Pain, tenderness and a feeling of pressure in the face, runny stuffy nose, headache, foul-tasting mucus going down the back of your throat, inability to smell properly.
These are all unpleasant symptoms of a sinus infection – sinusitis – but what are the sinuses and what happens when a person gets this condition?
“Sinuses are hollow areas in the skull which connect out to the nasal passageways,” Neil Riley, ENT specialist at Aut Even Hospital says.
The sinuses that we would be generally aware of are the ones in our faces, just above our molar teeth in our cheekbones, and also the frontal sinuses, which are in our foreheads.
“There are other sinuses further back within the skull which you don’t see. People living on a sheep farm may be familiar with sheep skulls where you can see the sinuses very clearly,” he says.
“A structure that looks like a bony honeycomb in the nose is the ethmoid sinus cordex. Normally the sinuses secrete mucus that drains out through little outlets, called ostia, into the nasal passageways.”
MUCUS IS UNABLE TO DRAIN PROPERLY
When a person gets sinusitis – inflammation of the sinuses – the build-up of mucus is unable to drain out properly through the nasal sinuses and the lining of the sinuses is inflamed.
“That leads to the feeling of pressure that people experience. It also means that because fluid has built up in there and is unable to get out, it becomes a site for infection to develop. Eventually the fluid may become purulent – turn into pus.
That means you’ll experience a post-nasal drip, where the foul-tasting material is swallowed into the mouth. It is disgusting and causes a lot of complaining usually.”
The person may also experience swelling in the face and round the eyes and a blockage in the nose, he adds.
FIRST LINE OF TREATMENT
So what can relieve the symptoms?
Decongestant drops and a course of antibiotics usually do the trick, he says.
“In 90% of cases they will work perfectly well. Most people will get better spontaneously, but of those who get antibiotics the majority will recover in a week or two.”
WHO IS PRONE TO SINUSITIS?
Those with cold viruses can be more prone to sinusitis as the sinus is inflamed and drainage is disrupted if there is swelling round the sinus outlets.
Those with allergies can be more liable to get sinusitis too for the same reasons.
“Some farmers can be allergic to dust on the farm, eg related to meal or hay or fungal spores, particularly after using bad hay or bad silage,” Mr Riley adds.
“Also animal dust, particularly an allergy to horse dust (cattle tend to cause less allergic phenomena) can trigger sinusitis.
You can also inhale fungal spores which could set off an allergic reaction from decayed bedding, straw or dung.
Nasal allergies can be dealt with by nasal steroid sprays or antihistamine tablets if it’s particularly bad, he states, for example during the harvest.
“Occasionally you get farmers who get quite severe allergy responses at the time of barley harvesting particularly and afterwards, where there are a lot of barley yanes/yawns.
“Some of those affected would use antihistamine medication around that time to alleviate symptoms, but nasal steroid sprays can help too.”
CHRONIC SINUSITIS MAY NEED
REFERRAL FOR SINUS SURGERY
While most people will recover from sinusitis after a couple of weeks, if you have recurrent episodes you may be referred to an ENT specialist.
“What would happen is that we’d put a fibre-optic scope up your nose first to see if there is any physical deformity that might be causing a sinus to be blocked.
“A very common blockage would be due to what’s called a deviation of the nasal septum.”
This is frequently found in those who were hurlers, he says.
We don’t see as many broken noses now since hurling has become safer with helmets. It used to be the most common cause of a broken nose, certainly in southeastern Ireland.
“When there is a septal deviation, the septum (the partition separating the nose into two passages) can be too bent over toward the outlet point of the sinus, thereby preventing proper drainage.”
An overgrowth of the lining of the nose could be another cause.
“That’s usually related to allergy. A CT scan would be done in that case to determine the condition of the lining of the sinus.
“If it’s particularly dense surgery might be performed with the objective of opening up the sinus and allowing it to drain properly. The nasal septum would be straightened out too if that was required.”
The opening-up-the-sinus surgery would be done as a day case in a hospital, he states. Getting one’s septum straightened usually means an overnight stay, with patients kept in until the day after surgery.
WHEN WOULD REFERRAL BE NECESSARY?
So at what point would a person be referred to an ENT specialist?
“Usually a GP would refer a person if he or she is getting three or four bouts of sinusitis a year for a couple of years, but people’s tolerance varies widely.
“Some people just put up with it throughout their life; others after one or two goes of it seek surgery.
“It’s important, though, to remember that sinusitis is common enough and that you’re not going to die of it.”
FAMILY TENDENCY FOR SINUSITIS
There can be a genetic component to sinusitis.
