Is It Sinusitis or Allergic Rhinitis? Here’s How To Tell The Difference

Living in an urban environment can often mean dealing with various respiratory issues, - thus distinguishing between them is crucial for effective treatment. Two common ENT conditions, sinusitis and allergic rhinitis, frequently cause significant discomfort and inconvenience. They not only share similar symptoms but also greatly affect one’s quality of life, making it essential to understand their nature and differences.

Singapore’s hot and humid climate [1], combined with urban pollution, significantly influences respiratory health among its residents. Sinusitis is best characterised as inflammation or swelling of the mucosal lining of the sinuses that surround our nasal airways. This often results from blockages filled with fluid where micro-organisms (like bacteria and fungus) can grow, leading to infections. Factors contributing to sinusitis include allergies, nasal polyps, or a deviated septum.

Allergic rhinitis [2] is another condition similar to sinusitis but with different causes. In casual conversation, this is commonly referred to as “sinus issues” - however, most people are in fact, referring to their allergic rhinitis related symptoms. A common misconception is that this allergic condition is caused by dust or temperature change. In reality, this condition is actually triggered by specific airborne allergens such as house dust mites, pollen, animal dander or fungus. Allergic rhinitis affects a substantial portion of the population worldwide and if left untreated, it can lead to poorer quality of life and predispose patients to more serious health problems.

In a city like Singapore, where high humidity and air quality fluctuate significantly, these conditions can be particularly exacerbated. Understanding the differences between sinusitis and allergic rhinitis is essential for proper management and to prevent them from progressing into more severe complications.

Sinusitis and allergic rhinitis share similar symptoms

What is Sinusitis? Symptoms and Causes

Sinusitis can be classified into several types – acute, chronic, and recurrent. Each type varies in underlying cause, as well as duration :

Acute Sinusitis typically lasts for up to 12 weeks (3 months) and often starts as a viral infection such as a common cold and then turns into a secondary bacterial infection.
Chronic Sinusitis lasts for 12 weeks or longer and can persist for months, or even longer. This is a different condition from acute sinusitis, where the cause is not necessarily infection. This is an immune-system-mediated condition which causes ongoing sinus symptoms and can lead to nasal polyp formation.
Recurrent Sinusitis occurs when there are more than 3 episodes of acute sinusitis within a year. Patients often describe recurrent periods of significant sinus symptoms, interspersed with short periods of feeling well.

Symptoms of sinusitis can range from mild to severe including:

Nasal congestion or blockage, leading to difficulty in breathing through the nose
Thick nasal discharge (yellowish or greenish, sometimes brown) and post-nasal drip
Pain and swelling around the eyes, cheeks, nose, or forehead
Aching pain in the upper jaw and teeth
Reduced or loss of sense of smell and taste
Cough or throat irritation, especially at night
Ear pain
Headache
Bad breath
Fatigue or irritability
Fever

Common causes of Acute sinusitis include viral infections such as the common cold, bacterial infections, fungal infections, and environmental irritants such as cigarette smoke and air pollution. Structural issues like a deviated septum, nasal polyps, or tumours can increase the chances of developing Acute Sinusitis by predisposing the person to develop obstruction of the nasal passages.

Sinusitis refers to the inflammation or swelling of the tissue lining the sinuses.

What is Allergic Rhinitis? Symptoms and Triggers

Allergic rhinitis is commonly divided into two types; seasonal (occurs at specific times of the year) and perennial (occurs year-round). The distinction between the two depends on the allergen. Seasonal allergic rhinitis is typically triggered by outdoor allergens like pollen from trees, grasses, or weeds. Perennial allergic rhinitis, on the other hand, is usually triggered by indoor allergens such as dust mites, pet hair or dander, cockroaches, and mould. Another classification according to ARIA classifies this condition into intermittent or persistent disease based on severity (mild vs moderate/severe).

Symptoms of allergic rhinitis include:

Sneezing
Running nose or rhinorrhea
Nasal congestion or stuffy nose
Itchy eyes, nose, or throat
Watering eyes
Puffiness under the eyes
Frequent headaches
Association with other allergic conditions (eczema, asthma, certain food allergies)
Excessive fatigue

Exposure to allergens is the primary trigger for allergic rhinitis symptoms. These can be exacerbated by other factors such as smoke, pollution, or weather changes. Treatment includes avoiding known allergens (Trigger avoidance) and anti-allergy medications to reduce symptoms using decongestants and other medications. However, the best option for longer-lasting management of the underlying cause of the allergy is to consider Allergen Immunotherapy - this comes in the form of either tablets or drops under the tongue taken once daily.

