Nasodren for Sinusitis Treatment

2012-02-24T01:33:00.000-08:00

Why Nasodren is used just once a day

In the first two minutes, the morphological and functional changes that take place in the epithelium and stromal structures of the nasal cavity produce a prompt discharge from seromucous glands, almost immediate dehydration as well as a reduction of the oedematous state in the tissues. Shrinking of swollen mucosa and opening of the swollen ostiomeatal unit is also achieved. This product promotes the increase of mucociliary transport in the nasal cavity.

This stimulated secretion leads to an intense physiological drainage of the paranasal sinuses, resulting in a highly effective therapeutic outcome.

The duration of the alveolar gland cell secretory cycle is 15-16 hours, while that of the tubular-alveolar gland cells is 24 hours (this is the time required to accumulate and remove the secretion). Therefore, after 24 hours, the seromucous glands have recovered and commencemucus secretion in the paranasal sinuses once again. It means that Nasodren should be administered once per day.

(Piskunov. Viability of the indication and use of cyclamen extract in Clinical practice. 22nd Congress of ERS & 27th ISIAN Crete. Greece. 15-19 June 2008).

Cameras and cleaners for endoscopic sinus surgeries

2012-02-23T01:12:00.000-08:00

Cameras and cleaners for endoscopic sinus surgeries

The sinus surgeries are performed in two ways: traditional and modern. The traditional method involves viewing through the endoscope’s eyepiece. The technique aids in assessing the orientation and depth of the surgical site. However, surgeons may have to bend their back or neck while using the traditional method. If during the surgery microdebrider or any other big instrument is also required, the instrument may reach the head of the surgeon, causing discomfort. The traditional method is good because the naked eye offers a good image of the surgical site but the technique may lead to the neck problems in the surgeon.

In modern technique, a video camera is connected to the endoscope so that the surgeon can operate through the monitor. Most of the surgeons prefer a video monitor for its ergonomic advantage, especially, while operating the frontal recess. The surgeon can either stand or sit near the patient without bending the neck or back to have a clear view of the nasal cavity. The video monitor has another advantage: It delivers magnified images of the organs and surgical site. The images are very useful during delicate surgeries involving skull base and optic nerve. The monitor also allows two surgeons to operate the patient simultaneously.

With the monitor, the experienced surgeons can monitor the trainee surgeons during the operation. The trainees can learn nuances of the sinus surgeries by carefully watching the professional surgeons engaged in the surgical process. The nurses can assess the need for instrument required in various steps of the procedure in advance. The anesthetist can supervise and intervene if required during the surgery.

The monitor should be of medical grade. A digital camera or three-chip camera with excellent light source is required. The 3–chip camera produces brilliant image, facilitating detailed paranasal sinus surgeries. Good lighting is also the prerequisite because redness of the blood absorbs most of the light, and making difficult to visualize the site from a poor image.

Single-chip cameras are unable to cover blood properly during the surgery, therefore, the tissue contrast and depth perception may not be captured correctly on the image. Cheap quality cameras affect orientation and visibility, hindering the surgeon’s work and increasing the chances of complications. A split beam can also be used to view the image, but image will be of low quality. So, use the monitor to operate.

An endoscope cleaner / scrubber washes the endoscope’s lens if blood obscures it, and thereby operation continues without removing the endoscope. There is no need for manual cleaning of the endoscope during the surgeries in case surgical site becomes bloody. As a result, the surgery goes uninterrupted and requires less time. Good visibility reduces chances of errors during the surgery, ensuring safety. The surgeons thus can work easily and quickly.

How to identify sinusitis headache

2012-02-22T01:01:00.003-08:00

How to identify sinusitis headache

The patients prefer term “sinusitis headache” instead of “tension headache” because the former is ‘publicly’ acceptable. In fact, they may not have either of the headaches. The cause of headache may be something else. For example, the forehead pain may occur owing to common cold or blocked nose. So, it is the duty of otolaryngologist to find the true cause of the headache. The following valuable information will help the physician in distinguishing between a “sinusitis headache” and other headaches.

The retro-orbital headache is related to sphenoid sinusitis.

The maxillary sinus pain may radiate to the temples and canine teeth.

The ethmoid sinus pain occurs in the medial canthal, upper cervical, temporal and parietal areas.

A tension headache, a muscle contraction tension, may lead to tenderness of the scalp and facial muscles. During forehead percussion, pain may occur. The physician may confuse this pain with frontal sinusitis related pain.

In the frontal recess region, swollen agger nasi cells cause pain due to infection or obstructions.

The physicians shall have thorough understanding of drug rebound, cluster, muscle contraction, migraine and other headaches. Tension-type headache is a composite of muscular, neurogenic and vascular headache. The tension-type headache resembles to “tightness” or “pressing” pain. The pressure felt over the head, temples, forehead, shoulders and the neck. Anxiety and stress causes these headaches.

The cluster headaches are uncommon. The patients feel severe pain that begins suddenly and lasts about 45 minutes. The pain episodes occur several times in a day. They may also have facial flushing, nasal congestion and sweating.

A drug rebound headache, the bilateral frontal headache, is felt almost daily for the whole day. It is moderate to mild in intensity.

While treating a sinusitis headache, blocked area needs thorough examination instead of extent of the disease, because even small blockage can cause severe pain. A bunch of sensory nerve fibers may have accumulated around the sinuses ostia, causing lesions and blockage, and pain.

Involvement of the more than one paranasal sinus complicates the symptoms and pain. In these cases, pain spreads to different locations in the body. If the patient also has facial pain owing to other disorders, the confusion increases. The physician shall review headache history of the patient, exact location of the pain, type of the pain, headache frequency, factors worsening or improving the pain, and related sinus symptoms. The pain could be dull, mild, pulsating, severe, sharp, squeezing, stabbing, steady, vicelike, etc.

Barosinusitis may also cause dull ache in divers and flyers.

2012-02-21T07:34:00.000-08:00

Are enough evidence from the use of antibiotics?

In a systematic review carried out by a Cochrane group, it concluded that in acute maxillary sinusitis antibiotics provide a minor improvement in simple

(uncomplicated) sinus infections. In spite of the fact that acute Rhinosinusitis can lead to severe complications, a study performed by Dr. Klossec also shows that, unfortunately, antibiotics do not seem to prevent these complications, and moreover, may produce a clear resistance to penicillin.

In a Cochrane systematic review on antibiotics in acute maxillary sinusitis authors observe that antibiotics provide a minor improvement in simple (uncomplicated) sinus infections.

However, 8 out of 10 patients improve without antibiotics within two weeks. The small benefit gained may be overridden by the negative effects of antibiotics, both on the patient and on the population in general. This review found that antibiotics help some people very slightly, but do not make a major difference to most people (Ahovuo-Saloranta).

In a double-blind, randomized, placebocontrolled factorial trial of 500 mg of amoxicillin 3 times per day for 7 days and 200 mg of budesonide in each nostril once per day for 10 days in patients with acute no recurrent sinusitis shows that neither an antibiotic nor a topical steroid alone or in combination was effective as a treatment for acute sinusitis in the

primary care setting (Williamson et al).

A study by Prof. Klossek looked at an estimated study population of 12 million in France, and found 30 complicationsper year, of which 11 were intracraneal and 44 of the patients had actually had antibiotics before the complication, 70% of whom had a proven bacterial infection. Acute Rhinosinusitis can lead to severe complications; unfortunately, antibiotics do not seem to prevent these complications. What is more, there is a clear correlation between antibiotic sales and the prevalence of penicillin resistance to normal Streptococcus in those countries where antibiotic use is high.

1. Ahovuo-Saloranta A, Borisenko OV, Kovanen N, Varonen H, Rautakorpi UM, Williams JW, Jr., et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev 2008(2):CD000243.

2. Ian G. Williamson, I.G., Rumsby, K.BA; Benge S. Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis. A Randomized Controlled Trial. JAMA. 2007;298(21):2487 2496.

3. M. Desrosiers, J-M Klossek, M. Benninger. Management of acute bacterial rhinosinusitis: current issues and future perspectives. International Journal of Clinical Practice. 2006; 60(2):190–200. DOI: 10.1111/j.1742- 1241.2006.00753.

4 diseases causing pain-sinus

2012-02-20T02:05:00.000-08:00

4 diseases causing pain-sinus

Pain in sinus is generally attributed to sinusitis. However, granulomatous inflammation and sinonasal malignancies may also trigger the pain.

Churg Strauss Syndrome (CSS)

CSS, the allergic angiitis, is the granulomatous inflammation of the vessels of lungs, peripheral nerves and skin. The patients suffering from asthma and rhinitis are prone to the syndrome. It may lead to chronic or acute paranasal sinus pain. Other symptoms of the syndrome include polyposis, rhinitis and the sinus’ opacification on radiograph.

Sinusitis

Sinusitis related pain may be a result of the pressure change, inflammation and / or blockage of the sinuses. To study the pain-sinus, heat, cold and electric probe stimulation has been used. The studies concluded that the mucosa lining the ostia (nasal opening) of the paranasal sinuses is the most pain prone region. Some times pain is associated with the sinus cavity, but the mucosal cavity located in the sinus is not very sensitive to pain.

Sinonasal cancers and tumors

The sinonasal cancers and tumors affect the nasal cavity and paranasal sinuses. The sinonasal tumors are generally diagnosed in the advance stage as no significant symptoms or signs appear in the early stages. The cancer and tumor symptoms are similar to that of sinus disease symptoms, such as nasal discharge and pain in the sinuses. The most common sinonasal malignancy is maxillary sinus carcinoma. The ethmoid sinus is the second most common place where tumors and cancers develop.

Wegener’s granulomatosis (WG)

The paranasal sinuses host a wide range of granulomatous conditions that are rare but could be risky. For instance, Wegener’s granulomatosis. Wegener’s, a rare medical condition, involves vasculitis of the nasal mucosa, the sinus and the respiratory tract, and granulomatous inflammation. If recurrent or chronic sinusitis patients have concurrent cutaneous, pulmonary or renal abnormalities, or inflammation of the nasal septa, they should be examined for Wegener’s signs. Wegener’s granulomatosis may lead to the pain-sinus. Clinical features of the WG include bloody or purulent nasal discharge, perforation in the nasal septa and the nose deformity. WG patients are administered cyclophosphamide and prednisone.

