Episode 155. Allergic Rhinitis and Sinusitis with Dr Andrew Martin (part 1)
Rhinitis, Sinusitis, and Rhinosinusitis are common conditions frequently seen in primary care. Studies indicate that 1.4 out of every 100 general practice encounters involve acute or chronic sinusitis, and over 2 million Australians are estimated to suffer from chronic rhinosinusitis. In some studies, this condition has shown a greater impact on social functioning than chronic heart failure, angina, or back pain.
Anatomy and Pathophysiology: The paranasal sinuses—frontal, maxillary, ethmoid, and sphenoid—are lined with ciliated epithelium and goblet cells, forming a mucociliary blanket that traps and moves harmful particles to the nasopharynx. The maxillary sinus, the largest air-filled sinus in the body, has a draining ostium only 2.4 mm in diameter, making it particularly prone to blockage during infection or inflammation. Treatment for sinusitis focuses on restoring mucociliary clearance and drainage while addressing underlying inflammation.
Acute Rhinosinusitis: The spectrum of acute rhinosinusitis (ARS) includes the common cold, post-viral ARS, and acute bacterial rhinosinusitis. Though less than 2% of viral upper respiratory infections progress to bacterial infections, antibiotics are prescribed in over 85% of sinusitis cases. Symptoms of ARS include nasal obstruction, discharge, changes in smell, facial pain or pressure, and cough. Facial pain may worsen when bending forward and can radiate to the teeth. Diagnosis requires the sudden onset of two or more symptoms, with at least one being nasal blockage, congestion, obstruction, or discharge, accompanied by facial pain or pressure and/or a reduction in smell. Nasal examination should assess for discharge (clear or purulent), polyposis, swelling, and erythema.
Chronic Rhinosinusitis (CRS): CRS presents in two forms, distinguished by the presence or absence of nasal polyps. It is defined by the persistence of symptoms for more than 12 weeks, including nasal congestion, discharge, facial pain or pressure, and reduced smell. Viral and bacterial infections are the most common causes, with Streptococcus, Pneumococcus, Haemophilus, and Moraxella being the usual bacterial suspects. Other factors such as allergies, structural abnormalities, ciliary dysfunction, immunodeficiencies, and fungal infections should also be considered.
Allergic Rhinitis: Allergic rhinitis, commonly known as hay fever, affects around 18% of Australians. Despite its name, allergic rhinitis is not caused by hay and does not result in fever. It typically presents with sneezing, itching, rhinorrhoea, nasal congestion, and lacrimation, triggered by allergen exposure. These allergens can often be identified through patient history, but RAST serology may be required when clear precipitants are not evident.
To deepen our understanding of these conditions, we welcome Dr. Andrew Martin, a practicing ENT surgeon in Melbourne's Southeastern suburbs and Northern Tasmania. Dr. Martin completed his MBBS at The University of Queensland in 2008 after earning a Bachelor of Pharmacy Sciences with Honours from Monash University in 2003. He completed his fellowship with the Royal College of Surgeons in Otolaryngology and Head and Neck Surgery in New Zealand in 2021, followed by an Advanced Fellowship in Head and Neck Surgery at The Royal Melbourne Hospital in 2022.
Dr. Martin’s specialties include nasal obstruction, obstructive sleep apnoea, ear and balance disorders, chronic sinus disease, mid-facial pain, paediatric ENT, and disorders affecting swallowing, voice, and throat. Outside of his medical practice, he is a devoted family man with two young daughters and enjoys hunting and fishing. It was a privilege to have this conversation with him as we explored rhinitis and rhinosinusitis in more detail. Please join me in welcoming Dr. Andrew Martin to the podcast.
References: