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A person experiencing signs of nasal discomfort (Image credit: Freepik)

Have you ever experienced bouts of sneezing and wondered if you are down with Rhinitis or Sinusitis?

Rhinitis and Sinusitis, which affects the nasal passages and the sinuses, are two common conditions that can cause significant discomfort. Although they share some overlapping symptoms, they are distinct disorders with different underlying causes, treatment approaches and potential complications.

What are Rhinitis and Sinusitis?

Rhinitis refers to the inflammation of the mucus membranes lining the nasal passages. It can be triggered by a variety of factors, including allergens such as pollen, dust mites, pet dander, viral infections (common cold), or irritants (like smoke or pollution). 

Sinusitis on the other hand, is the inflammation of infection of the sinuses, which are the air-filled cavities located within the skull, above the eyes, behind the cheeks, and along the forehead. When these sinuses become inflamed or blocked due to infection, allergic reaction or other factors, fluid can accumulate, leading to an infection known as Sinusitis. Sinusitis can be diagnosed as acute or chronic. Acute Sinusitis is often caused by a bacterial or viral infection and typically lasts for less than four weeks. A persistent condition lasting for more than 12 weeks, is often related to chronic Sinusitis.

Overlapping symptoms of Rhinitis and Sinusitis

Since both conditions involve the nasal passages, many symptoms of Rhinitis and Sinusitis overlap. They include nasal congestion, cough, and fever if an infection is present. However, while these symptoms are common, there are differences that can help to distinguish between the two.

1. Duration

Rhinitis typically resolves within a few days to weeks, particularly if it is caused by a viral infection or allergies. Sinusitis symptoms tend to develop more abruptly with symptoms usually persist for more than 10 days. Persistent or worsen condition could indicate bacterial Sinusitis.

2. Type of discharge

Rhinitis nasal discharge is usually clear and watery, while the discharge of Sinusitis is thicker, and may be yellow or green, indicating an infection.

3. Facial pain and pressure

Rhinitis does not cause significant facial pain or pressure. On the other hand, Sinusitis may cause facial pain or a feeling of pressure around the eyes, forehead, and cheeks.

4. Loss of smell

Rhinitis rarely causes a significant loss of smell, but loss of smell (anosmia) is common and can be severe in Sinusitis, especially in chronic or bacterial Sinusitis.

5. Headache

Symptoms of headaches are usually not as intense in Rhinitis, although they may occur in some cases especially during nasal congestion. On the other hand, headaches are typically more common for Sinusitis, and are often localised to the area around the sinuses.

Treatment options for Rhinitis and Sinusitis

Rhinitis and Sinusitis are generally self-limiting, and they typically resolve on their own without the need for extensive medical intervention. However, the discomfort they cause, ranging from nasal congestion to facial pain can be significant, prompting the need to seek relief.

Viral Rhinitis, commonly known as the common cold, is usually caused by viruses like rhinoviruses, coronaviruses or the influenza virus. Antihistamines are often used to alleviate symptoms like sneezing, runny nose, and itching. Oral or nasal decongestants can also be used to help reduce nasal congestion by constricting blood vessels in the nasal passages. However, nasal decongestants should not be used for more than three consecutive days, as prolonged use can lead to rebound congestion. To further relieve congestion, you may use saline nasal rinses to rinse and clear out mucus, allergens, and irritants like pollen or dust.

The use of a saline nasal rinse to relieve congestion

Unlike viral Rhinitis, allergic Rhinitis is the result of an immune system overreaction to harmless substances. Managing allergic Rhinitis typically involves reducing exposure to allergens and controlling the immune response.

Most cases of Sinusitis are viral in nature and antibiotics are not required as they are only effective against bacterial, so treatment is generally focused on symptom relief using nasal decongestants, saline nasal rinses and pain relief medication. However, if symptoms of Sinusitis last for more than 10 days or worsen after an initial improvement, it may be caused by a bacterial infection. In these cases of bacterial Sinusitis, antibiotics may be prescribed to treat the infection. It is crucial to complete the full course of antibiotics as prescribed to ensure the infection is fully eradicated and to prevent antibiotics-resistance.

In some cases of chronic Sinusitis or when symptoms are severe and unresponsive to medical treatment, surgical intervention may be considered. Surgery is typically aimed at improving sinus drainage by removing blockages or correcting anatomical issues, such as a deviated septum, where your two nostrils are crooked or off-center, making it harder to breathe, or nasal polyps (soft and painless growths).

Differentiating between Rhinitis and Sinusitis can primary be done through a clinical evaluation, with doctors carefully reviewing symptoms and duration. Most cases of both conditions are uncomplicated and do not require routine tests. However, for persistent or troublesome symptoms, especially in allergic Rhinitis or complicated Sinusitis, allergy tests, CT scans, or referrals to ENT specialists may be needed to guide treatment decisions. Doctors can recommend the most appropriate treatments, ranging from medications to lifestyle modifications, and in more severe cases, advanced surgical options.

When should a patient seek medical help?

A patient should seek medical attention if typical over-the-counter medications are ineffective, and if persistent symptoms are interfering with daily activities. This is especially important if the symptoms are accompanied by a fever higher than 38.9°C, sudden and severe facial or head pain, double vision, swelling or redness around one or both eyes, or a stiff neck.

A doctor performs an examination to assess patient's symptoms

Rhinitis, when left untreated or poorly managed, can lead to Sinusitis, which can in turn cause a variety of serious and even life-threatening complications. These complications range from infections in the skin and eyes, to more severe conditions like brain abscesses and blood clots in the veins of the skull. Chronic cough due to post-nasal drip is another common outcome of Rhinitis and Sinusitis that can significantly impact quality of life. Seeking early treatment and addressing any persistent or severe symptoms can help prevent the progression to more serious conditions. Ultimately, if in doubt, always consult your healthcare provider for guidance and advice.

This article was contributed by Dr Tan Teck Shi, Consultant and Clinical Lead for Respiratory Workgroup, SingHealth Polyclinics.

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