Acute maxillary sinusitis: symptoms, microbiology and treatment

2012-02-16T01:48:00.000-08:00

Acute maxillary sinusitis: symptoms, microbiology and treatment

Generally, acute maxillary sinusitis is related to viral infections of the upper respiratory tract. However, other factors, such as dental problems may also cause acute maxillary sinusitis. The sinusitis symptoms affect day-to-day life, including school / office and leisure activities. Some of the common symptoms follow:

Headache

Painful sensation

Maxillary tooth pain

Facial pressure or pain

Swelling over the sinus

Moderate to severe nasal obstruction

Pus coming out from the middle meatus

Extremely stale and bad smelling breath

Pain may vary from moderate to severe.

Pain increases while pressing the maxilla.

Numbness in maxillary premolars and molars

Posterior and / or anterior nasal drainage (rhinorrhea)

Pain may occur in different parts such as ear, posterior teeth and cheek.

Microbiology

The acute maxillary sinusitis microbiology is well defined. The main pathogens are facultative anaerobic and aerobic bacteria. The facultative anaerobes depend on fermentation process for energy required to grow when oxygen is inadequate, and use oxygen if it is available in sufficient amount. The following bacteria have been found in the adult patients with acute maxillary sinus symptom (s):

Anaerobes

Enterobacter

Escherichia coli

Haemophilus influenze

Moraxella catarrhalis

Neisseria coli

Pesudomonas aeruginosa

Staphylococcus aureous

Streptococcus penumoniae

Streptococcus sp

There are two (2) types of strains of the facultative gram-negative coccobacillus Haemophilus influenzae: encapsulated and unencapsulated. The unencapsulated strains cause bronchitis, otitis media, sinusitis and other infections of upper respiratory tract. Streptococcus penumoniae, a ά-hemolytic group of streptococci, are resistant to various antibiotics. The aerobic and gram-negative coccobacilli Moraxella catarrhalis are also resistant to some isolates.

These three bacteria also cause acute maxillary sinus symptom(s) in children. However, Moraxella catarrhalis-related infections are common in children than adults, since respiratory aerosols spread the infection.

Treatment
Acute maxillary sinusitis lasts for four or less weeks and sinus symptom(s) appear suddenly. Subacute maxillary sinusitis signs persist from four (4) to twelve (12) weeks. If treated in time and completely, acute maxillary sinusitis is resolved fully. The therapy may consist of intranasal corticosteroids, nasal lavage and vasoconstrictors. The oral treatment may include antibiotics, analgesics, mucolytics and antipyretics. The acute sinusitis caused by H. influenzae, S. pneumoniae or M. catarrhalis can be treated with macrolides.

Treatment of maxillary sinusitis

2012-02-15T01:31:00.000-08:00

Treatment of maxillary sinusitis

General medications for acute and chronic maxillary sinusitis are similar. However, anti-microbial medication prescription may require extra care in chronic and acute exacerbation of chronic condition due to chronic inflammation of the mucosa and variation in microbiology of the former. In both acute and chronic maxillary sinusitis, culture-based therapy is selected. A short-term course of antibiotics may be helpful in case of acute exacerbation of chronic maxillary sinusitis.

Acute maxillary sinusitis is mainly infectious disease, whereas more than one factor is responsible for chronic maxillary sinusitis. The purpose of the treatment of acute sinusitis is to eliminate infection and reduce symptoms. However, treatment of chronic sinusitis is complex due to need for examining and resolving other associated problems, such as anatomical defects, atopy and immunodeficiency. Thus, treatment of chronic maxillary sinusitis spreads over long period of time. And, it requires reviewing and reassessing the selected therapy.

The treatment for both forms of maxillary sinusitis consists of anti-inflammatory, decongestants and mucus modulation medicines.

Anti-inflammatory medications

Anti-inflammatory medications are divided into six (6) subcategories: allergen-specific drugs, antihistamines, leukotriene modifiers, mast cell stabilization, monoclonal antibodies and steroids.

Allergen-specific therapy involves elimination of foods causing allergy and immunotherapy. The patients who do not respond to medications or whose symptoms last for six (6) months are advised to undergo immunotherapy.

Physicians may choose from first- and second- generation of oral, and topical intranasal antihistamines for the treatment. Azelastine and olopatadine are commonly used topical intranasal medications. The first-generation oral antihistamines comprise brompheniramine, chlorpheniramine and diphenhydramine. The range of second-generation oral antihistamine consists of cetirizine, desloratadine and fexofenadine.

The leukotriene modifiers consist of 5-lipoxygenase inhibitors and leukotriene receptor antagonists. Cromolyn sodium is used for mast cell stabilization. Monoclonal antibodies include antiimmunoglobuline E and antiinterleukin-5.

There are three different types of steroids used in the treatment. Intranasal corticosteroids include budesonide, ciclesonide, flunisolide, mometasone furoate and triamcinolone acetonide. Oral corticosteroids consist of methylprednisolone and prednisone. Budesonide respules is an example of topical steroid medication.

Decongestants

Doctors may prescribe oral or topical decongestants such as oxymetazoline, phenylephrine and pseudoephedrine.

Mucus modulation

Anticholinergics, mucolytics and nasal saline are used for mucus modulation. The topical anticholinergic nasal spray, ipratropium bromide is generally used with topical nasal steroids. The spray reduces rhinorrhea. However, it should not be used for chronic maxillary sinusitis because its continuous use results in prolonged thick discharge. Although the spray is safe, not much research has been done on its efficacy in respect to acute and chronic maxillary sinusitis.

Does Nasodren® have an effect similar to that of peppermint?

2012-02-14T07:45:00.000-08:00

Does Nasodren® have an effect similar to that of peppermint?

Peppermint, Mentha piperita, comes from the Greek Mintha. There are 25-30 species of Peppermint. Peppermint has different components, among which there are the essential oils like menthol, neomenthol, isomenthol, neoisomenthol, piperitoles, piperitenol, isopiperitenol. The pharmacology of peppermint focuses almost entirely on its menthol components. Peppermint oil vapor is used as an inhalant for respiratory congestion.

Peppermint and menthol are essential oils that are used as an external nasal decongestant, menthol does not objectively decrease nasal decongestion (1-7), in spite of the fact that there is a subjective improvement in the sensation of easier breathing by subjects.

While Nasodren® has had its objective decongestant effect proved by different controlled studies, it offers therapeutically multi-action functions, opening the ostiomeatal complex, and activating the mucociliary system. Consequently, it increases the drainage of mucus retained in the sinonasal area; produces fast dehydration and a detumescent effect (calms and relieves swelling). Unlike other products used in Rhinosinusitis treatment, Nasodren® is not indicated for a specific etiology, but rather aimed at improving the symptomatology regardless of the cause that produces it.

1. Eccles R, Griffiths DH, Newton CG, Tolley NS. The effects of menthol isomers on nasal sensation of airflow. Clinical Otolaryngology & Allied Sciences 1988; 13:25-9.

2. Eccles R, al e. The effects of D and L Isomers of menthol upon nasal sensation of airflow. The Journal of Laryngology and Otology 1988; 102:506-508.

3. Eccles R, Jones AS. The effect of menthol on nasal resistance to air flow. J Laryngol Otol 1983; 97:705-9.

4. Nishino T, Tagaito Y, Sakurai Y. Nasal inhalation of l-menthol reduces respiratory discomfort associated with loaded breathing. Am J Respir Crit Care Med 1997; 156:309-13.

5. Eccles R, Jawad MS, Morris S. The effects of oral administration of (-)-menthol on nasal resistance to airflow and nasal sensation of airflow in subjects suffering from nasal congestion associated with the common cold. J Pharm Pharmacol 1990; 42:652-4.

6. Eccles R, Morris S, Jawad MS. The effects of menthol on reaction time and nasal sensation of airflow in subjects suffering from the common cold. Clin Otolaryngol 1990; 15:39-42.

7. Burrow A, Eccles R, Jones AS. The effects of camphor, eucalyptus and menthol vapour on nasal resistance to airflow and nasal sensation. Acta Otolaryngol (Stockh) 1983; 96:157-61.

Nosocomial sinusitis

2012-02-13T01:11:00.000-08:00

Nosocomial sinusitis

Patients who have to spend long time in an intensive care unit (ICU), or other parts of the hospital, and / or use nasogastric or endotracheal tubes may suffer from nosocomial sinusitis, a ‘hospital-borne’ infection. The prolonged usage of nasogastric or endotracheal tubes increase chances of developing signs of sinus infection. Many patients using nasotracheal tubes for more than five days suffer from nosocomial sinusitis. The hospital stay of patients with burns and serious trauma, and patients who have undergone surgery may prolong, increasing risk of catching the sinusitis. Head trauma and neurological disorders may also trigger the sinusitis.

The nasogastric or nasotracheal tubes plug the sinus ostia and thereby the secretions accumulate in the area. As a result, the drainage system of the paranasal sinuses is affected severely. This mechanical obstruction hinders normal bacteria drainage process. The bacteria, therefore, multiply in the sinuses causing inflammation and other signs of sinus infection.

Gram-negative enterics, including Serratia marcescens, Proteus mirabilis, Enterobacter species, Klebsiella pneumoniae and Pseudomonas aeruginosa are the main pathogens causing nosocomial sinusitis. Nosocomial sinusitis is a non-airborne infection because endogenous microbes causing the disease come in direct contact of the sinus via intubations.

In the patients with acute nosocomial sinusitis associated with nasogastric and nasotracheal tubes, population of gram-negative organisms, such as Staphylococcus aureus and Staphylococcus epidermidis, is large. Common signs of the sinusitis include leukocytosis and fever. The patients may also complain about purulent rhinorrhea.

The signs of sinus infection may develop in the patients using mechanical ventilation for a long time and oropharyngeal tubes simultaneously, or nasoenteric tubes. Anaerobes, including S. aureus, Acinetobacter spp. and P. aeruginosa are the primary source of sinus infection in these patients. They may also suffer from sepsis and fever.

During microbiological analysis of the acute nosocomial sinusitis, polymicrobial infection in conjunction with Bacteroides species, P. aeruginosa and S. aureus has been identified. If younger patients use blind nasotracheal intubations in emergency, chances of staphylococci infection are high. If older patients who are operated in an ICU or operating room require elective intubations, gram-negative organisms may cause the sinusitis.

