“Sinusitis should be more correctly called rhinosinusitis, precisely because there is an implication not only of the nose, but also of the paranasal sinuses; the nose and the paranasal sinuses are in fact two communicating environments through a labyrinthine pathway”: to specify and talk about rhinosinusitis “il mio medico” presents Dr. Luca Malvezzi, otorhinolaryngologist and specialist in cervical facial surgery in Humanitas, as guest in the studio on TV2000.

“In the presence of a congestion of the nasal pits mucus is produced, the nose closes with consequent difficulty in breathing and we develop a cold also with a sharing of the neighboring rooms (the sinuses or more precisely paranasals), which at the same time produce mucus and become congested. The symptomatological picture therefore gradually increases: we lose our sense of smell, we have ear congestion, we feel that our head is heavy and sometimes the mucus is over-infected because the environment is not healthy but colonized by bacteria; in this case the mucus becomes yellow and at this point we need to treat this condition seriously”, said the specialist.


What are the causes of rhinosinusitis?

“We don’t know all of them yet; surely the thermal shock is a shock for our organism and also for the nasal-sinus environment. Several factors are known, but we still do not have the complete picture regarding the diagnosis and treatment of rhinosinusitis, especially in its most complex forms. The picture is particularly difficult because the nasal-sinus environment can be complicated both from an anatomical point of view and by the presence of important cofactors (such as spring, with the arrival of allergies, as well as the end of the summer period or pollution) favoring the inflammation of the nose and the paranasal sinuses”.


When should I contact my doctor?

“In general, the common cold passes by on its own without any need for therapy. However, it is important to make patients and family doctors aware of the repetitiveness of the symptomatology over the course of the year and years and of the continuity of the symptomatology itself. It is therefore advisable to consult your specialist if the cold includes yellowish mucus, if it occurs several times a year or if it lasts longer than 12 weeks.

Today, chronic rhinosinusitis and recurrent rhinosinusitis are considered more important diseases than in the past, also because they are related to other problems of our body: very frequently rhinosinusitis is related to an immunological panel that is not properly adequate, or to diseases of the lower respiratory tract; the link between the upper and lower respiratory tract is very important, as is the link between chronic rhinosinusitis and asthma, on which we need to raise awareness,” explained Dr. Malvezzi.


How is rhinosinusitis treated?

“If rhinosinusitis is bacterial (and therefore we no longer have a viral cold), we need antibiotic therapy, to which cortisone must be added in some cases. The communication between nose and sinuses is in fact very close, here the mucosa becomes congested and swollen, preventing the entry of air into the sinuses with consequent impediment in the drainage of mucus and therefore the anti-edema effect of cortisone helps to have a faster evolution towards healing.


When do I need surgery?

“In this case, we have many changes over the past. Chronic symptomatology frequently leads the patient to the surgical solution, but it is important to note that there are different forms of rhinosinusitis. The most important one from the point of view of inflammation is rhinosinusitis with nasal polyps, considered in a certain sense the model of chronic inflammation. It is also the form most frequently associated with comorbidities such as allergy and asthma, more resistant to surgical treatment and more frequent relapses.

Surgery therefore plays a fundamental role in the control of symptoms, but it must be accompanied by cortisone, which for years has been the only drug capable of positively modifying the symptoms of the sinus patient.

Today, however, we are beginning to have some biological drugs, still in an experimental phase, which act at the level of inflammation more precisely than cortisone,” said the specialist.


Daily nasal washings for prevention

“The first rule is to sensitize oneself with regard to one’s own symptomatology; I recommend performing daily nasal washing, also with simple saline, in order to remove the substances that we breathe and that can be irritating because they impact negatively on the nasal mucosa, but also with the objective to liquefy the mucus, thus helping the nasal mucosa itself to transport the mucus in a more effective way”, concluded Dr. Malvezzi.


Watch the full interview with Dr. Luca Malvezzi, click here.