Allergic Rhinitis is an allergic response to specific allergens.

Comparing Sinusitis and Allergic Rhinitis: The Major Differences

Understanding the key differences between sinusitis and allergic rhinitis can help in identifying the appropriate treatment approach. The table below presents a detailed comparison between the two:

Characteristics	Sinusitis	Allergic Rhinitis
Type of Discharge	Thick, smelly, coloured nasal discharge (yellow/green)	Thin, clear nasal discharge, watery
Onset of Symptoms	After a common cold or other viral respiratory infection	Exposure to allergens
Symptom Timing	Symptoms persist or worsen over time	Symptoms are episodic, often aligning with allergen exposure
Duration	Lasts a few weeks to several months	Can be seasonal or persist year-round depending on allergen exposure
Facial Pain	Common around the forehead, cheeks, and nose	Rare; mild discomfort may occur
Fever	May be present, especially in acute cases	Rarely associated
Smell and Taste	Often affected, sometimes complete loss of smell	Usually not affected unless congestion is severe
Triggers	Infections, structural nasal problems, pollutants	Specific allergens like pollen, dust, pets
Treatment Approach	May include antibiotics, nasal corticosteroids, endoscopic sinus surgery	Antihistamines, nasal corticosteroids, allergen avoidance, allergen immunotherapy

This table highlights how sinusitis is generally more associated with infection or physical blockages in the nasal passages (especially for Acute Sinusitis), whereas allergic rhinitis is tied to immune system reactions to environmental allergens.

Prevention Tips: How to Avoid Sinusitis and Allergic Rhinitis in Singapore’s Climate

Given the challenges posed by Singapore’s climate, there are several preventive measures we can take to mitigate the effects of sinusitis and/or allergic rhinitis:

For Sinusitis:

Stay hydrated to help keep mucous membranes moist and healthy to prevent infections.
Avoid exposure to irritants such as tobacco smoke, air pollutants, and strong chemicals.
Practice good hand hygiene to reduce the risk of catching or spreading viral infections.
Manage allergies effectively to avoid complications that can lead to sinusitis.

For Allergic Rhinitis:

Monitor local air quality and pollutant forecasts and stay indoors when levels are high.
Use HEPA filters [3] in air conditioners and vacuum cleaners to reduce indoor allergens.
Keep windows closed during high pollution periods to prevent allergens from entering your home.
Shower and change clothes after being outdoors to remove allergens.
Strongly consider allergen immunotherapy to decrease sensitivity to allergens over time.

Allergic Rhinitis is characterised by an inflammation of the nasal passages.

Diet and Lifestyle in Managing ENT Disorders

Diet and lifestyle play a crucial role in the management and prevention of ENT disorders [4], particularly those related to the nasal passages and sinuses. A balanced diet, adequate hydration, and healthy lifestyle choices can all contribute to better nasal health and reduced symptoms.

Dietary Recommendations: Including anti-inflammatory foods in one’s diet can help manage and prevent symptoms of sinusitis and allergic rhinitis. Foods rich in omega-3 fatty acids, such as salmon and flaxseeds, as well as fruits and vegetables high in antioxidants, can reduce inflammation. Staying well hydrated helps keep the mucous thin and less likely to cause clogging of the nasal passages.
Reducing Allergen Exposure: Lifestyle adjustments are essential for those with allergic rhinitis. This includes using allergen-proof [5] mattress and pillow encasements, regularly cleaning filters in air conditioning units, and avoiding smoking and exposure to secondhand smoke. Maintaining a clean home environment to reduce dust mites and pet dander is also crucial.
Holistic Approaches: Incorporating yoga [6] and other forms of exercise can improve overall health and help manage stress, which may exacerbate ENT symptoms. Techniques like nasal irrigation [7] with saline solutions (in the short term) can be highly effective in keeping the nasal passages clear of irritants and allergens.

By understanding and implementing these dietary and lifestyle modifications, individuals can significantly improve their ENT health, reducing the reliance on medications and possibly avoiding more invasive treatments. These proactive measures support the medical treatments provided by ENT specialists in Singapore and are essential components of a comprehensive approach to managing nasal and sinus health.

Treatment Options for Sinusitis and Allergic Rhinitis

In Singapore, patients benefit from a diverse array of treatment options tailored to effectively manage and treat sinusitis and allergic rhinitis. The country's robust healthcare system ensures that both conventional and advanced treatments are accessible, enhancing the capabilities of ENT specialists to provide targeted and efficient care.