The organisms causing a wide range of nosocomial infections are also responsible for nosocomial sinusitis. For example, gram-positive cocci and gram-negative enterics, such as Proteus mirabilis, Enterobacter sp, K. pneumoniae and P. aeruginosa, are the main pathogens associated with nosocomial infection. The bacteriology of chronic and acute nosocomial sinusitis is quite similar if edema and inflammation of tissue play an important role. An untreated infectious nosocomial sinusitis may lead to nosocomial pneumonia. So, timely treatment is necessary. Here is an overview of the sinusitis treatment:

Lavage and drain the sinus.

Administer the suitable antibiotics.

Remove all types of nasal tubes to minimize mucosal edema and nasal irritation.

If a maxillary puncture is done to diagnose the disease, a simultaneous antral wash will be useful.

Elevate the patients’ head and use topical nasal vasoconstrictor drops to open the sinus ostia for draining out the accumulated mucus.

Maxillary sinusitis: classification and microbiology

2012-02-09T01:28:00.000-08:00

Maxillary sinusitis: classification and microbiology

Classification

Maxillary sinusitis refers to the inflammation and infection of the maxillary sinuses. The sinusitis is categorized based on its etiology and symptom duration. According to etiology, the maxillary sinusitis could be of odonotgenic and non-odontogenic origin. Just 10% of all maxillary sinusitis cases are of odontogenic origin. Non-odontogenic factors, such as allergic reactions and infections of the upper respiratory tract, are primary cause of the sinusitis. Based on duration of the sinus infection’s symptoms, infectious maxillary sinusitis is divided into two (2) categories: acute and chronic.

Acute maxillary sinus infection’s symptoms, such as purulent nasal discharge accompanied by facial fullness, pressure or pain, and / or nasal congestion, last up to twenty-one (21) days. However, chronic maxillary sinus infection’s symptoms persist for more than two and a half months.

Microbiology

An array of bacterial pathogens causes maxillary sinusitis. The pathogen pattern may vary with individual characteristics of the patient and chronicity of the disease. The primary cause of acute sinus infection is facultative and aerobic organisms, whereas gram-negative rods and anaerobes are mainly responsible for chronic sinus infection.

Several studies focusing on the maxillary sinus microbiology have been conducted, as it is quite safe and easy to access the sinus. Thorough knowledge of bacteriology of maxillary sinusitis will facilitate accurate and successful therapy with a little side effect. For example, the bacteriology study helps in limiting the misuse of antibiotics.

The bacteriological analysis of the sinus also enables documentation of antibiotics and surgical processes’ effectiveness, helping in developing novel therapies. Scientists use both traditional and modern methods and techniques to investigate the bacteria profile. For instance, earlier, the contents of the sinus were only sampled directly, whereas today the direct sample analysis is studied with findings of the minimally invasive procedures using state-of-the-art endoscopic technology.

Prior to the discovery of endoscopes, the maxillary sinus was punctured through the inferior meatus or canine fosa to collect the cultures. However, the traditional procedure not only creates discomfort but also has many other limitations. With the launch of sinonasal endoscopy technology in the1980s, endoscopically guided middle meatus (EGMM) cultures became a reality. A small wire tipped with calcium alginate is used for swabbing the meatus under endoscope.

EGMM vs. MSP

During comparison of EGMM and maxillary sinus puncture (MSP) cultures, it is found out that the former has higher sensitivity and specificity than the latter. In fact, after some practice, doctors can obtain EGMM cultures easily, and thereby reducing contamination risk, chances of morbidity and discomfort level in patients.

2012-02-08T01:16:00.000-08:00

Nosocomial sinusitis

Lavage and drain the sinus.

Administer the suitable antibiotics.

Remove all types of nasal tubes to minimize mucosal edema and nasal irritation.

If a maxillary puncture is done to diagnose the disease, a simultaneous antral wash will be useful.

Elevate the patients’ head and use topical nasal vasoconstrictor drops to open the sinus ostia for draining out the accumulated mucus.

Signs of a sinus infection of odontogenic origin

2012-02-07T00:40:00.000-08:00

Signs of a sinus infection of odontogenic origin

Since the upper jaw teeth are located close to the maxillary sinus, the sinus infection may spread to the oral cavity or vice versa. This odontogenic maxillary sinusitis is ascribed to anaerobic organisms that dominate the oral cavity. The sinusitis could be acute and chronic. The management, microbiology and pathophysiology of odontogenic maxillary sinusitis, which is unilateral, are different from that of non-odontogenic maxillary sinusitis.

Causes of odontogenic sinusitis

Odontogenic cysts

Periapical abscesses

Alveolar or dental trauma

Maxillary osteomyelitis

Perforations in the sinus while extracting the tooth

Secondary infection and irritation due to intra-antral foreign objects

Damage to the Schneiderian membrane owing to periodontal disease

Inadvertent displacement of bone graft materials, dental implants and other foreign bodies during dental surgeries and treatments

Microbiology of odontogenic sinusitis

Many similarities have been identified while analyzing microbiology of odontogenic sinusitis and a dentoalveolar abscess. Anaerobes, such as Fusobacterium, Prevotella, Porphyromonas and Peptostreptococcus, and viridians streptococci are commonly associated with both the conditions. The bacteria sitting in the nasophrynx and nasal cavity may also live in the odontogenic sinusitis' microflora. Thus, a wide range of organisms may trigger the odontogenic sinusitis.

The bacteriological analysis could not distinguish between chronic and acute odontogenic maxillary sinusitis. However, anaerobe, gram-negative bacilli- Fusobacterium sp. and Peptostreptococcus- are the primary organisms responsible for the infection. Two aerobes, S. aureus and ά-hemolytic streptococci, play major role in case of mixed infection.

Acute and chronic of odontogenic sinusitis

If the inflammation in the antral mucosa prolongs after acute odontogenic maxillary sinusitis, symptoms of chronic odontogenic sinusitis develop. The antral mucosa thickens due to fibers, leukocytes and edema during the chronic condition. In some cases, polyps may also develop.

Symptoms and signs of acute form

Malaise

Headache

Oral malodor

Pressure-like dull pain

Mucopurulent rhinorrhea

Occasional eyebrow edema

Nasal obstruction or congestion

Erythema i.e. redness of the skin

Swelling of the anterior maxilla and cheeks

Fullness or pressure near the maxillary sinus

Smelly mucopurulent material draining into the nasophrynx and the nasal cavity

If a periapical abscess is the source of the infection, swelling may occur in the buccal vestibule and gingiva.

Symptoms and signs of chronic form

Malodor

Dull headache

Nasal congestion

Constant pus from the oroantral fistula

Nasal discharge with / without postnasal drip

Tenderness in anterior maxillary area

Pain in tooth while chewing
However, signs of a sinus infection are subtle in chronic form.

Treatment of odontogenic sinusitis

As maxillary sinusitis and odontogenic infections are related, the oral cavity of the patients having signs of a sinus infection should also be examined. Dental infections shall be treated simultaneously with maxillary sinusitis.

2012-02-06T01:49:00.000-08:00

Rhinorrhea: anterior and posterior

Both paranasal sinuses and nasal cavities’ membranes secrete mucus regularly. Normally, the mucus is swallowed with saliva. However, the mucus starts dripping if

its production increases,

it does not evaporate,

it does not flow normally through the throat and the nose as an even thin film,

its chemistry / composition alters due to changes in secretion,

bacteria causing infections change its composition and / or

sinus cilia paralyze.

Changes in the mucus irritate the throat, causing rawness that creates a desire to clear the throat constantly. In some cases, hard and thick phlegm even accumulates in the nose and throat. It is difficult to remove this phlegm. The irritation may extend into the lung, the bronchi and the windpipe. Although many remedies have been invented to treat the drip, resolving nasal obstruction and congestion is the best therapy.

In medical terminology, this excessive nasal discharge is called nasal drip (rhinorrhea). The rhinorrhea could be anterior or posterior. The discharge draining from the nares is called anterior rhinorrhea. The anterior nasal drip is generally associated with allergic or viral rhinitis. The phlegm dripping into the throat from the nose is referred to as posterior nasal drip (posterior rhinorrhea). The color of rhinorrhea is greenish or yellowish in purulent sinusitis and transparent or white in vasomotor rhinitis.

Postnasal drip during acute sinusitis, cough and nasal congestion can cause pain in the face and headache. The drip may also occur in chronic sinusitis, but the pain is generally non-existent. The drip invariably accompanies nasal obstruction. Most of the asthma patients have nasal congestion, thus, they also suffer from the drip.

Posterior nasal drip may occur in the patients suffering from nasal polyposis. The drip may worsen the cough in the night while the patient is lying down. Reoccurring pharyngitis is also associated with the drip.

In non-smokers, posterior nasal drip syndrome (PNDS) is one of main causes of chronic cough. Diagnosis of which is based on a number of symptoms, such as nasal congestion, postnasal drip, swelling of inferior turbinates and mucus draining into the posterior pharynx. But, the syndrome diagnosis is not always precise. The differential diagnosis (Dx) of the syndrome includes rhinitis medicamentosa, vasomotor rhinitis, non-perennial non-allergic rhinitis and hay fever. Oral decongestants, inhaled steroids and / or first generation antihistamines are administered to treat the syndrome.

What are the differences between sinusitis, rhinosinusitis and the common cold?

2012-02-03T04:30:00.000-08:00

What are the differences between sinusitis, rhinosinusitis and the common cold?

Cold also known as viral upper respiratory tract infection, acute viral rhinopharyngitis, acute coryza, or common cold is a contagious, viral infectious disease of the upper respiratory system mainly caused by rhinoviruses and coronaviruses. Symptoms include a sore throat, runny nose, and fever. There is no cure, however symptoms usually disappear spontaneously in 7 to 10 days. It is one of the most frequent infectious diseases in humans, with two to four infections a year in adults and up to 6 - 12 in children.

Sinusitis is an inflammation of the nasal passages, which may or may not be as a consequence of infection, from bacterial, fungal, viral, allergic or autoimmune issues.

