Avoiding the common cold and chronic sinusitis

The common cold is mild on its own, but in some cases a blocked nose can lead to further infections, turning into chronic sinusitis over time. Chronic sinusitis is a much more serious condition that can permanently damage your nose. Expert rhinologist Mr Joe Marais explains how a blocked nose becomes chronic, when to see a doctor, and how to reduce your risk of further infection.

How common are sinus problems in the winter?

The common cold is a viral upper respiratory infection, and it invariably involves infection of the sinus linings. The average adult suffers 2-3 episodes per year and children may get twice that many. Sinusitis is therefore an extremely common infection which affects a very high percentage of the population during and after the common cold.

However, like most viral infections, the body recovers as the infection recedes and all reverts to normal. This is of course much more common in winter, when viral coughs and colds abound.

How sinusitis becomes chronic

In a smaller group of people, the sinuses can become infected because of a bacterial infection elsewhere. This may be because the sinus drainage pathways (the ostia) are too narrow for proper drainage of mucus to occur and therefore mucus collects in the sinuses. This is an ideal culture medium for bacteria which can quickly colonise the mucus – turning it from thin, clear mucus to thick sticky, yellow or green phlegm.

Because the sinuses are not draining properly, they are more susceptible to further infection. This sets up a vicious cycle which can cause permanent damage to the sinus’ lining, and is therefore much more serious. You may get repeated acute infections – or even constant infection symptoms that never go away. This is what we call chronic sinusitis. It cannot be resolved by short courses of oral antibiotics or nasal sprays – other medical treatment or even surgical treatment is required.

When should I see an ENT Specialist?

If you have had persistent sinus symptoms for more than a month, or they recur several times a year, you need an expert opinion. Symptoms to watch out for include:

• facial pain (especially on bending down)
• nasal blockage
• catarrh (especially if discoloured)
• headache
• facial congestion/fullness
• loss of your sense of smell.

Certainly, if your GP has not treated you with antibiotics, you need a course of appropriate antibiotics for long enough to eradicate the infection completely. Sadly, GPs are under a lot of pressure not to prescribe antibiotics for sinusitis. This is quite right in cases of viral sinusitis, but the difficulty is to know when a sinus infection is just viral or has become bacterial. The latter definitely requires antibiotics promptly and appropriately to avoid severe damage to sinus lining.

Diagnosing a blocked nose

Tips for preventing sinusitis

Many viral colds are not transmitted by droplet spread (e.g. getting sneezed on by someone), but can easily be contacted by contact spread. This is when someone who has (or is developing) a cold blows their nose, sneezes and gets some viruses on their hands. They then touch a bannister or door-handle, and the next person comes along and touches the same object, picking up the virus. This person later touches their face – transferring the virus to their mouth or nose.

To prevent this from happening to you:

• wash your hands or use a hand-sanitiser in a small bottle – this kills the germs before they are transferred to your own respiratory system.
• avoid unnecessary touching of objects in public places in winter – especially hand-rails and bannisters
• get plenty of vitamin C and maintain a good diet – this is thought to help reduce viral infection by improving your immunity.
• try to avoid those with obvious cold symptoms in winter (although it is sometimes impossible!)

If you are unfortunate enough to contract a cold:

• Try flushing your nose with saline irrigations . This is available without prescription from pharmacies and it assists in sinus drainage. This helps prevent things turning from a simple viral infection to a much worse bacterial infection.
• Alternatively, use a decongestant nasal spray for a short period of a few days.
• Keep well hydrated during common colds . This helps prevent the sinus mucus from becoming thick and sticky, which impedes drainage and is more likely to result in the dreaded secondary bacterial infection.
• Mucolytics (mucus-thinners) can also help, but must be taken several times a day.
• Smoking damages the sinus linings which impedes mucus drainage from the sinuses – so try to reduce the amount you smoke.