A deviated septum can obstruct breathing and is one of the commonest reason for people to visit an ENT specialist. The degree of the shift could be mild or severe—and, at times, can even deform the shape of the nose.

What causes Deviated Nasal Septum?

A person can be born with a deviated septum, which might get dislodged due to some pressure in the uterus or at the time of delivery.

In later life, it may occur due to an injury, assault or accident. It is common in people who play contact sports and hence seen more commonly in men than women.

What are the symptoms?

Although the main symptom is difficulty in breathing, symptoms can vary from being mild to severe depending upon the degree of deviation. Mild DNS, however, doesn’t lead to significant difference in appearance.

Depending on the severity of the deviation, you may have one or more of these symptoms:

• Discharge and bleeding from the nose
• Altered sense of smell
• Excessive sneezing and irritation in the nose
• Discharge from the nose, cough and change in voice
• Sinusitis and nasal polyps
• Snoring and sleep apnoea
• Chronic facial pain and headaches.

The symptoms aggravate in case of an accompanying sinus infection, nasal allergy or exposure to extreme cold environment.

How is it diagnosed?

Some tests that are used to diagnose a Deviated Nasal Septum include:

• Rhinoscopy, which is an inspection of the nose with a thin tube-like instrument that has a lens attached to its end.
• Conventional radiography such as X-ray.
• CT imaging, which is a standard diagnostic tool.
• Diagnostic Nasal Endoscopy [DNE].

A simple nasal examination may not be sufficient to evaluate the type and degree of respiratory impairment caused by DNS. For that a CT scan is required.

How is Deviated Nasal Septum treated?

Since the sinuses open in the nasal cavity, a deviated nasal septum can block the outflow of discharges from them, causing mucus to collect. And this can lead to bacterial infection of the sinuses.

Persistent nasal blockage forces you to breathe through the mouth, which can cause sore throat, mouth odour and tooth decay.

In cases of sinusitis caused by deviated nasal septum, removing the obstruction and draining the sinuses is all that is necessary to facilitate ventilation.

But mostly, treatment involves managing symptoms. The aim is to prevent complications or worsening of the symptoms. Since most people suffer from mild DNS, they respond well to non-surgical forms of therapy like anti-histamine, anti-allergy, decongestant preparations, and allergy desensitisation. However, if the symptoms do not show signs of improvement, surgery could be the way out.

Surgery involves septoplasty, a procedure that is performed entirely through the nostril. The significantly deviated portions of the septum are removed or repositioned and remodelled.

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• Acute: Up to four weeks
• Chronic: More than eight weeks [sometimes, several months, or even years].

What are sinuses

Sinuses are hollow air-filled cavities in the bones of the face, situated around the nose. Each sinus has an opening in the nose that helps in the ventilation and drainage of mucous. The sinuses also have a lining that is linked with the nose. There are tiny hair-like cells in this lining that move to and fro to drain out the mucous.

There are four sinuses:

• Above the eyes [forehead]
• On either side of the nose [cheek]
• Behind the bridge of the nose; in-between the eyes
• Above and behind the nose.

Acute sinusitis

Anything that causes swelling of the sinus lining, or prevents the hair like cells from moving the mucous, can cause sinusitis. Acute sinusitis mostly starts as common cold—usually caused by a virus. This further develops into a sinus infection, as the lining of the sinus swells, providing the perfect soil for the multiplication of bacteria. Allergy, irritation from pollutants, changes in temperature or air pressure, excessive usage of nasal decongestant drops/sprays, and smoking, predispose acute sinusitis.

Chronic sinusitis

Some experts think that chronic sinusitis is an infectious disease, while others debate about it being an allergy. Individuals with asthma or allergies—including air-borne allergens like house-dust mites, mould or pollen—are prone to chronic sinusitis. People who have had acute sinusitis and are not properly treated with antibiotics or other therapies may eventually develop chronic sinusitis.

Infection from the throat, upper jaw, and trauma to the sinuses can also cause chronic sinusitis. Poor living conditions, obstruction to sinuses due to deviation of the nasal septum, allergies, small growths [polyps] and asthma, are other predisposing factors.

Symptoms

• Aching, redness and swelling of the cheek spreading to the lower eyelid
• Swelling of the upper eyelid
• Marked swelling of the eyelids and area above and towards the root of the nose
• Fever
• Nose block
• Runny nose
• Aching in upper jaw and teeth
• Pain over the forehead, when you wake up in the morning; this gets aggravated when you bend
• Pain on the bridge of nose, between the eyes, which is increased by eye movements
• Pain at the top of the head, earache, and pain in the neck.

Diagnosis

Acute sinusitis is treated with  antibiotics, decongestant tablets and nose drops [to reduce the swelling of the nasal lining and sinus openings], anti-inflammatory and pain-killer tablets, and steam inhalation [10 minutes after instilling nose drops, 2 – 3 times a day; the ventilation of the sinuses improves after nasal decongestion]. Most patients of acute sinusitis respond well to medical therapy and rarely require surgery.

When medical treatment fails, or if your CT scan reveals extensive chronic sinusitis, surgery may be necessary.

Preventive Measures

There are certain precautions you can take to reduce the frequency and severity of sinus attacks and probably prevent acute sinusitis from becoming chronic.

• Alcohol: causes the lining of nose and sinuses to swell
• Swimming: Chlorinated water causes irritation of the nasal and sinus lining
• Diving: causes forceful entry of water into the sinuses through the nose
• Smoking: Nicotine irritates and also affects the movement of the cilia in the sinus lining
• Air travel: Use a nasal decongestant spray before take-off to avoid pressure build-up and blockage of sinuses.