Rhinosinusitis, however, is an inflammation of the nose and paranasal sinuses, the consequence of an infection, from bacterial, fungal, viral, allergic or autoimmune issues, characterized by nasal blockage, obstruction, congestion or nasal discharge (anterior or posterior nasal drip), with or without facial pain and pressure and/or reduction or loss of smell.

Newer classifications of sinusitis refer to it as rhinosinusitis, taking into account the thought that inflammation of the sinuses cannot occur without some inflammation of the nose as well (rhinitis).

Acute Rhinosinusitis (ARS) lasts less than 12 weeks. It is usually an early upper respiratory tract infection of viral, bacterial or fungal aetiology. Viral Rhinosinusitis could be a common cold or acute viral rhinosinusitis (lasting from 7 to 10 days), while a non-viral rhinosinusitis presents an increase of symptoms after 5 days or persistence of symptoms after 10 days, but lasting less than 12 weeks.

Chronic Rhinosinusitis (with or without nasal polyps) (CRS) is when symptoms last more than 12 weeks without complete relief. It is usually produced by factors such as dust or pollution, aerobic and anaerobic bacterial infection, or fungus (either allergic, infective, or reactive). Non-allergic factors such as vasomotor rhinitis can also produce chronic sinus problems. Other etiologic factors are abnormally narrow sinus passages (such as a deviated septum), which can impede drainage from the sinus cavities.

Rhinosinusitis symptoms may include any combination of the following: nasal congestion; facial pain; headache; night-time coughing; an increase in previously minor or controlled asthma symptoms; general malaise; thick green or yellow discharge; feeling of facial 'fullness' or 'tightness' which may worsen on bending over; aching teeth, and/or halitosis. Chronic Rhinosinusitis can often lead to anosmia, a reduction in the ability to smell or detect odours. In a small number of cases, acute or chronic maxillary sinusitis is associated with a dental infection.

Other common symptoms include sinus headache. Acute and chronic sinusitis may be accompanied by thick purulent nasal discharge and localized headache (toothache) or migraine misdiagnosis. The confusion with migraine stems from activation of the trigeminal nerves, which innervate both the sinus region and also the meninges that surround the brain.

Review of Acute Rhinosinusitis

2012-02-02T03:55:00.000-08:00

Review of Acute Rhinosinusitis

ABSTRACT:

Acute rhinosinusitis is a common ailment accounting for millions of

office visits annually, including that of Mrs D, a 51-year-old woman

presenting with 5 days of upper respiratory illness and facial pain.

Her case is used to review the diagnosis and treatment of acute rhinosinusitis.

Acute viral rhinosinusitis can be difficult to distinguish from acute

bacterial rhinosinusitis, especially during the first 10 days of symptoms.

Evidence-based clinical practice guidelines developed to guide

diagnosis and treatment of acute viral and bacterial rhinosinusitis

recommend that the diagnosis of acute rhinosinusitis be based on the

presence of "cardinal symptoms" of purulent rhinorrhea and either facial

pressure or nasal obstruction of less than 4 weeks' duration.

Antibiotic treatment generally can be withheld during the first 10 days

of symptoms for mild to moderate cases, given the likelihood of acute

viral rhinosinusitis or of spontaneously resolving acute bacterial rhinosinusitis.

After 10 days, the likelihood of acute bacterial rhinosinusitis

increases, and initiation of antibiotic therapy is supported by practice guidelines. Complications

of sinusitis, though rare, can be serious and require early recognition and treatment.

COMMENTS:

Antibiotics are not recommended during the first 10 days of symptoms due

to the fact that the main etiology of Acute Rhinosinusitis is viral, and therefore

symptomatic treatment is indicated. Nasodren®, which acts locally

within the nasal sinuses, facilitates natural secretion and drainage, thereby

reducing the signs and symptoms of the underlying inflammatory process

associated with Rhinosinusitis. Nasodren® can be used as monotherapy

or adjunctive therapy.

Peter H. Hwang, MD, Discussant

JAMA. 2009; 301(17): 1798-1807.

Win an awesome body care kit-choose from our set for women or the kit for men

2012-02-01T01:10:00.000-08:00

Win an awesome body care kit-choose from our set for women or the kit for men

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When is a turbinectomy indicated?

2012-01-31T00:54:00.000-08:00

When is a turbinectomy indicated?

Nasal obstruction is the most common complaint treated by otolaryngologists.

Turbinectomy or conchotomy is the surgical removal of an abnormally enlarged turbinate, which opens up the nasal passages by removing bone and soft tissue from inside the nose to improve breathing.

The turbinate or conchae is a bone in the nose; it is an extension of the ethmoid bone and is situated along the sidewall of the nose, covered by mucous membrane.

It may be warranted in cases in which the upper airway is obstructed due to:

deviated nasal septum
swelling of the turbinate due to allergy, chronic inflammation, or chronic sinusitis
nasal polyps or other tumour obstructing the nose
swelling of the adenoids

When a 'turbinate bone' or 'conchae' is abnormally enlarged, it produces an ‘empty nose syndrome’, with symptoms like chronic nasal dryness, inflammation, 'paradoxical obstruction' (loss of airflow sensation) leading to breathing difficulties, grogginess and dizziness, and often pain and repeated nasal infections. These symptoms have a significant impact on the patient’s quality of life and sense of well-being. It can produce difficulty concentrating (appears in the medical literature as 'aprosexia nasalis'), pre-occupation with symptoms, anxieties and often clinical depression.[1]

The goals of nasal airway surgery include the following: to improve airflow through the nose, to control nosebleeds, to enhance visualization of the inside of the nose, to relieve nasal headaches associated with swelling of the inside of the nose, and to promote drainage of the sinus cavities. Nasal airway surgery is done through the nostrils without the need for external incisions.

Over resection of the inferior turbinates in the nose may lead to chronic nasal dryness, chronic mucosal inflammation, squamous metaplasia, mucosal atrophy and in rare cases even to full blown atrophic rhinitis. The remaining mucosal structures (the septum and the remaining turbinates) often hypertrophy and complicate diagnosis.[2][3][4][5][6]

Bibliography

Rice DH, Kern EB, Marple BF, Mabry RL, Friedman WH. The turbinates in nasal and sinus surgery: a consensus statement. Ear Nose Throat J. 2003;82(2):82-84.
Cottle MH. Nasal Atrophy, Atrophic Rhinitis, Ozena: Medical and Surgical Treatment. Journal Of The International College Of Surgeons. Volume 29(4), pages 472-484, 1958.
Passàli D, Lauriello M, Anselmi M, et al. Treatment of the inferior turbinate: long-term results of 382 patients randomly assigned to therapy. Ann Otol Rhinol Laryngol. 1999;108:569-75.
Moore GF, Freeman TJ, Yonkers AJ, Ogren FP. Extended follow-up of total inferior turbinate resection for relief of chronic nasal obstruction. Laryngoscope, 1985 Sept., volume 95 (9 Pt. 1): 1095-9.
Berenholz L, et al'. Chronic Sinusitis: A sequela of Inferior Turbinectomy. American Journal of Rhinology, July-August 1998, volume 12, number 4.
Wang Y, Liu T, Qu Y, Dong Z, Yang Z. Empty nose syndrome. Zhonghua Er Bi Yan Hou Ke Za Zhi. 2001 Jun;36(3):203-5.

Symptoms and treatment of cavernous sinus thrombosis

2012-01-30T02:15:00.001-08:00

Symptoms and treatment of cavernous sinus thrombosis

Symptoms

Patients suffering from cavernous sinus thrombosis (CST), one of dangerous side effects of sinus infection may feel very ill and complain about the following:

sudden headache,
nausea and vomiting,
lethargy,
pain in eye and
neck stiffness (nuchal rigidity).

Cranial nerve testing may reveal sensory deficit of the trigeminal nerve’s ophthalmic branch and muscle paralysis (palsies) of the some nerves.

Doctors may observe sluggish or dilated pupils, bulging eyeballs (proptosis), swelling of optic nerve (papilledema), retinal hemorrhages, tenderness and orbital edema during eye examination.

Inflammation and blood clot (thrombosis) in the cavernous sinuses and / or nearby area occur.

Cornea swelling (chemosis) may drooping eyelids (ptosis) may also indicate CST.

Other CST symptoms include

Quick development of proptosis

The motor cranial nerves paralysis

Symptoms of acute orbital cellulites

Meningitis signs

Picket fence fever in which temperature reaches to high level

Stupor, unconsciousness and unclear thoughts

If CST is spreading from the sphenoid sinuses, papillitis and proptosis may occur with thrombosis in cavernous sinuses.

Headaches may lead to periorbital edema and fever after some days.

The orbital veins may get blocked, causing periorbital edema. So, never ignore side effects of sinus infection.

Treatment

During initial stage, aggressive treatment is required to prevent the infection from spreading further. Patients shall be monitored during treatment to observe any further complications and / or improvements. However, even after treatment, cranial nerve paralysis (palsies) does not disappear. Half of the patients who recover from CST suffer from complete or partial palsies of the cranial nerve.

An assortment of antibiotics is administered to treat these side effects of sinus infection. However, the type of antibiotics depends on the result of the sinus exudate and blood cultures. Besides systemic antibiotic therapy, emergency surgery may be required to drain the infection. If CST patients do not respond to antibiotics, corticosteroids may be administered to reduce chances of adrenal insufficiency and orbital congestion. However, use of systemic corticosteroids is controversial.

Intravenously given anticoagulants may check growth of the thrombosis. Anticoagulants may facilitate recanalization of thrombous (clot), enabling easy and quick penetration of antibiotics. However, anticoagulation therapy may cause septic emboli, thereby causing risk of intracranial bleeding. In addition, very few studies have been conducted on effectiveness of anticoagulation. The use of anticoagulation, thus, is controversial. Some times steroid therapy is used for the treatment, but it is also controversial. So, consult your physician.

Symptoms and treatment of cavernous sinus thrombosis

2012-01-27T00:54:00.000-08:00

Symptoms and treatment of cavernous sinus thrombosis

Symptoms

Patients suffering from cavernous sinus thrombosis (CST), one of dangerous side effects of sinus infection may feel very ill and complain about the following:

sudden headache,
nausea and vomiting,
lethargy,
pain in eye and
neck stiffness (nuchal rigidity).

Cranial nerve testing may reveal sensory deficit of the trigeminal nerve’s ophthalmic branch and muscle paralysis (palsies) of the some nerves.

