Is it sinusitis or COVID-19?

It is crucial to differentiate sinusitis and COVID-19 since their symptoms overlap and especially at a critical time when the healthcare system is stretched to accommodate a surge in COVID-19 cases.

Headache, fever, blocked and/or runny nose, fatigue, and loss of the sense of smell can be observed in patients with sinusitis as well as those with COVID-19. In both groups, the nasal passages are affected but awareness of both conditions helps healthcare professionals (HCPs) distinguish one from the other.

Consultant ENT and head and neck surgeon Dr Chai Chiun Kian emphasized that when patients present with loss of smell or taste, HCPs should have a high index of suspicion for COVID-19.

“A significant number of patients with proven COVID-19 infection [develop a] loss of smell. In more serious cases, patients may experience shortness of breath when the disease has progressed to the lungs, resulting in pneumonia. In contrast, symptoms of sinusitis are typically centred around the nose and the throat, and rarely cause shortness of breath,” said Chai.

He pointed out that while both conditions will require medical attention at varying degrees, patients suspected to have either condition should be attended to immediately. It is advisable for patients with nondistinguishable symptoms to go for a COVID-19 real-time polymerase chain reaction (RT-PCR) test, which would confirm the diagnosis.

Early treatment is ideal
Sinusitis is defined as an inflammation of the mucous membrane that lines the paranasal sinuses. Recurrent sinusitis may be caused by allergic rhinitis or structural abnormalities in the nose that affect drainage of the sinuses.

Common symptoms of sinusitis include unusual nasal discharge, nasal congestion, facial pain in the forehead and cheek areas, and headaches. The assessment is done in the outpatient clinic, where a nasal endoscope is used to examine the patient’s nasal cavities. Based on the findings, the patient will then be advised by the specialist on the corresponding medical or surgical treatment. Treating patients as soon as the diagnosis is confirmed, is the best way to resolve sinusitis without additional complications.

According to Dr Tang Mee Ling, also a consultant ENT and head and neck surgeon, patients should be advised to keep their sinuses healthy by maintaining good ventilation and eliminating risk factors such as air pollution, dust mites, and cigarette smoke. There are several home remedies that patients can be encouraged to conduct at home if their symptoms are not very severe.

“Steam inhalation and nasal saline irrigation may help to reduce nasal congestion and nasal discharge by hydrating the nasal cavity. Eating food highly seasoned with garlic can provide short-term decongestant effect. To reduce facial pain, applying warm towel around nose, cheek and eyes may provide certain degree of pain relief. However, if nasal symptoms persist or fever is present, it is advisable to seek medical treatment early,” said Tang.

Surgical intervention, such as septoplasty, polypectomy, inferior turbinate hypertrophy, functional endoscopic sinus surgery (FESS) and adenoid curettage, may even be required to reduce the symptoms.

Complications of sinusitis
It is dangerous to delay treatment for sinusitis, especially in immunocompromised patients with high blood glucose levels. The infection may worsen and spread beyond the bony walls of the sinuses into the surrounding structures like the eyes, brain, ears, and throat, or even worse, abscesses may form. This can lead to orbit abscesses, meningitis, brain abscess, middle ear infection, and pharyngitis.

The key indicators of complications are high fever and chills while meningitis may cause the patient to become drowsy, have seizures and even lapse into a coma due to increased pressure in the brain. Hospitalization, intensive care, and high doses of intravenous antibiotics will then have to be administered, and surgeries performed to drain the abscess, said Tang.

“It is paramount to see an ENT specialist if your ‘flu’ does not go away within 1–2 weeks or is worsening despite taking the usual flu medication. Early sinusitis treatment is always better than treating sinusitis complications,” said Tang.