Handy tips during sinusitis

• Take rest. At times lying down can increase the heaviness in the sinuses, leading to headache and nasal blockage. Rest in propped up position, or lie on the sides
• Drink plenty of liquids, especially warm fluids [e.g., soups]
• Steam inhalation: 2 – 3 times/day
• Rinse the nasal cavity with saline solution. This helps in removing the thick sinus discharge.

This was first published in the December 2013 issue of Complete Wellbeing.

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If the cough persists for a prolonged period [even after the cold has subsided], it can lead to pain in the throat, neck and back, as well as nausea.

A cough that lasts for less than three weeks is most often caused by infections, such as pneumonia, or due to exposure to pollutants or allergens. It will subside once exposure to the pollutant is stopped or if the infection is treated with antibiotics.

A cough that persists for more than three weeks is termed as chronic and may be due to asthma, allergic rhinitis, sinus infection, oesophageal reflux. In case of a chronic cough, you must seek medical attention. Along with fatigue caused by sleep interruptions, it could also lead to chest pain, stomach pain, worsening of hernias and urinary incontinence.

When should you worry?

Chronic cough: Smoking is one of the main causes of a chronic cough, lending it the name ‘smoker’s cough’. However, even non-smokers are susceptible; the most probable causes in this case being post-nasal discharge, chronic bronchitis and acid reflux from the stomach. If the cough lasts for more than three weeks and produces thick sputum, appropriate blood tests and a chest X-ray are necessary to diagnose tuberculosis. Usually, if it is a case of TB, other symptoms such as evening fever, weight loss and fatigue will also be observed.

Cough with breathlessness: This could be due to asthma, and can be ruled out with the help of lung function tests. In case these tests are inconclusive, another way to diagnose if the cough is due to asthma would be to check if you respond to anti-asthma medications.

Cough with blood: This could be due to throat or lung cancer. In less serious instances it could be because of irritation of the lining of the air passages. With every bout of cough the lining of the airways get ruptured and causes some bleeding. At times blood from a stomach ulcer may be coughed up and may cause confusion about the source of bleeding.

Chronic cough in the elderly could be due to disorder called gastro oesophageal reflux disease [GERD], in which the acid from the stomach travels up leading to irritation of the upper oesophagus, pharynx and larynx causing cough.

After effects of a chronic cough:

• Pain in the ribs: In those with brittle bones or osteoporosis it may even lead to fractures in the ribs.
• Loss of sleep: In cough that gets worse on lying down sleep may get disturbed because any attempt to recline can result in a bout of coughing.
• Headache: Cough associated with cold or sinusitis may cause a throbbing headache especially in the temples and forehead. Excessive coughing may also cause pain in the neck.
• Urinary incontinence: This is more common in women. Coughing causes an increase in the abdominal pressure and this causes some urine to leak out.
• Exhaustion: Severe coughing can be tiring.
• Inability to focus on work.
• Worsening of hernia: Continuous and severe cough can cause or worsen hernias in those with weak abdominal muscles.

In case of chronic cough, visit your doctor, diagnose the cause and get it treated accordingly. Neglecting or self medication in this case can be dangerous.

This was first published in the September 2012 issue of Complete Wellbeing.

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Sinusitis is the inflammation of the lining of the sinuses—the air spaces present in our skull. There are four pairs of sinuses: one pair just above the eyebrows, two pairs around the eyes, and one pair in the cheeks.

Inflammation of the sinuses can occur due to various reasons like infections, allergens like dust particles, dry environment [like when using air conditioners], smoking and consumption of alcohol.

Some common allergens that cause sinusitis include pollens, mould spores, house dust, mite excreta, epidermis and saliva of furred pets and cockroach bodies.

Symptoms of sinusitis include cold with a thick discharge from the nose, severe headache especially early in the morning, tiredness and body ache.

Early morning headache is typical of sinusitis and this differentiates it from other forms of headache, which persist through the day. Puffy eyes and tenderness are other signs of sinusitis.

Sinusitis can be acute or chronic. Acute attacks resolve in a week to ten days but chronic cases persist. In chronic sinusitis symptoms may not be intense always but may get exacerbated due to triggers such as seasonal changes or certain allergens.

Often, sinusitis also worsens asthma. And when it is identified and corrected, the asthma also improves significantly. Those suffering from sinusitis may experience difficulty in breathing as a result of nasal congestion.

High risk factors for developing sinusitis include infections, foreign particles, medical interventions involving the nasal passage or dental procedures, exposure to respiratory tract irritants, allergic rhinitis and nasal polyps [nasal tumour].

Sinusitis is diagnosed using physical examination and computed tomographic scanning, which helps understand the degree of sinusitis.

Treatments options include antibiotic and pharmacologic therapy for acute sinusitis. In case of chronic sinusitis, the triggering factor has to be identified and treated. In case of people who still experience recurrent infections, surgical intervention may be considered. One surgery that is widely used to treat sinusitis nowadays is Functional endoscopic sinus surgery [FESS]. This surgery has largely revolutionised the way sinusitis is treated, as it is minimally invasive.

Sinusitis can be prevented by identifying and avoiding the factors that trigger the disease and consuming a diet rich in vitamin C.

Try this

• Soak fenugreek seeds in water overnight. Boil them till the water reduces to half. Consume the water twice a day to find relief.
• Inhale garlic or eucalyptus oil.
• Consume one teaspoon of ginger juice twice a day.

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