Sinusitis


Sinusitis

Description, Causes and Risk Factors:

Sinusitis is an inflammation (irritation and/or swelling) of the sinuses caused by low body oxygen levels (less than 20 seconds for the body oxygen test in cases of infections) due to hyperventilation (breathing at least twice more than the medical norm). Additional factors that reduce oxygen levels in cells are upper chest (thoracic) breathing and habitual mouth breathing.

Almost all people experience sinusitis at least once in their lives. The most common bacteria that cause chronic infections are the Haemophilus influenza (a bacterial species found in the respiratory tract that causes acute respiratory infections, including pneumonia, acute conjunctivitis, otitis, and purulent meningitis in children (rarely in adults in whom it contributes to sinusitis and chronic bronchitis). Originally considered to be the cause of influenza, it is the type species of the genus Haemophilus) and the Streptococcus pneumoniae (a species of Gram-positive, lancet-shaped cocci and diplococci frequently occurring in chains; cells are readily lysed by bile salts. Virulent forms are enclosed in type-specific polysaccharide capsules, the basis for an effective vaccine. Normal inhabitants of the respiratory tract, and the most common cause of lobar pneumonia, they are the most common causative agents of meningitis, and pneumonia worldwide, and also cause sinusitis, and other infections. It is the type species of the former genus Diplococcus). Severe coughs, colds and similar infections can lead into infection of the sinuses too.

Some people are also predisposed to developing nasal infections because of the structure of their sinuses. There are people with deviated or narrow nasal cavities such as the septum, concha bullosa and sinus ostia. Some studies show that people who frequently experience the condition are likely to experience more similar infections. Subsequent infections make the nasal linings more irritable and vulnerable to virus or bacteria.

Sinusitis can be triggered by viruses, bacteria, allergies and certain health conditions. However, since chronic hyperventilation is a norm in the sick, overbreathing plays the central role in development of other problems as well. It is known that overbreathing leads to tissue hypoxia, suppresses the immune system and creates conditions for new infections and chronic inflammation.

Preventive Measures: There are many things you can do to reduce your chance of developing sinusitis or to relieve early sinusitis symptoms. Here are some suggestions:

• Bathe your nasal passages daily. Run water gently into the nasal passages to help clear excess mucus and moisten membranes. Good times to do it are in the morning and at night, when you brush your teeth.

• Drink lots of water. Good hydration helps keep the mucus thin and loose.

• Inhale steam. Linger in a hot shower. Or bring water to a boil, and pour it into a pan; place a towel over your head, and carefully bend over the pan to inhale the steam.

• Avoid dry environments. A humidifier in your home (and where you work can help prevent nasal passages from drying out.

• Sleep with your head elevated. Mucus pools in your sinuses at night when your head is down, so have your head propped up during sleep.

• Be nice to your nose. Blow your nose gently, one nostril at a time. Forceful blowing can irritate the nasal passages and propel bacteria-laden mucus back up into your sinuses.

• Avoid antihistamines unless prescribed. Antihistamines make mucus thick and hard to drain.

• Be careful with decongestants. Tablets containing pseudoephedrine act on blood vessels to shrink membranes and keep nasal passages open. Nasal sprays also work well — and quickly. But using topical nasal decongestants for more than a day or two runs the risk of setting off a spiral of dependency as a result of rebound — increased swelling after the medication wears off. Oral decongestants can cause jitters and increase blood pressure, so if you have high blood pressure, don't use them without consulting a clinician first.

Symptoms:

Sinusitis can cause different symptoms for kids of varying ages. Younger kids often have cold-like symptoms, including a stuffy or runny nose and slight fever. If your child develops a fever 5-7 days after cold symptoms begin, it could signal sinusitis or another infection (like bronchitis, pneumonia, or an ear infection), so call your doctor.

Many parents mistake cold-related headaches in young kids for sinus infections. But the sinuses in the forehead don't start developing until kids are 6 or 7 years old and aren't formed enough to get infected until the early teen years, so headaches in kids who have colds usually aren't sinus infections.

In older kids and teens, the most frequent symptoms of sinusitis are a daytime dry cough that doesn't improve after the first 7 days of cold symptoms, fever, worsening congestion, dental pain, ear pain, or tenderness in the face. Sometimes teens who have sinusitis also develop upset stomachs, nausea, headaches, and pain behind the eyes.