“There can be a familial tendency toward allergy,” he says, “and also there will be a familial tendency in the structure – the shape – of your nose inside, which might lead you to be more prone to getting recurrent infection of the sinuses.
“We’ve all got our own shape of nose, but if you are an ex-hurler you are particularly susceptible.”
REMEMBER - DON’T USE DECONGESTANT DROPS FOR TOO LONG
The Aut Even specialist says that you shouldn’t use over-the-counter decongestant drops (eg Otrivine) for more than a week if you have sinusitis, however.
“That’s because although they make you feel better at the time, they do become less effective as time goes on and using them too long can cause quite significant damage to the lining of the nose.
“Steroid drops (only available on prescription) have fewer side effects.”
FARMERS SHOULD WEAR MASKS IF AFFECTED
Wearing a mask around decayed fodder or when harvesting may help avoid allergic responses that can lead to sinusitis.
“It may help a bit in avoiding it, but masks are not always effective. A lot of people simply take an antihistamine and get on with it.”
He points out that antihistamine tablets that are now available over the counter don’t cause fatigue in the same way that older-type antihistamine medication did.
GOING OFF DAIRY PRODUCTS
NOT THE ANSWER
Sinusitis is very common, but Neil Riley informed me that going off dairy products, sometimes recommended for the condition by alternative practitioners, is not necessary.
“There is a bit of a fad for going off milk and dairy products at present, as there is a certain belief that this makes you better, but it actually doesn’t.
“Yes, dairy products have been shown to promote mucus production, but that won’t do you any harm. In most cases you will simply swallow it and that’s the end of it.
“I certainly wouldn’t be telling patients to stop drinking milk if they have sinusitis.”
Is it a cold or a sinus infection? How would you know? See Table 1 to learn the difference.
Types of sinuses
You have four sinuses in your head:
1. Two frontal sinuses (behind your forehead).2. Two higher back at either side of the bridge of your nose (ethmoid sinuses).3. Two further back in the skull (sphenoid sinuses).4. Two behind your cheekbones (maxillary sinuses).TIPS FOR COPING WITH SINUSITIS
• Use over-the-counter nasal decongestants, but not for more than a week at one time, as they can damage the lining of the nose.• See your GP about a course of antibiotics if the condition is severe and there is a temperature. CL Read more
Tackle your health costs in 2018
Farmer health: dealing with depression
Pain, tenderness and a feeling of pressure in the face, runny stuffy nose, headache, foul-tasting mucus going down the back of your throat, inability to smell properly.
These are all unpleasant symptoms of a sinus infection – sinusitis – but what are the sinuses and what happens when a person gets this condition?
“Sinuses are hollow areas in the skull which connect out to the nasal passageways,” Neil Riley, ENT specialist at Aut Even Hospital says.
The sinuses that we would be generally aware of are the ones in our faces, just above our molar teeth in our cheekbones, and also the frontal sinuses, which are in our foreheads.
“There are other sinuses further back within the skull which you don’t see. People living on a sheep farm may be familiar with sheep skulls where you can see the sinuses very clearly,” he says.
“A structure that looks like a bony honeycomb in the nose is the ethmoid sinus cordex. Normally the sinuses secrete mucus that drains out through little outlets, called ostia, into the nasal passageways.”
MUCUS IS UNABLE TO DRAIN PROPERLY
When a person gets sinusitis – inflammation of the sinuses – the build-up of mucus is unable to drain out properly through the nasal sinuses and the lining of the sinuses is inflamed.
“That leads to the feeling of pressure that people experience. It also means that because fluid has built up in there and is unable to get out, it becomes a site for infection to develop. Eventually the fluid may become purulent – turn into pus.
That means you’ll experience a post-nasal drip, where the foul-tasting material is swallowed into the mouth. It is disgusting and causes a lot of complaining usually.”
The person may also experience swelling in the face and round the eyes and a blockage in the nose, he adds.
FIRST LINE OF TREATMENT
So what can relieve the symptoms?
Decongestant drops and a course of antibiotics usually do the trick, he says.
“In 90% of cases they will work perfectly well. Most people will get better spontaneously, but of those who get antibiotics the majority will recover in a week or two.”
WHO IS PRONE TO SINUSITIS?
Those with cold viruses can be more prone to sinusitis as the sinus is inflamed and drainage is disrupted if there is swelling round the sinus outlets.
Those with allergies can be more liable to get sinusitis too for the same reasons.
“Some farmers can be allergic to dust on the farm, eg related to meal or hay or fungal spores, particularly after using bad hay or bad silage,” Mr Riley adds.
“Also animal dust, particularly an allergy to horse dust (cattle tend to cause less allergic phenomena) can trigger sinusitis.
