ON a rainy day in Kuala Lumpur, a lady in her early 30’s, looking very tired and stressed out, came to my clinic, complaining of a blocked nose for the past two weeks, which disturbed her daily activities
She also complained of a severe headache over her forehead and cheek region, making it difficult to concentrate on her work.
She felt a lot of thick mucus behind her nose and throat, which was difficult to clear, causing her to frequently clear her throat and cough in an attempt to remove it.
These symptoms became more apparent when she was lying down and sleeping at night, as well as during prayer time when she bent forward.
She had sought multiple medical opinions and treatments, however, her symptoms were not fully resolved.
She had had infections like this in the past, but never quite so severe with such persistent symptoms.
I personally hate having a blocked nose as it disturbs my work.
I can’t concentrate when my nose is blocked as I have to breathe through my mouth, which makes my throat dry and uncomfortable.
I’d just recovered from a common cold, which lasted about 10 days.
It was the worse experience I have ever had.
Because of the nose block, I couldn’t sleep well at night.
My symptoms were similar to those of the lady above.
My patient and I were suffering from acute rhinosinusitis – a common condition also known as resedung in Bahasa Malaysia.
Our symptoms are related to the inflammation of the paranasal sinuses (which surround the nose or nasal cavity) and nasal mucosa, leading to swelling of the turbinates (soft tissue that projects into the nasal cavity from its walls) and increased mucus production.
These are the major contributions to the blocked and “running” nose in acute rhinosinusitis.
The inflammatory changes in nasal mucosa lead to the congestion, and inefficient drainage and ventilation, of the paranasal sinuses.
The stagnation of mucus in the sinuses may lead to bacterial infection if treatment is not given.
This may result in headache, facial pain, or greenish mucus, and fever.
Sinusitis refers to inflammation in the paranasal sinuses, while rhinitis refers to inflammation in the nasal mucosa.
The term “rhinosinusitis” – a combination of rhinitis and sinusitis – is preferred to “sinusitis”, as inflammation of the sinuses rarely occurs without concurrent inflammation of the nasal mucosa.
Acute rhinosinusitis lasts less than four weeks, whereas symptoms lasting more than 12 weeks are classified as chronic rhinosinusitis.
occurs when a patient has four or more episodes of rhinosinusitis a year, without persistent symptoms in between.
A patient has complicated rhinosinusitis when the inflammation has spread outside the paranasal sinuses and nasal cavity at the time of diagnosis (e.g. affecting the nerves, eyes or other soft tissue).
I am frequently asked by patients, “I catch colds quite frequently, but this is the worst cold I’ve ever had, is there any particular reason for this?”
There are certain conditions that may contribute to the severity of the rhinosinusitis.
These include a family history of rhinosinusitis; asthma, especially in the presence of chronic rhinosinusitis with nasal polyps; allergies; chronic bronchitis; chronic rhinitis; a personal history of acute rhinosinusitis; gastroesophageal reflux; sleep apnoea and adenotonsillitis. People with these conditions are also prone to having recurrent rhinosinusitis.