What is a permanent cure for sinus?
Hi, I have a perpetual sinus problem. I’ve taken anti histamines like Telfast D but they generally have little effects. I am looking for a permanent solution and came to know of the option of undergoing surgery. What is the procedure like, (e.g must I go to a specialist clinic) and what are the rough costs for such a surgery in Singapore?
Thank you for your question. Based on the clinical history provided, I will answer your questions in a few sections as follows:
Sinus vs Sinusitis – What is the difference?
“Sinus” is a common term that many people incorrectly use to describe nose symptoms such as frequent blocked nose, runny nose and sneezing. Sinuses, or the precise term is paranasal sinuses, are hollow spaces that is surrounds the nasal cavity. Everyone has them and it is a normal part of the anatomy in your face. The lining of these spaces (called mucous membranes) produces mucous that drains into the nose.
Sinusitis (infection of the sinuses, aka rhinosinusitis) occurs when the sinuses are blocked and trapped mucous in the sinuses are infected. Patients with sinusitis often present with nasal blockage, nasal congestion (feeling of mucous stuck in the nose or face – ie inability to blow the mucous out), facial pain (most often in the cheek, forehead and in between the eyes), postnasal drip and coloured phlegm or nose mucous.
What is Rhinitis?
Blocked nose, clear or transparent runny nose, itchy nose and eyes, postnasal drip and sneezing are likely symptoms of Rhinitis. Rhinitis is a medical term for inflammation of the nasal cavity (often called “Sensitive Nose”).
There are broadly 2 types of Rhinitis:
1. Allergic Rhinitis (commonly called “Hay Fever”) – Due to exposure to a particular protein (e.g house dust mite, cat or dog fur, grass or fungus)
2. Non-allergic Rhinitis – Due to unknown causes but common triggers include change in temperature as well as exposure to perfumes and cigarette smoke.
How do I differentiate Allergic Rhinitis (AR) from Non-allergic Rhinitis (NAR)?
AR can be differentiated from NAR with a combination of medical history, nasoendoscopy examination and an allergy test called Skin Prick Test (SPT) or blood tests. The most commonly used allergy test used is a Skin Prick Test. This involves placement of droplets of allergens (protein that causes an allergic reaction – e.g house dust mite, cat and dog furs etc) on to the patient’s forearm. Very small needles are then used to perform a superficial prick on the outer layer of the skin, to allow small amounts of allergens to enter the skin. If a patient is allergic to an allergen, a wheal (small area of swelling like a mosquito bite reaction) will develop over the next 15-20 minutes.
Is there a cure for Rhinitis?
This depends on the type of Rhinitis. Majority of symptoms from Allergic and Non-allergic Rhinitis are usually well controlled by:
1. Allergen or trigger avoidance – e.g getting rid of dust mites by washing your bedsheets and pillow cases once a week with hot water (at least 60 degrees Celsius high to get rid of the dust mites), avoiding cigarette or strong perfume smells etc
2. Nasal steroid sprays – These are the workhorse in the treatment of Rhinitis. It reduces inflammation in the nasal cavity and usually improves all symptoms of Rhinitis. It however has to be used on a long-term basis.
3. Oral antihistamines and decongestants – Antihistamines (E.g. Zyrtec, Telfast, Xyzal, Bilaxten etc) work well in reducing itchy nose, runny nose and sneezing. They do not work very well in relieving blocked nose. Blocked nose is best relieved with medications which have decongestants in them (e.g. Telfast D, Zyrtec D, Clarinase, Sudafed etc). These medications however should not be taken on a long-term basis due to potential side effects (e.g hypertension)
If you have Allergic Rhinitis (tested positive for one or more allergens on a skin prick test), there is a potential cure known as Immunotherapy. Immunotherapy involves desensitizing the patient to the known allergen by exposing them to small amounts of the allergen over a period of at least 3 years. The allergens can be given as an injection (called subcutaneous immunotherapy or SCID) or sprayed/placed under the tongue daily (called sublingual immunotherapy or SLIT). Most ENT Clinics in Singapore use SLIT to treat patients with Allergic Rhinitis. This is the only known treatment that modifies the disease process and may offer a potential cure for Allergic Rhinitis.
What if my main problem is blocked nose and I want a long-lasting solution to it?
If your main symptom is nasal blockage and you do not wish to use medications on a long-term basis, there are surgical options to increase the space your nose. Most commonly, blocked nose in patients with Rhinitis is due to enlarged inferior turbinates with or without a deviated nasal septum. The common surgical procedures to correct these include inferior turbinoplasty and septoplasty respectively. Surgical outcome from these procedures are usually good. These procedures are done through the inside of the nose (no cuts or external wounds seen on the face or nose) under general anaesthesia. Unfortunately there is no good surgical options to relieve runny nose or sneezing. Medical treatments are still the best to address these symptoms.
What is the cost of such surgery in Singapore?
You will need an assessment by an ENT Specialist to determine the nature of your condition. The cost depends on the type of surgery/s that is recommended for you.
For example, the total cost could range from SGD 1,000 - 1,500 (coblation of turbinates alone) to over SGD 20,000 (if you need to do septoplasty, inferior turbinoplasty and full sinus sugery ie functional endoscopic sinus surgery). This is partially Medisave claimable.
It is also important for the ENT Specialist to ensure that you are not suffering from concurrent chronic rhinosinusitis.
Hope this helps, and all the best!