Doctors may observe sluggish or dilated pupils, bulging eyeballs (proptosis), swelling of optic nerve (papilledema), retinal hemorrhages, tenderness and orbital edema during eye examination.

Inflammation and blood clot (thrombosis) in the cavernous sinuses and / or nearby area occur.

Cornea swelling (chemosis) may drooping eyelids (ptosis) may also indicate CST.

Other CST symptoms include

Quick development of proptosis

The motor cranial nerves paralysis

Symptoms of acute orbital cellulites

Meningitis signs

Picket fence fever in which temperature reaches to high level

Stupor, unconsciousness and unclear thoughts

If CST is spreading from the sphenoid sinuses, papillitis and proptosis may occur with thrombosis in cavernous sinuses.

Headaches may lead to periorbital edema and fever after some days.

The orbital veins may get blocked, causing periorbital edema. So, never ignore side effects of sinus infection.

Treatment

Nasodren®: How much time to symptom relief and clinical recovery?

2012-01-26T01:27:00.000-08:00

Nasodren®: How much time to symptom relief and clinical recovery?

Nasodren® has demonstrated its efficacy and safety in rhinosinusitis treatment in 15 comparative studies and in 7 cohort follow-up studies. In all of these studies, Nasodren® was administered at a dose of 2.6 mg /day (1.3 mg per nostril/ day) between 7 and 14 days in monotherapy or in combination.

In 5 of these studies (3 performed in adults and 2 in children) the time to symptom relief and clinical recovery with Nasodren® was compared with a combination of standard therapy.

Symptom relief: Nasodren® relieves symptoms after 3-4 days of treatment. In comparison with the conventional combination treatment, alone or in combination it shows a quicker recovery (3-4 versus 6-7 days) (1,2,3). Nasodren® administered in monotherapy shows similar efficacy than the standard combination treatment, but with a quicker recovery. In patients with purulent RS, Nasodren® also showed a quicker recovery, with a 4-day difference vs. conventional treatment group (7.3 versus 11.4 days) (1).

Clinical recovery (Cure): Nasodren® recovery from RS symptoms in 7-10 days of treatment, starting on days 6-7. Nasodren presents a faster cure

than the standard combined therapy (7-10 versus 10- 12 days) (1, 3). In children, Nasodrenâ recovery from clinical symptoms after 2-3 days of treatment. Nasodrenâ also normalized the rhinoscopic pattern quicker than in the control group (4-5 versus 8-10 days) (4,5).

In a cohort study, Nasodren® improved the overall state and reduced the relevant symptom in patients with ARS and CRS exacerbation in 5 days (6).

From this review it can be concluded that in all clinical studies Nasodren® shows that it is one of the treatment options for the beginning of an ARS episode, as monotherapy, even in non-purulent cases, as well as in combination. Compared with other treatments, Nasodren halved the time to relieve symptoms in adults and children, with a fast improvement in the general well-being and QoL of patients. Nasodren also reduces time to cure by 55% to 75% in comparison to the standard treatments, with an important contribution to the reduction of disease progression time, as well as to the number of complications and chronification (4).

BIBLIOGRAPHY

1) Mashkova TA, Matveeva VN. Objective evaluation of the effectiveness of secretolytic, secretostimulant therapy in complex treatment of acute rhinosinusitis. Russian Otorhinolaryngology 2007;5(30):109-112.

2) Ianov IuK, Riazantsev SV, Timchuk LE. [Efficacy of Sinuforte monotheraphy in patients with acute and chronic rhinosinusitis at an exacerbation stage]. Vestn Otorinolaringol 2007;(4):49-51.

3) Bogatov PP. Treatment of acute purulent sinusitis with Sinuforte. Rhinology, Journal of the Society of scientists and otorhinolaryngologists of Ukraine 2003:1.

4) Printz OM, Bashek V. Study of the use of Sinuforte® in the treatment of children with inflammatory conditions of the paranasal sinuses. Central Children’s Hospital in the city of ZHITOMIR (Ukraine). 2004.

5) Chernisheva LI, Siniachenko VV. Clinical and immunological investigation of the efficacy of Sinuforte use in children with acute sinusitis. J Otorynolaryngol Dis (Kiev) Special Edition 2004;3.

6) Timoshenko NA, Guriev TA. Experience on Sinuforte administration for the treatment of acute and chronic rhinosinusitis. 2nd International Conference of the Belarusian-Polish Otorhinolaryngologists. Grodno (Belarus), 2003.

7) Petrova LG. Treatment of exudative otitis media with Sinuforte. Journal of otorhinolaryngological diseases 2004;2.

Symptoms-sinus infections causing osteomyelitis

2012-01-25T00:57:00.000-08:00

Symptoms-sinus infections causing osteomyelitis

Although osteomyelitis is rare now-a-days, the past medical records confirm that the physicians were aware of the disease even in the first century A.D. For instance, Celsus, the Roman physician, mentioned about osteomyelitis in 1st century A.D and suggested surgical removal of the affected bone. In 17th century, Fabricius Hildanus described the osteomyelitis of the frontal bone.

The frontal sinuses’ mucous membranes have veins. These veins communicate with the sinus’s diploic veins draining the frontal bone and the marrow cavity. Since the intracranial venous sinus system and the veins have a direct contact, the veins deposit bacteria in the frontal bone’s marrow space and cause thrombophlebitis, and thereby spread the frontal sinus infection.

Spread of sinus infection into the cranial bone marrow via diploic veins causes local osteitis, the bone inflammation. The diploic veins, draining the frontal sinus via bone marrow, do not have valves, so spreading of the infection is easier. The frontal bone erosion may further the process and true osteomyelitis signs may develop. The infection may even cross the suture lines, spreading the infection in vast area. The infection removes the dura matter from the bone’s inner surface. The loss of dura matter results in bone devascularization because the dura supplies blood to the bone. As a result, signs of vascular necrosis (i.e. changes in morphology indicating death of the cells) appear and thereby the infection reaches the devascularized tissues easily.

To treat osteomyelitis, the affected bone is removed completely and the frontal sinus is obliterated. Post surgery, antibiotics are administered up to six weeks. The advent of antibiotics has checked the number of incidences, especially of the frontal osteomyelitis. The related mortality rate has declined from 60% before the invention of antibiotics to just about 4% in the post antibiotic era. Sooner the disease is diagnosed, lesser the chances of complications.

Symptoms-sinus infections, trauma, including surgical trauma, and the frontal sinus fracture can cause frontal osteomyelitis. The disease may appear after the first instance of the frontal sinusitis even if there is no trauma. Alternatively, it may occur when chronic symptoms-sinus infections are accompanied by acute infection. A number of osteomyelitis patients might have suffered from allergic rhino sinusitis in the past. Vascular insufficiency and immunodeficiency may aggravate the problem and reduce the effect of treatment therapy. Thus, these deficiencies should also be treated simultaneously. Generally, young adults and adolescents suffer from osteomyelitis. Divers and swimmers having acute bacterial sinusitis are prone to osteomyelitis.

Macrolide antibiotics for sinus symptoms

2012-01-24T02:21:00.000-08:00

Macrolide antibiotics for sinus symptoms

There are over 2,000 macrolides extracted from natural sources besides their several synthetic and semi-synthetic derivations. Macrolide antibiotics, popular antimicrobial agents, have been associated with infectious disease treatment since ages. The agents boast a broad antimicrobial activity spectrum, high safety level on the therapeutic index and effective oral administration. However, macrolides have some limitations too: drug action starts slowly and lower efficacy against Gram +ve bacteria as compared to that of penicillin. Since gastric acid destroys macrolides, they are sold as enteric-coated tablets. And, the absorption of macrolides depends on type of food consumed.

If patients suffering from H. influenzal sinusitis or streptococcal sinusitis are allergic to penicillin, macrolide antibiotics may be prescribed. Japan pioneered the use of macrolides to treat chronic sinus symptoms. In Japan, macrolide therapy is commonly used to treat chronic sinusitis and the sinusitis related to diffuse panbronchiolitis. Anti-inflammatory activity of macrolide antibiotics helps in treating chronic sinusitis. The macrolides used for treating the sinusitis include erythromycin (EM) and newly developed three macrolides- azithromycin (AZM), clarithromycin (CAM) and roxithromycin (RXM). McGuire and his colleagues discovered EM derived from Streptomyces erthreus strain in mid of twentieth century. AZM, CAM and RXM are derived from EM.

EM, mainly Gram positive, is a common macrolide resembling penicillin G. Gram positive organisms include streptococci penumonea and pyogenes, B. anthracis and C. diptheriea, clostridia. However, there are also some Gram-negative organisms, such as H. influenzea, M. catarrhalis and N. meningitides.

Newer AZM, CAM and RXM have long action duration. Administration frequency of these macrolides is low and thereby compliance is good. The macrolides have less impact on gastrointestinal tract (GIT), so these antibiotics are more tolerable. The three new macrolides have wider microorganism range consisting of Myco. Tuberculosis (atypical), Mycoplasma penumonea and H. influenza.

The semi-synthetic macrolide RXM is resistant to acid. Its oral tolerability is good. The drug is more active against G. vaginalis and Br. Catarrhalis. The antibiotic administration is also quite convenient. RXM is preferred for sinusitis, otitis media and pneumonia.

The antimicrobial spectrum of CAM resembles to that of EM. CAM is active against H. pylori, Mycoplasma pneumonia and Myco. avium complex (MAC). GIT irritation associated to CAM is less. Acid stable AZM is effective against N. gonorrhoea, mycoplasma and H. influenzea. The AZM drug is not metabolized.

Controlled clinical studies have shown that AZM and CAM are effective for acute bacterial sinusitis like amoxicillin-clavulanate and amoxicillin. Recent research studies also suggested that calrithromycin and azithromycin are comparable to amoxicillin in terms of efficacy to treat acute maxillary sinusitis. However, erythromycin (EM) is not prescribed for acute sinus symptoms.

What is Capsaicin in intranasal application?

2012-01-23T00:49:00.000-08:00

What is Capsaicin in intranasal application?

Capsaicin is a phenolic chemical contained within the oil of the Capsicum pepper.

