Sinusitis

SINUSITIS

Sinusitis is an incredibly common patient complaint. The thinking and understanding around sinusitis is changing.

The paranasal sinuses are a collection of air containing pockets in the frontal, ethmoid, sphenoid and maxillary bones.

ACUTE SINUSITIS

Acute sinusitis presents in one of two classic fashions. The first is on the tail of an acute upper respiratory tract infection (URI). Rhinitis in the form of an acute upper URI, Virtually everyone suffering from an upper URI initially develops a clear nasal discharge emanating both from the nose and the paranasal sinuses. This invariably develops into a bacterial super infection, manifest clinically as a green or yellow mucopurulent nasal discharge. During the upper URI, many patients have signs and symptoms of paranasal sinus disease. These include pressure, pain, nasal congestion, purulent rhinorrhea, both anterior and posterior, presenting as a postnasal drip. If following upper respiratory infection which is viral usually symptomatic treatment is enough.This includes oral & topical decongestants & steam inhalations.

If symptoms persist antibiotics are considered.

The other classic case of acute sinusitis is the individual with allergic rhinitis. Typically the allergic rhinitis worsens during the allergic season. Because one or another of the sinus ostia is obstructed, infection ensues and the patient develops acute sinusitis. This infection is exactly the same as that seen at the tail end of an URI. The evaluation and management are identical.

CHRONIC SINUSITIS

The thinking regarding chronic sinusitis has evolved rapidly in the past quarter century. We use to view sinusitis as a bacterial disease and research was focused on identifying the bacteria and prescribing the best antibiotic. Chronic sinusitis is not a bacterial disease, it is an illness caused by dysfunction of the mucociliary transport system and by osteal obstruction, either anatomic or inflammatory.

Endoscopic sinus surgeries are performed the gold standard in surgical management of chronic sinusitis.

ALLERGIC RHINITIS

The most common inflammatory nasal disorder is allergic rhinitis. Allergic rhinitis presents with itchy nose, sneezing, itchy eyes, congestion and a clear or white nasal discharge. The condition may be seasonal or perennial.

First and foremost part of management is environmental control. If specific allergens such as pets are present in the house, they should be removed, but in addition, almost everyone with an allergic diathesis has sensitivity to molds, fungi, mites, dust, and so forth, and to whatever degree the home and work environment can have their allergic load reduced, the patient will do better.

The most powerful allergic nasal medications available today are the nasal steroids.

There is no surgical therapy for allergy, but those individuals with compounding problems such as a deviated nasal septum or bacterial sinusitis may be advised to consider surgical correction of those problems.

Sinuses and Sinusitis

Sinuses are air-filled spaces in the bones of the face and head. They are connected to the inside of the nose through small openings. The sinuses are important in the way we breathe through the nose and in the flow of mucus in the nose and throat.

When the sinuses are working properly we are not aware of them but they often are involved in infections and inflammations which cause symptoms. These infections and inflammations are called sinusitis. Sinusitis is caused by blocked, inflamed or infected sinuses. Patients will often complain of a blocked nose, pressure or congestion in the face, runny nose or mucus problems. Other symptoms include headache and lose of sense of smell. Sinusitis can be difficult to diagnose and your specialist will want to examine your nose with a telescope in order to help find out what is wrong. Most patients with sinusitis get better without treatment or respond to treatment with antibiotics or nose drops, sprays or tablets. In a very small number of patients with severe sinusitis an operation may be needed. In rare cases if sinusitis is left untreated it can lead to complications with infection spreading into the nearby eye socket or into the fluid around the brain. These very rare complications are just some of the reasons that a sinus operation may become necessary.

What is endoscopic sinus surgery or FESS?

Endoscopic Sinus Surgery is the name given to operations used for severe or difficult to treat sinus problems. In the past sinus operations were done through incision (cuts) in the face and mouth but endoscopic sinus surgery allows the operation to be performed without the need for these cuts. Before any operation patients will be treated using drops, tablets or sprays for a period of weeks if not months. Only if these treatments are unsuccessful will an operation become necessary. After an examination of your nose with a telescope your surgeon will discuss whether or not you will need to have a CT scan to help decide about the need for an operation.

What if I don’t have the operation?

Endoscopic sinus surgery is only one approach to the treatment of sinusitis. Endoscopic sinus surgery is as safe, and possibly safer, than other methods of operating on the sinuses.

