Disrupted sleep, steroid psychosis

How chronic rhinosinusitis with nasal polyps, often misdiagnosed or missed altogether, affected hawker's life

- Amrita Kaur

When Mr Ho Kian Thong began coughing persistently at night in 2015, he chalked it up to a passing illness. He did not think much of it until disrupted sleep and shortness of breath prompted him to see a respiratory specialist.

Mr Ho, who sells prawn noodles and laksa at Sims Vista Market & Food Centre, was diagnosed with asthma.

Realising that he also had sinus symptoms like nasal congestion and loss of smell, the doctor referred him to an ear, nose and throat (ENT) specialist.

The 71-year-old hawker was diagnosed with chronic rhinosinusitis with nasal polyps (CRSwNP). It is a long-term condition where soft, benign growths - nasal polyps - develop in the sinuses.

These polyps block airflow and drainage, leading to symptoms like constant nasal congestion, facial pressure, thick mucus and a diminished or lost sense of smell.

Unlike a cold, these symptoms linger for months, often becoming part of a patient's new normal, says Dr David Chin, a consultant ENT surgeon at Ascent Ear Nose Throat Specialist Group.

There is a strong link between CRSwNP and asthma. Up to 60 per cent of people with CRSwNP also have asthma. "That's because both conditions are driven by the same type of airway inflammation," says Dr Chin.

Among patients referred for sinus issues, he says CRSwNP accounts for roughly 30 per cent of cases, especially in adults aged 30 to 65.

"It is often under-recognised in primary care settings, but makes up a large part of the caseload in a subspecialist rhinology practice," adds Dr Chin.

OFTEN MISDIAGNOSED CRSwNP is often misdiagnosed or missed altogether, mainly due to a lack of awareness about the diagnosis.

"Since polyps form deep in the nose, they aren't visible without nasal endoscopy. Some patients seek help only when their sense of smell has been gone for months or even years," says Dr Chin.