Capsaicin has been used clinically with moderate success as a topical treatment for pain from rheumatoid and osteoarthritis, psoriasis, diabetic neuropathy, and postherpetic neuralgia.

When used intranasally, capsaicin irritates the nasonasal area. However, the area becomes desensitized to the irritation after repeated use. Nerve endings responsible for rhinorrhea, sneezing, and congestion become desensitized when capsaicin is applied to the nasal mucosa. Capsaicin use has been targeted at patients presenting congestion, rhinorrhea, sneezing, or a combination of these symptoms.

Clinical studies revealed a 60% reduction in nasal airway resistance. In most patients, effectiveness continued for more than 4 months after study completion. In addition, most patients showed significantly improved scores on visual analog scales. However, no significant difference was documented for nasal blockage, rhinorrhea, sneezing, coughing, mucus production, or eye irritation before, during, or after study completion. Documented adverse reactions were limited to initial nasal irritation and increased nasal airway resistance.

The majority of studies on capsaicin intranasal application have been addressed to nasal mucosa pathologies (idiopathic rhinitis, allergic rhinitis, chronic rhinopathy, etc.).

A double-blind, randomized, placebo-controlled pilot study on capsaicin nasal spray was recently completed (pending publication). The study was designed to evaluate the effectiveness and safety of capsaicin for the treatment of sinus and nasal congestion in patients suffering from non-allergic rhinitis. It measured the improvement in nasal congestion, sinus pressure, and pain. It also evaluated speed of action and safety parameters. Key findings include:

Capsaicin started to provide relief from sinus/nasal congestion, pressure, and headache pain in less than one minute.
Capsaicin subjects continued to show a statistically significant improvement in nasal congestion and sinus pain at each of the established intervals and follow-up visits over the two-week duration of the study.
Capsaicin is a powerful solution for sinus congestion, pressure and headaches that not only provides immediate relief, but also sustains this relief throughout the course of the two-week treatment period.
Additional clinical trials are needed to confirm these findings in a larger patient population.

Capsaicin versus Nasodren /Sinuforte

Articles comparing the efficacy of Nasodren/Sinuforte versus capsaicin have not been published. According to available data, we have compiled the following table comparing both products:

	Nasodren/Sinuforte	Capsaicin
Clinical trials in rhinosinusitis	15	1
Reduction of mucosal obstruction and mucopurulent secretion evaluated by endoscopy	Shown	Not Shown
Reduction of sinus occlusion evaluated by CT-Scan.	Shown	Not Shown
Provides significant therapeutic benefit in adults and children (aged ≥5 years) with acute and chronic rhinosinusitis as a first line, administered in monotherapy or in combination	Shown	Not Shown

Administered with other drugs efficacy is improved, especially with antibiotics, antibiotics + corticoids and decongestants

Shown

Not Shown

Is associated with lower costs per successfully treated patient, in terms of the health system and from a socio-economic perspective*

Shown

Not shown

* Pending publication

Can divers be affected by a sinus barotrauma?

2012-01-19T01:15:00.000-08:00

Can divers be affected by a sinus barotrauma?

Sinus barotrauma is the result of disparate pressure between the nose and sinuses as a result of ostial insufficiency. Even if the sinus ostium is sufficiently large to permit a gradual equalization of pressure, a person cannot be accommodated to the rapidly changing pressure that occurs during scuba diving. For this reason, sinus barotrauma is more commonly observed in divers.

Barotrauma of the sinuses in diving was reported more than 50 years ago. 7,8 The most common symptom is pain referred to the frontal area, although radiological examination showed that the maxillary sinus was most affected. X-rays showed a mucosal thickening and air/fluid levels. Half of the patients present a recent upper respiratory infection or symptoms referable to nasal disease.

The sinonasal symptoms and radiographic findings 10 were observed in a more recent study of 50 scuba divers affected by sinus barotrauma. 28% of patients developed an acute sinusitis 10, and another 14% of patients presented a preexisting chronic sinusitis (condition that predisposed the sinuses to recurrent barotrauma). The maxillary nerve involvement is the only neurological complication of sinus barotrauma. Possibly, repeated diving may foster permanent sinus mucosal changes or progressive ostial insufficiency. 10

It is important to differentiate between recurrent sinus barotrauma and chronic sinusitis. Patients with recurrent sinus barotrauma may have no clinical or radiological evidence of sinusitis between barotraumatic episodes. Upper respiratory infection, rhinitis, sinusitis, and intranasal pathology (e.g., nasal polyps or septal deviation) are a few factors that can compromise the capacity of the sinus ostia to accommodate the large, rapid pressure changes that occur during scuba dives. Ostial insufficiency always puts patients at risk of developing barotrauma when scuba diving. There are also some important barriers that separate the central nervous system and ocular globe from the nose and sinuses like, in all probability, the nasal mucosa, periosteum and dura. They are important in preventing the spread of infections from the nose to the eye or central nervous system, avoiding the complications reported here that would otherwise be much more common.

The air locked in patients who had a history of chronic sinusitis, may have formed within the sinuses or nasal cavity, the hyperplastic polypoid mucosa functioning like a ball valve, and both circumstances preventing highly pressurized air inspired at depth from escaping as the patients ascended. Complicating factors included the repeated, forceful Valsalva manoeuvre by both divers at depth; this manoeuvre can produce more than 250 mm Hg of pressure and could have forced pus through a small defect in the cribriform plate into the intracranial cavity (in the first diver) and air into the orbit and middle ear (in the second diver). As diver 2 ascended, the air in the orbit and middle ear expanded and compromised blood flow through the retinal artery. Pressurized air in the middle ear thus probably caused the inner ear barotrauma in each diver, as well as repeated episodes of facial palsy. 14

When examining patients with recurrent sinus barotrauma, clinicians should first rule out causative pathology by examining the nasal cavities endoscopically and possibly by obtaining a CT-scan of the sinuses. Divers with recurrent sinus barotrauma should be advised not to dive with a congested nasal cavity (e.g., during an upper respiratory infection or during an episode of either allergic or nonallergic rhinitis). In addition, intranasal disease (e.g., nasal polyps or septal deviation) in these divers may require correction to avoid compromising the ostiomeatal complex. Divers with persistent difficulty equalizing pressure in the ear and sinuses should be taught methods of equalizing this pressure. These divers should be advised to begin this equalization while at the surface of the water, then to descend slowly (with feet descending first) and to equalize continuously until a depth of 20 feet or more is reached. Those who have persistent difficulty clearing their ears and sinuses should be advised not to dive at all.

Patients who show evidence of chronic sinusitis should be treated with appropriate medical management. If radiological evidence of disease persists, functional endoscopic sinus surgery should be considered. If no clinical or radiological evidence of ostial insufficiency persists, then a pressure test should be conducted either in a hyperbaric chamber or (more practically) in a 14-foot or deeper swimming pool. If no pain develops at this depth, diving may be resumed. However, these patients must be warned that clearing may still be difficult and that this problem could result in disabling or life-threatening injuries.

Divers who present chronic rhinosinusitis should be instructed on the optimal control of their sinus disease and on non-forceful methods of clearing. Only when medical management fails, endoscopic sinus surgery is beneficial for preventing recurrent episodes of barotrauma in divers 11,13 who have recurrent or chronic sinusitis.

BIBLIOGRAPHY

1. Roydhouse N. 1001 disorders of the ear, nose and sinuses in SCUBA divers. Can J Appl Sport Sci 1985; 10:99–103.

2. Becker GD, Parell CJ. Otolaryngologic aspects of scuba diving. Otolaryngol Head Neck Surg 1979; 87:569–572.

3. Buisson P, Darsonval V, Dubin J. Sinus infection and diving [in French]. Rev Laryngol Otol Rhinol (Bord) 1990; 111:141–143.

4. Goldmann RW. Pneumocephalus as a consequence of barotrauma. JAMA 1986; 255:3154–156.

5. Bellini MJ. Blindness in a diver following sinus barotrauma. J Laryngol Otol 1987; 101:386–389.

6. Murrison AW, Smith DJ, Francis TJR, Counter RT. Maxillary sinus barotrauma with fifth cranial nerve involvement. J Laryngol Otol 1991; 105:217–219.

7. Campbell PA. Aerosinusitis: its causes, course and treatment. Ann Otol 1944; 53:291–301.  

8. Flottes L. Barotrauma of the ear and sinuses caused by underwater immersion [in Spanish]. Acta Otorinolaryngol Iber Am 1965; 16:453–483.

9. Fagan P, McKenzie B, Edmonds C. Sinus barotrauma in divers. Ann Otol Rhinol Laryngol 1976; 85(1 Pt 1)61–64.

10. Edmonds C. Sinus barotrauma: a bigger picture. SPUMS J 1994; 24(2):13–19.  

11. Taniewski M, Graczyk M, Laba L. Mucous membrane of the nose and paranasal sinuses in professional divers. Bull Inst Marit Trop Med Gdynia 1979; 30:237–244.

12. Parsons DS, Chambers DW, Boyd EM, Long-term follow-up of aviators after functional endoscopic sinus surgery for sinus barotrauma. Aviat Space Environ Med 1997; 68:1029–1034.

13. Bartley J. Functional endoscopic sinus surgery in divers with recurrent sinus barotrauma. SPUMS J 1995; 25(2):64–66.  

14. Becker GD. Recurrent alternobaric facial paralysis resulting from scuba diving. Laryngoscope 1983; 93:596–598.

Symptoms-sinus infections causing osteomyelitis

2012-01-18T01:07:00.001-08:00

Symptoms-sinus infections causing osteomyelitis

Cephalosporin antibiotics

2012-01-17T01:29:00.000-08:00

Cephalosporin antibiotics

Cephalosporins, commonly used antibiotics, are made from a fungus. Cephalosporins work against both Gram-negative and Gram-positive bacteria. When compared to penicillin, cephalosporins are more effective against Gram-negative bacteria and less effective against Gram-positive bacteria. However, both penicillin and cephalosporins have similar chemical compositions. Cephalosporins are broadly divided into the following four classes:

First-generation cephalosporins

Cefazolin sodium, the first generation cephalosporin, is active against staphylococci, streptococci, H. influenzae, P. mirabilis, C. diptheriae and Listeria.