Medications: The choice of medication depends on the underlying cause and severity of the symptoms. Common treatments include:

Decongestants to reduce nasal congestion.
Antibiotics are prescribed in selected cases, for persistent bacterial sinusitis.
Antihistamines and nasal corticosteroids are used to control nasal allergies and reduce inflammation in the nasal passages.

Surgery: For chronic sinusitis or severe/recurrent cases of Acute sinusitis, particularly when caused by physical obstruction like nasal polyps or a deviated septum, surgical intervention may be required. Functional endoscopic sinus surgery (FESS) is a minimally invasive option that allows surgeons to access the sinuses through the nasal passages to remove blockages, improve drainage, and restore normal function.

Immunotherapy: This treatment is particularly beneficial for patients with allergic rhinitis. It involves gradually increasing doses of the specific allergen to desensitize the body’s immune response. This treatment is the only one that deals with the underlying cause of the allergy, modifying the immune system, to cause desensitization over time, with significant reduction or resolution in the severity of the allergic symptoms over time. Unlike other treatments, once this treatment course is completed, symptoms usually do not recur. Immunotherapy also has been proven to have the significant benefit of reducing the likelihood of developing new allergies or other allergy-related conditions such as Asthma.

Advanced ENT Technologies and Treatments:

Minimally Invasive Sinus Surgery: The use of endoscopic techniques has revolutionised sinus surgery. These procedures are less invasive, which helps reduce recovery time and discomfort.
Allergy Testing and Treatments: Recent advancements in allergy diagnostics allow for specific identification of triggers, which can be particularly helpful for crafting personalised treatment plans, which include allergen immunotherapy.

This comprehensive approach allows for a personalised treatment regimen that addresses both the immediate symptoms and the underlying causes of sinusitis and allergic rhinitis, leading to better health and improved quality of life for patients.

When to Visit an ENT Specialist in Singapore

Seeking professional advice from an ENT specialist is recommended when:

Symptoms are resistant to over-the-counter treatments or persist despite self-management strategies.
There's a significant impact on your quality of life, such as persistent sleep disturbances, fatigue, or poor concentration.
You experience warning signs of more severe conditions, such as severe sinus pain, vision disturbances, swelling around the eyes, or a high fever.
You suspect chronic or recurrent sinusitis or you need specialised care such as immunotherapy for allergies.

Consistent follow-up with an ENT specialist can lead to better-tailored and more effective treatment plans for both sinusitis and allergic rhinitis. ENT specialists can provide advanced diagnostic tests, more specialised treatments, and ongoing support for chronic issues, enhancing overall nasal health and improving the quality of life for those suffering from these common conditions.

With proactive management and professional care under ENT Specialists like Dr. Soma, individuals can improve their sinus and nasal health, leading to more comfortable and productive lives despite the challenges of Singapore's climate and fluctuating environmental pollutants.

Reference:

[1] Grigorieva, E., & Lukyanets, A. (2021). Combined Effect of Hot Weather and Outdoor Air Pollution on Respiratory Health: Literature Review. Atmosphere, 12(6), 790. https://doi.org/10.3390/atmos12060790

[2] Cleveland Clinic. (2023). *Sinus infection (Sinusitis): Causes, symptoms & treatment*. https://my.clevelandclinic.org/health/diseases/17701-sinusitis

[3] Dunkin, M. A. (2022). HEPA filters for allergies. WebMD. Medically reviewed by Nayana Ambardekar, MD. https://www.webmd.com/allergies/hepa-filters-for-allergies

[4] Juszczak, Hailey M., and Richard M. Rosenfeld. "Lifestyle Medicine and Otolaryngology: Embracing the Future." OTO open 5.4 (2021): 2473974X211059091 https://journals.sagepub.com/doi/full/10.1177/2473974X211059091

[5] Mayo Clinic. (2022, December 22). Allergy-proof your home. https://www.mayoclinic.org/diseases-conditions/allergies/in-depth/allergy/art-20049365

[6] Abishek, K., Bakshi, S. S., & Bhavanani, A. B. (2019). The Efficacy of Yogic Breathing Exercise Bhramari Pranayama in Relieving Symptoms of Chronic Rhinosinusitis. International Journal of Yoga, 12(2), 120-123. https://doi.org/10.4103/ijoy.IJOY_32_18

[7] Cafasso, J. (2019, January 28). How to do a sinus flush at home. Healthline. Medically reviewed by J. Keith Fisher, MD. https://www.healthline.com/health/sinus-flush#_noHeaderPrefixedContent