You can also inhale fungal spores which could set off an allergic reaction from decayed bedding, straw or dung.
Nasal allergies can be dealt with by nasal steroid sprays or antihistamine tablets if it’s particularly bad, he states, for example during the harvest.
“Occasionally you get farmers who get quite severe allergy responses at the time of barley harvesting particularly and afterwards, where there are a lot of barley yanes/yawns.
“Some of those affected would use antihistamine medication around that time to alleviate symptoms, but nasal steroid sprays can help too.”
CHRONIC SINUSITIS MAY NEED
REFERRAL FOR SINUS SURGERY
While most people will recover from sinusitis after a couple of weeks, if you have recurrent episodes you may be referred to an ENT specialist.
“What would happen is that we’d put a fibre-optic scope up your nose first to see if there is any physical deformity that might be causing a sinus to be blocked.
“A very common blockage would be due to what’s called a deviation of the nasal septum.”
This is frequently found in those who were hurlers, he says.
We don’t see as many broken noses now since hurling has become safer with helmets. It used to be the most common cause of a broken nose, certainly in southeastern Ireland.
“When there is a septal deviation, the septum (the partition separating the nose into two passages) can be too bent over toward the outlet point of the sinus, thereby preventing proper drainage.”
An overgrowth of the lining of the nose could be another cause.
“That’s usually related to allergy. A CT scan would be done in that case to determine the condition of the lining of the sinus.
“If it’s particularly dense surgery might be performed with the objective of opening up the sinus and allowing it to drain properly. The nasal septum would be straightened out too if that was required.”
The opening-up-the-sinus surgery would be done as a day case in a hospital, he states. Getting one’s septum straightened usually means an overnight stay, with patients kept in until the day after surgery.
WHEN WOULD REFERRAL BE NECESSARY?
So at what point would a person be referred to an ENT specialist?
“Usually a GP would refer a person if he or she is getting three or four bouts of sinusitis a year for a couple of years, but people’s tolerance varies widely.
“Some people just put up with it throughout their life; others after one or two goes of it seek surgery.
“It’s important, though, to remember that sinusitis is common enough and that you’re not going to die of it.”
FAMILY TENDENCY FOR SINUSITIS
There can be a genetic component to sinusitis.
“There can be a familial tendency toward allergy,” he says, “and also there will be a familial tendency in the structure – the shape – of your nose inside, which might lead you to be more prone to getting recurrent infection of the sinuses.
“We’ve all got our own shape of nose, but if you are an ex-hurler you are particularly susceptible.”
REMEMBER - DON’T USE DECONGESTANT DROPS FOR TOO LONG
The Aut Even specialist says that you shouldn’t use over-the-counter decongestant drops (eg Otrivine) for more than a week if you have sinusitis, however.
“That’s because although they make you feel better at the time, they do become less effective as time goes on and using them too long can cause quite significant damage to the lining of the nose.
“Steroid drops (only available on prescription) have fewer side effects.”
FARMERS SHOULD WEAR MASKS IF AFFECTED
Wearing a mask around decayed fodder or when harvesting may help avoid allergic responses that can lead to sinusitis.
“It may help a bit in avoiding it, but masks are not always effective. A lot of people simply take an antihistamine and get on with it.”
He points out that antihistamine tablets that are now available over the counter don’t cause fatigue in the same way that older-type antihistamine medication did.
GOING OFF DAIRY PRODUCTS
NOT THE ANSWER
Sinusitis is very common, but Neil Riley informed me that going off dairy products, sometimes recommended for the condition by alternative practitioners, is not necessary.
“There is a bit of a fad for going off milk and dairy products at present, as there is a certain belief that this makes you better, but it actually doesn’t.
“Yes, dairy products have been shown to promote mucus production, but that won’t do you any harm. In most cases you will simply swallow it and that’s the end of it.
“I certainly wouldn’t be telling patients to stop drinking milk if they have sinusitis.”
Is it a cold or a sinus infection? How would you know? See Table 1 to learn the difference.
Types of sinuses
You have four sinuses in your head:
1. Two frontal sinuses (behind your forehead).2. Two higher back at either side of the bridge of your nose (ethmoid sinuses).3. Two further back in the skull (sphenoid sinuses).4. Two behind your cheekbones (maxillary sinuses).TIPS FOR COPING WITH SINUSITIS
• Use over-the-counter nasal decongestants, but not for more than a week at one time, as they can damage the lining of the nose.• See your GP about a course of antibiotics if the condition is severe and there is a temperature. CL Read more
Tackle your health costs in 2018
Farmer health: dealing with depression
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