Sinus & Nasal Issues

Allergic rhinitis is an immune response to allergens — pollen, dust mites, pet dander, mould — causing sneezing, watery nasal discharge, nasal congestion, and itchy eyes. It is not an infection. Sinusitis is inflammation of the sinus cavities — usually from a viral or bacterial infection but sometimes from allergy or structural problems — causing thick coloured discharge, facial pain and pressure, reduced smell, and congestion. They frequently overlap: poorly controlled allergic rhinitis inflames the sinus openings and predisposes to sinusitis. Treatment differs: allergic rhinitis is managed with antihistamines, intranasal corticosteroid sprays, and allergen avoidance; acute bacterial sinusitis may need antibiotics (though most acute sinusitis is viral). Nasal corticosteroid sprays benefit both conditions.

Nasal corticosteroid sprays (fluticasone, mometasone, budesonide) are the most effective treatment for allergic rhinitis and chronic sinusitis — but they are widely used incorrectly, reducing effectiveness. Correct technique: blow your nose first. Shake the bottle. Tilt your head slightly forward (not back — that causes the medication to run down the throat). Direct the spray toward the outer wall of the nostril (away from the nasal septum) — pointing toward the ear on that side. Breathe in gently through the nose as you spray. Don't sniff hard. Breathe out through the mouth. Repeat in the other nostril directing toward its outer wall. These sprays take 1-2 weeks of consistent use to reach full effect — don't judge them after one dose. They are safe for long-term use at prescribed doses.

Nasal polyps are soft, non-cancerous growths that develop from inflamed nasal or sinus lining — they look like small grapes and cluster near the sinus openings. They cause persistent congestion, significantly reduced or absent sense of smell, post-nasal drip, and recurrent sinusitis. They are strongly associated with allergic rhinitis, asthma, and aspirin sensitivity. Treatment starts with high-dose nasal corticosteroid sprays and, in more severe cases, short courses of oral steroids — these shrink polyps effectively. Newer biologic treatments (dupilumab) are highly effective for severe polyps with asthma. Surgery (FESS — functional endoscopic sinus surgery) removes polyps when medical treatment fails, but polyps recur in 40-60% of patients without ongoing medical treatment. Surgery and medical treatment work best together.

A deviated septum — where the wall between the nostrils bends to one side — is present in the majority of people to some degree. Most cause no problems at all. Surgery (septoplasty) is indicated only when the deviation is causing significant symptoms that don't respond to medical treatment: persistent nasal obstruction on one side, recurrent sinusitis due to blocked drainage, sleep disruption from severe obstruction, or nosebleeds from exposed dry mucosa on the deviation. It is not cosmetic surgery (that's rhinoplasty) unless the external shape of the nose is also being altered. Recovery is 1-2 weeks. Results are good for obstruction but surgery doesn't 'cure' allergies — if allergic rhinitis is the main driver, medical treatment matters more.

Yes — loss of smell (anosmia) or reduced smell (hyposmia) is one of the most distressing symptoms of chronic sinusitis and nasal polyps. It happens because swelling and polyps physically block the olfactory cleft (where smell receptors are located) and because chronic inflammation damages the receptor cells. With effective treatment — nasal steroids, systemic steroids when needed, and surgical clearance if polyps are large — smell often returns partially or fully, though recovery can take months. Post-COVID anosmia is a distinct mechanism (direct nerve damage) and recovers differently. Smell training — deliberately sniffing four different essential oils twice daily for months — has the best evidence for post-viral smell loss and is increasingly recommended for post-sinusitis smell recovery too.