The other methods of operating on the sinuses involve cuts in the face or mouth and if you feel that this maybe more appropriate in your case you should discuss this with your surgeon. In some patients an operation can be avoided by use of antibiotics and steroid medicines, again this should be discussed with your surgeon.

Nasal corticosteroid sprays

A nasal corticosteroid spray is a treatment prescribed for allergic rhinitis. The medicine in the spray is placed directly in the nose to help reduce symptoms and make breathing through the nose easier.

HOW NASAL CORTICOSTEROIDS HELP YOU

Nasal corticosteroid sprays help to reduce swelling and mucus in the nasal passageway and relieve other bothersome nasal symptoms. The sprays work well:
For people with allergic rhinitis symptoms, such as congestion, runny nose, sneezing, itching, or swelling of the nasal passageway
To treat nasal polyps (benign growths in the lining of the nasal passage)
Nasal corticosteroid sprays are different from the sprays you can buy at the store without a prescription. They work best when used every day without stopping.

It may take two weeks or more for your symptoms to improve the most. Be patient. Relieving the symptoms can help you or your child to feel and sleep better and have fewer symptoms during the day.
You may also use them on an as-needed basis only, or as-needed along with regular use. Regular use, however, will typically give you better benefit.
Starting nasal corticosteroids at the beginning of a pollen season will give you the best results in decreasing symptoms during that season.
Several brands of nasal corticosteroids are available, such as Flixonase or Furamist. There various other brands in the market-all equally effective.They all have very similar effects.

HOW TO USE NASAL CORTICOSTEROIDS

Make sure you understand your dosing instructions. Make sure you apply only the prescribed number of sprays in each nostril. You may be asked to use the spray 1 – 2 times per day.

  1. Wash your hands.
  2. Gently blow your nose to clear the passageway.
  3. Shake the container several times.
  4. Keep your head upright. Breathe out.
  5. Block one nostril closed with your finger.
  6. Insert the nasal applicator into the other nostril.
  7. Aim the spray toward the outer wall of the nostril.
  8. Inhale slowly through the nose and press the spray applicator.
  9. Breathe out and repeat to apply the prescribed number of sprays.
  10. Repeat the steps for the other nostril.
  11. Avoid sneezing or blowing your nose right after spraying.

SIDE EFFECTS

Nasal corticosteroid sprays are considered safe for all adults. Specific types are safe for children (over age 2). Pregnant women can safely use nasal corticosteroids.

Nasal corticosteroid sprays generally affect only the nasal passageway, where the medicine is deposited, and do not impact other parts of the body. They carry a low risk for widespread side effects unless the drug is used too much.
Side effects of nasal steroids may include:

  • Dryness, burning, stinging in the nasal passage. This can be helped by using the nasal corticosteroid after showering or placing your head over a steamy sink or steaming pot for 5 – 10 minutes.
  • Sneezing
  • Throat irritation
  • Headaches and nosebleed (uncommon, but you should report them to your doctor immediately)
  • More likely to have an infection in the nasal passages
  • Rarely, perforation (hole or crack) in the passageway may occur. This occurs more commonly if you do not use the proper technique of spraying away from the middle of your nose.

Make sure you, or your child, take the corticosteroid spray exactly as prescribed. This is the best way to avoid side effects. If you, or your child, use the spray regularly, see a doctor periodically for examination of the nasal passages to make sure problems are not developing

WHEN TO CONTACT ME

  • You have nasal irritation, bleeding or other new nasal symptoms.
  • You have continued allergy symptoms after repeated use of nasal corticosteroids.
  • You have questions or concerns about your symptoms.
  • You are having trouble taking the medication.

Steam Inhalations & Vapour Rubs

The simple way is sitting with your head over a bowl of hot water. Place a towel over your head, close your eyes and breathe deeply. Avoid getting the hot steam in your eyes.

Adding menthol, eucalyptus, camphor, thymol or pine oil to the water may help,however plain water also does the job of loosening the mucus.

Steam inhalation in children as described above should be avoided due to the risk of scalding in babies & younger children. Instead, a child may benefit from sitting in a hot, steamy bathroom.

There are now steamers available in the market which prevent the risks of accidental burns & scalding.However get a good product as my personal experience with a local made product has been mould in the equipment if left unused for some days!

Vapour rubs are also traditionally used.However it is not advisable to put the in steam/hot water.Apply the rub to your chest and back. Don’t apply it to their nostrils because this could cause pain and breathing difficulties

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