conditions in which there is inflammation of the affected airway. The symptoms of rhinitis are runny nose, stuffy nose, nose itching, sneezing and mucus dripping down the back of the nose. Asthma usually causes episodes of breathlessness, chest tightness and wheezing. The severity of both conditions can vary by season.
Allergic rhinitis and asthma are often present in the same patient. The presence of one condition can significantly affect the course of the other. A workshop of experts from around the world collaborated with the WHO (World Health Organization) to create a report called ARIA (Allergic Rhinitis and its Impact on Asthma). They found that irritation of the bronchial airway, a part of the lung, causes nasal inflammation and that nasal irritation causes bronchial inflammation.
Another airway disease is rhinosinusitis (what is generally called sinusitis). Rhinosinusitis symptoms include nasal blockage and congestion, nasal drainage, facial pain or pressure and loss of sense of smell. Since rhinosinusitis occurs more often in patients with allergic rhinitis, the three conditions are frequently seen together in patients. Most asthmatics have rhino sinusitis on CT scan. Severe chronic rhinosinusitis is seen more often in severe asthmatics than mild asthmatics. There is also a condition called aspirin-exacerbated respiratory disease (AERD), also called Samter’s triad, that is characterized by aspirin allergy, growths in the nose called nasal polyps, and asthma.
Combining strategies to treat both the upper airway disease (allergic rhinitis, sinusitis, nasal polyps) and lower airway disease (asthma) improves the effectiveness of treatment. Although there is limited information regarding the effectiveness of allergy treatment therapy in patients with rhinosinusitis, it is reasonable to consider adding allergy treatment for patients with both sinusitis and allergy. Patients with allergic rhinitis and rhinosinusitis that recurs frequently or does not respond well to treatment should be evaluated for the possible presence of asthma. Adding medications for allergic rhinitis to the treatment for asthmatic patients can improve control of asthma. Endoscopic sinus surgery for the treatment of rhinosinusitis and nasal polyps in patients with asthma also appears to improve asthma control.