Second-generation cephalosporins

These drugs are more effective for anaerobic and some Gram-negative organisms than the first generation cephalosporins. The antibiotics may therefore be used for infections that cannot be treated with other antibiotics, such as infections due to E. coli, Klebsiella species and Haemophilus influenzae. Cefprozil, cefurxime axetil, cefaclor and cefdinir, the 2nd generation cephalosporins, are used for treating symptoms-sinus.

Studies concluded that 250 mg of cefuroxime axetil is better than cefaclor in case of patients suffering from acute maxillary symptoms-sinus. Efficacy of amoxicillin and cefuroxime are same.

Cefoxitin sodium, the second-generation cephalosporin, works against B. fragilis, which is resistant to many common antimicrobial drugs.

Cefuroxime sodium, the second-generation cephalosporin, is similar to other cephalosporins of the second generation. It is administered to children suffering from bacterial meningitis.

Third-generation cephalosporins

The third-generation cephalosporin antibiotics are active against a wider range of Gram-negative bacteria. The drugs work against scores of strains resistant to 1st and 2nd generation cephalosporins and other antibiotics. Therefore, the drugs may be useful to treat infections caused by Providencia, Serratia and Citrobacter species. These drugs can also reach inflamed meninges, thus used for meningeal infections caused by Streptococcus penumoniae and H. influnenzae. As cephalosporins move from first to thrid generation, their activity against Gram-negative bacteria increases and activity against Gram-positive bacteria decreases. Since 2nd and 3rd generation drugs are highly resistant to cephalosporinases, the beta-lactamase enzymes released by inactive cephalosporins or some organisms, these are more effective for Gram-negative bacteria. The third generation cephalosporins are used for intracranial abscess caused by streptococci, and dural sinus thrombophlebitis, a complication of symptoms-sinus.

Cefotaxime sodium (claforan), the third generation cephalosporin, is known for ant-bacterial activity against numerous strains that are resistant to many other antibiotics, and Gram-negative and Gram-positive bacteria. The drug is prescribed to patients suffering from serious infections caused by microorganisms.

Ceftazidime (fortaz), the third generation cephalosporin, is active against bacterial strains resistant to amino glycosides and P. aeruginosa and other Gram-negative bacteria. It also works against Gram-positive organisms.

Ceftriazone sodium (rocephin), the third generation cephalosporin, is effective for most of the Gram-negative and Gram-positive bacteria.

Fourth-generation cephalosporins

The fourth generation drugs cover a wide range of anti-microbial activities. The drugs are more stable against beta-lactamase enzyme action when compared to the 3rd generation cephalosporins.

Cefepime, the first cephalosporin of the 4th generation cephalosporins, works against Gram-negative (P. aeruginosa) and Gram-positive (staphylococci and streptococci) bacteria. The drug is more effective against Enterobacteriaceae than the 3rd-generation cephalosporins.

Cefepime hydrochloride (maxipime), the fourth generation cephalosporin, is prescribed for infections caused by K. penumoniae or E. coli, and soft and skin tissue infection due to staphylococci and streptococci.

Brain abscess

2012-01-16T06:55:00.001-08:00

Brain abscess

Brain abscesses are rare. The abscesses can occur from contiguous structures like sinuses or from distant sources. Thus, the brain abscesses can broadly be divided into two categories: contiguous abscesses and hematogenous abscesses (i.e. distant sources). The cases of contiguous foci-based abscesses are more common than that of from the distant sources.

The contiguous abscesses include abscess that originate within nose, throat and ear. These abscesses affect the cortical area. Infection spreads directly or indirectly. If infection source is known, organisms causing the abscess can generally be predicted. For instance, frontal abscess due to sinusitis usually occurs because of streptococcus milleri. A wide range of antibiotics is administered up to six months for treating the abscess. Complete removal of the affected body part is also necessary.

A brain abscess affecting the fontal lobe (cortical area) is generally secondary to the frontal sinuses’ symptoms(sinusitis). About 15% of brain abscesses are due to sinusitis. However, in developed nations, incidences of sinusitis related brain abscess have declined. Since the frontal lobe is generally neurologically silent, there may not be any signs indicating the abscess. Frontoethmoidal disorder is the main cause of the sinugenic brain abscesses, i.e. sinuses’ symptoms-induced abscess.

A brain abscess may grow slowly or rapidly. If the abscess forms gradually, minimal constitutional signs appear. Especially in case of frontal abscesses, only subtle changes in the behavior or mood are seen. However, if surrounding part of the brain has notable edema, intracranial pressure may increase. And if the abscess breaks within the ventricular system, patient dies quickly. The abscess may also grow rapidly and the edema may lead to herniation of the uncus.

A sinuses symptoms-induced brain abscess usually occurs in boys and men who are in their 20s and 30s. The infection may spread directly or indirectly. In case of direct source, the infection may spread via meninges, intervening bone and tissues. The indirect source of the infection is diploic veins’ retrograde thrombophlebitis. The brain abscess location depends on predisposing causes. For instance, sinusitis related abscesses occur in the brain’s cortical area.

Common brain abscess symptoms

Patients having brain abscess may have the following symptoms:

Fever

Drowsiness

Lack of attention (inattention)

Generalized hemicranial headache

Minor changes in behavior or mood

Changes in mental status and reduced mental function

Seizures may occur before abscess’ surgical draining.

Increase in the intracranial pressure may cause vomiting and nausea.

Intracranial complications related to symptoms of sinus infections

2012-01-13T01:08:00.000-08:00

Intracranial complications related to symptoms of sinus infections

In some cases, partially treated or untreated symptoms of sinus infections may cause various intracranial complications, such as meningitis, superior sagittal sinus thrombosis (SSST), intracerebral abscess, subdural empyema, epidural abscess and osteomyelitis. The frontal sinus infections are the main cause of intracranial disorders, followed by infections originating in the ethmoid, maxillary and sphenoid sinuses. Both acute stage of chronic sinusitis and acute sinusitis may result in intracranial problems, especially in adolescent male patients. If fever of an adolescent patient suffering from frontal sinusitis is not reducing and pain is not relieved within two days of starting the therapy, it implies that the intracranial problems have developed.

During intracranial complications, retrograde thrombophlebitis spreads the infection through Breschet’s veins, the diploic veins without valves. The diploic veins enable free flow between the sinuses and cranial periosteum, orbital and dural veins. The cortical and dural veins travel to the sagittal sinus, offering a direct channel for the movement of septic thrombi between the sinuses and brain parenchyma.

Although the complications related to symptoms of sinus infections are lethal, but with the invention of antibiotics, incidences of intracranial problems have reduced substantially. A successful treatment requires a multi-disciplinary approach. Services of neurosurgeons are needed. A surgical process done at right time will resolve both sinus infection and related intracranial problems. If ocular symptoms, particularly those reducing vision of the patient, increase, a quick surgery is necessary.

Antibiotics are administered intravenously to ensure that medicine reaches the affected area. Initially, a combination of penicillin that is resistant to penicillinase and other antimicrobial agents is given to the patients. In fact, results of the culture of the affected area determine the most suitable antibiotic. Although steroids are a controversial treatment, these are used if the brain edema is severe. Seizures occur in about 80% of intracranial complications, thus anticonvulsant drugs are required.

For diagnosis, a high-resolution computed tomography (CT) scan of the sinuses, orbit and brain is required, but initial level pathology may not be clear in the scan and the sinus scan documents may not be accurate. Thus, the CT scan report should be studied with the report of a clinical examination while selecting the suitable therapy. Alternatively, a MRI scan can be used as it identifies the problem earlier than a CT scan and accurately. In some cases, additional image analysis is also required to assess the amount of infection and decide the time for surgery.

What causes cavernous sinus thrombosis?

2012-01-12T00:56:00.000-08:00

What causes cavernous sinus thrombosis?

Cavernous sinus thrombosis (CST), one of the infections-sinus-induced complications, affects cranial nerves passing through the cavernous sinus. This thrombophlebitis results in thrombosis and inflammation. Bilateral ocular findings are characteristic of CST, but unilateral ocular symptoms occurring simultaneously with meningitis symptoms may also indicate presence of the thrombosis. Bilateral CST is rare and fatal. The unilateral CST may affect the opposite eye within 48 hours of the onset of the thrombosis.

Generally, blood-borne infection travels from the paranasal sinuses, nasal cavity, ear or face to the cavernous sinus or the surrounding area via inferior and superior ophthalmic veins. The thrombosis, therefore, interrupts the venous flow, especially flow in the superior ophthalmic vein that is the main drainage channel of the orbit. Even untreated or poorly managed orbital infections may also cause CST. Staphylococcus aureus is the main cause of CST (up to 70% cases).

CST, a serious condition, can be of aseptic (non-infectious) or septic (infectious) origin. However, infections-sinus-induced CST, an ocular emergency, is septic. Although infections-sinus and orbital cellulites are principally responsible for CST, dental abscess, gingivitis and other odontogenic infections may lead to CST. If only one eye is affected, diagnosing CST is quite difficult. CST may also follow upper respiratory tract symptoms. CST may occur in immunity deficient host. For instance, in diabetic patients, fungal sinusitis may cause CST.

The cavernous sinuses, located on the sides of the sphenoid, intercommunicate and feature a network of venous passages. The cerebral veins and superior ophthalmic vein supply blood to the cavernous sinuses. The cranial nerves passing through the cavernous sinus enters the orbit and performs many basic eye functions. For instance, cranial nerves III, IV and VI control eye movements. Except cranial nerve VI, all these nerves occupy cavernous sinus’s lateral wall. The cranial nerve VI is located near carotid artery and is affected by the cavernous sinus diseases fast due to its location.

CST could be dangerous. For instance, if phlebitis, inflammation of the veins, reaches the cortical veins and dural sinuses, abscesses, multiple cerebral thrombosis and meningitis may develop. If inflammation also affects the pituitary gland, pituitary insufficiency may occur. If contralateral ocular symptoms develop, loss of vision, paralysis of the eye muscles (ophthalmoplegia) and bulging of the eyeball (proptosis) may happen. However, blindness, ophthalmoplegia and pituitary insufficiency are non-fatal. The CST mortality rate is up to 30%, but untreated CST is fatal.

What is the value of Sinus punctures in Rhinosinusitis?

2012-01-11T02:01:00.000-08:00

What is the value of Sinus punctures in Rhinosinusitis?