Diagnosis:

In a primary care setting, a good history and physical examination to detect the presence of most or all of the commonly manifesting signs and symptoms can provide a reliable diagnosis of acute sinusitis. The presence of purulent secretions has the highest positive predictive value for diagnosing sinusitis clinically.

Differentiating it from a common viral URTI (upper respiratory tract illness) is most important. Mucus in URTIs is typically not described as persistently purulent. Nasal congestion is a predominant symptom without persistent or worsening head congestion, headache, or facial pain or fatigue. URTI symptoms would be expected to peak on about day 3 to 5 and resolve within 7 to 10 days. Most other diagnostic modalities, described later, aid in the differential diagnosis of persistent nasal symptoms.

Other Tests May Include:

• Radiographic Evaluation.

• Transillumination: A common practice before plain radiographs and CT scans were widely available, transillumination is of limited use and ahs a high rate of error.

• Ultrasonography: Ultrasonography has not been proved accurate enough to substitute for a radiographic evaluation. However, it may be considered to confirm sinusitis in pregnant women, for whom radiographic studies could pose a risk.

• Nasal Smear: By examining the cellular contents of the nasal secretions, one might find polymorphonuclear cells and bacteria in sinusitis. In a viral infection, these would not be found, and in allergic disease, one would expect to find eosinophils.

• Sinus Puncture: The most accurate way to determine the causative organism in sinusitis is a sinus puncture. After anesthetization of the puncture site, usually in the canine fossa or inferior meatus, the contents of the maxillary sinus are aspirated under sterile technique, and bacterial cultures are performed to identify the organism. Culture specimens obtained from nasal swabs correlate poorly with sinus pathogens found by puncture because of contamination of the swab with normal nasal flora. However, because sinus puncture is an invasive procedure, it is not routinely performed. More recently, studies have shown a close correlation between organisms found by sinus puncture and by endoscopically guided aspiration of the sinus cavities through the middle meatus. Although this needs to be done by an otolaryngologist trained in the procedure, it may be necessary for defining the pathogenic organism when standard therapy has failed or in an immunocompromised patient who is at high risk for sequelae of untreated sinusitis, such as orbital or central nervous system complications.

Treatment Options:

Majority of cases can be cured with water therapy and without antibiotics. However, if the condition is identified to be bacterial, treatment is done with amoxicillin and other anti-bacterial drugs. Conservative treatment can also be done through nasal irrigation. With a use of an irrigation device, water is allowed to pass through the sinus in and out of the nostrils. The method aids in faster draining of the harmful elements in the facial sinuses.

Treatment begins with simple remedies, such as nasal irrigation and, if necessary, progresses to more advanced strategies, such as prescription drug therapy or surgery.

Most people with acute sinusitis get better without treatment, although you can ease the symptoms and reduce the likelihood of needing stronger medicine if you keep your nasal passages clear with a few low-tech preventive techniques (see “Preventing sinusitis”). It's hard to predict who will develop chronic sinusitis, but knowing more about the two main types can help you decide how to treat your symptoms and when to see a clinician. Here are the basics:

Acute sinusitis usually starts with a cold. Viruses, not bacteria, cause colds, so it's useless to treat them with antibiotics. But when a cold turns into sinusitis, it means that blocked nasal passages have set off a secondary infection caused by bacteria and you may eventually need an antibiotic. If symptoms are severe and last for more than a week, you may want to see your primary care clinician. If you do have sinusitis, you may be prescribed an antibiotic, especially if preventive drainage strategies aren't helping.

For the pain, try a warm compress on your face, or inhale steam (see “Preventing sinusitis”). An over-the-counter pain reliever such as aspirin, ibuprofen, or acetaminophen can also relieve facial pain, as well as headache and fever.

If symptoms linger or keep returning, you may have chronic sinusitis, a more complex disorder that calls for evaluation by an ear, nose, and throat (ENT) specialist

Nasal irrigation and decongestants can help in the treatment of chronic sinusitis by keeping mucus loose and nasal passages clear. The mucus-thinning agent guaifenesin (Mucinex) is another option. Nasal steroids may be added to help counter inflammation. Oral steroids are also effective, especially in reducing large polyps, but they can have serious long-term effects, such as weakened bones and greater susceptibility to infection.

Sometimes the main problem is anatomical, such as nasal polyps, a deviated septum, congenitally narrowed paranasal passages, or tissue thickened by years of infection. In this case, minimally invasive surgery may help, reducing the number and severity of sinus infections and sometimes restoring normal sinus function.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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