Sinus puncture is a technique used in the diagnosis of bacterial sinusitis and in the treatment of rhinosinusitis as a drainage procedure, when patients do not respond to medical treatment.
Sinus puncture as a diagnosis method for rhinosinusitis

Sinus puncture is used to identify acute rhinosinusitis and acute bacterial rhinosinusitis. It is the most accurate way to determine the causative organism in sinusitis. 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 (1).
Sinus puncture provides culture material to guide antibiotic selection when empiric therapy has failed or when antibiotic choice is limited. This is particularly important in patients who are immunocompromised or under intensive care, in whom sinusitis can be a prominent source of sepsis (2). However, because sinus puncture is an invasive procedure, it is not routinely performed. Sinus puncture with culture is the diagnostic reference standard in some countries like Eastern European countries or Nordic countries, but in other countries it is rarely used because it is invasive and costly; it is not a practical routine procedure. Alternative less invasive reference standard methods for diagnosing acute rhinosinusitis are needed (3).
A meta-analysis of six studies shows that sinus radiography has moderate sensitivity (76 percent) and specificity (79 percent) compared with sinus puncture in the diagnosis of acute bacterial rhinosinusitis. Studies comparing sinus ultrasonography with puncture or sinus radiography were inconclusive in determining how well ultrasonography identifies patients with acute bacterial rhinosinusitis. The results of ultrasonography varied substantially, possibly because of differences in patient populations, ultrasonography techniques, or medical personnel involved in diagnostic testing (3). 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 (1). No studies comparing magnetic resonance imaging with radiography or sinus puncture were found. The one randomized trial comparing computed tomography with sinus radiography was inadequately reported (3).
Future studies of clinical criteria (including risk scores), ultrasonography, and endoscopy with middle meatal sampling, ideally comparing them with sinus puncture in a variety of research and clinical settings, are needed to establish their diagnostic utility (3).

Sinus puncture as a treatment for Rhinosinusitis
Several techniques have been described for drainage of the maxillary sinus. Sinus puncture is used to drain sinus when appropriate medical therapy has failed to control the infection, resulting in prolonged or slowly resolving symptoms, or for the prevention of, or treatment for rhinosinusitis complications (2).
Sinus puncture and irrigation techniques allow for surgical therapy, a means of removing thick purulent sinus secretions. The purpose of surgical drainage is to enhance mucociliary flow and provide material for culture and sensitivity. A surgical means of sinus drainage should be used when appropriate medical therapy has failed to control the infection and prolonged or slowly resolving symptoms result, or when complications of sinusitis occur (2).
There are no statistics for the use of sinus puncture in diagnosis or treatment. In spite of the lack of a standard method of diagnosis or treatment for rhinosinusitis, the use of sinus puncture is controversial and changes from country to country.
Bibliography
1. Christine Radojicic. Sinusitis. Disease Management Project Main. August 1, 2010. (http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/)
2. S.E. Sobol, M D Schloss, T L Tewfik, Sinusitis, Maxillary, Acute, Surgical Treatment. E-Medicine: Medscape continually updated Clinical reference. Jul 14, 2009. (http://emedicine.medscape.com/article/862030-overview)
3. AHRQ Evidence Report Summaries. 9 Diagnoses and Treatment of Acute Bacterial Rhinosinusitis: Summary. Bookshelf ID: NBK11860. Rockville (MD): Agency for Healthcare Research and Quality (US); 1998-2005. (http://www.ncbi.nlm.nih.gov/books/NBK11860/)

Sinuses infection-induced eye complications

2012-01-10T00:59:00.000-08:00

Sinuses infection-induced eye complications

The orbit (eye socket) is structurally located near the sinuses. Thus, sinuses’ infection may cause orbital complications if surgery is delayed, stubborn and virulent organisms are present, host immunity is impaired and medication is inadequate. The sphenoid and ethmoid sinuses bound the orbit medially. The frontal sinus is located superiorly, whereas the maxillary sinus is placed inferiorly. Ethmoid sinuses infection is the main reason of the complications followed by maxillary sinusitis and frontal sinusitis. The problems ascribed to the sphenoid sinusitis are rare. The complications may occur any time in life but generally are common in young children.

How does infection spread?

The infection may reach the orbit due to retrograde thrombophlebitis and direct extension. Retrograde thrombophlebitis means that infection spreads through the valve-less vein network enabling smooth movement between the orbit and the sinuses, nasal cavity and face. The eroded bony wall of the lamina papyracea, congenital body splitting or unstitched suture line may spread the infection.

Types of orbital complications

The orbital complications are divided into five groups: cavernous sinus thrombosis, inflammatory edema, orbital abscess, orbital cellulite and subperiosteal abscess. Periorbital cellulite is the most common complication.

Cavernous sinus thrombosis (CST) is mainly ascribed to infection of the sphenoid and ethmoid sinuses. The infection may spread due to retrograde thrombophlebitis involving the ophthalmic vein or direct extension. Initially, the patient may suffer from periorbital edema, diplopia, photophobia, headache and fever.

Inflammatory edema is also called preseptal or periorbital cellulite. Eyelids swell near the orbital septum, but the orbit’s soft tissues are not affected. The septum prevents infection from spreading into the orbit. If extra ocular movement stops, soft tissues are also affected.

Orbital abscess means pus accumulation within the tissue of the orbit. This complication may lead to proptosis, which means forward displacement or projection of the eyeball, and loss of vision. The abscess may also limit the extra ocular movement.

Orbital cellulite implies inflammation and edema of the orbit area, but there is no abscess. Partial or complete paralysis of eye muscles (ophthalmoplegia), conjunctival edema (chemosis) and proptosis may occur. If the cellulite is not treated, an abscess may develop and the patient may become blind.

Subperiosteal abscess is pus accumulation between the orbital wall bone and the orbital periosteum. During initial stage, displacement may occur in the orbit area. If the infection continues to spread, ocular movement is affected, thereby conjunctival edema develops. The abscess may reach the eyelids.

21 interesting facts about nasal treatments

2012-01-09T04:18:00.000-08:00

21 interesting facts about nasal treatments

The 1500 BCE records reveal that Egyptians mastered the art and skill of removing the cranial material through the nose to avoid any disfiguration of the face while mummifying the bodies.

Records of various rhinologic procedures practiced during 700 BCE are found in the Egyptian and Indian medical books.

In 5th century, Susruta, the famous Indian surgeon, invented nasal reconstructive flaps and rhinoplasty that are still used.

Do you know that physicians examined the anterior of the nose in candlelight until 16th century?

In 1744, Boerhaave introduced a ground-breaking idea: nasal polyps are elongated sinus membranes.

The German doctor Hirshberg reported aspirin sensitivity in 1899.

In 1933, Shenck and Kern suggested that nasal polyps were related to allergy. The polyps were commonly found in the ethmoid air cell system.

In 1940s, advancements in immuno-biology and immuno-histochemistry techniques enabled description of lymphocyte and eosinophil present in the polyps.

In 1959, Lurie discovered relationship between the polyps and cystic fibrosis for the first time.

In 1969, Beer and Samter threw light on the triad of asthma, nasal polyps and aspirin sensitivity.

In the end of the twentieth century, the first rigid and flexible fiber-optic endoscope was discovered. The invention changed the way upper aero-digestive tract was examined.

Since Hippocrates influence was strong during golden age of the Greek civilization, he is remembered as the father of medicine and rhinology. However, Susruta used highly advanced surgical techniques to treat nasal disorders. Hippocrates recorded disorders related to nasal polyps and fractures. He named the nasal growth as polypus, as it resembled to the polyps found in the sea. He defined polyps as “the sacs of phlegm that cause nasal obstruction and derange the sense of smell.”

Hippocrates knew that nasal polyps are recurrent in nature.

The world-famous physicians like Fabricius Hildanus, Paulus Aegineta and Claudius Galen also treated the polyps dexterously.

Egyptian physicians believed that a bad smelling nose confirmed presence of polyps.

Celsus said, “Large polyps dangled into the pharynx and on cold and damp days strangulate a man.”

A crude nasal speculum was used by Hippocrates, Haly Abbas- an eminent Islamic medicine expert, and the Indian Ayurvedic physicians in bygone eras. In fact, these speculums were an improvisation of the instruments employed for rectal and gynecological examinations.

Fabricius Hildanus invented an aural speculum, which resembles the modern speculum.

Alfred Kirstein pioneered use of artificial light for nasal examination. He invented first headlight that inspired the modern headlights.

In Greece, tampons and nasal packs soaked in copper salts and honey were used to prevent reoccurrence of polyps.

The Roman physicians used turpentine and other irritating substances, calf tallow, goose fat and oily products to treat the polyps.

2011-12-29T02:03:00.000-08:00

What is Capsaicin in intra nasal application?

Capsaicin is a phenolic chemical contained within the oil of the Capsicum pepper.

Capsaicin has been used clinically with moderate success as a topical treatment for the pain of rheumatoid and osteoarthritis, psoriasis, diabetic neuropathy, and postherpetic neuralgia.

When used intra nasal, capsaicin irritates nasonasal area. However, the area becomes desensitized to the irritation after repeated use. Nerve endings responsible for rhinorrhea, sneezing, and congestion become desensitized when capsaicin is applied to the nasal mucosa. Capsaicin use has been targeted to patients presenting with congestion, rhinorrhea, sneezing, or a combination of these symptoms.

Clinical studies revealed a 60% reduction in nasal airway resistance. In most patients, effectiveness continued for more than 4 months after study completion. In most patients, scores on visual analog scales significantly improved. However, no significant difference was documented for nasal blockage, rhinorrhea, sneezing, coughing, mucous production, or eye irritation before, during, or after study completion. Documented adverse reactions were limited to initial nasal irritation and increased nasal airway resistance.

The majority of studies on capsaicin intra nasal application have been addressed to nasal mucosa pathologies (idiopathic rhinitis, allergic rhinitis, chronic rhinopathy, etc.).

A double-blind, randomized, placebo-controlled pilot study on capsaicin nasal spray was recently completed (publication pending). The study was designed to evaluate the effectiveness and safety of capsaicin for the treatment of sinus and nasal congestion in patients suffering from non-allergic rhinitis. It study measured the improvement in nasal congestion, sinus pressure, and pain. It also evaluated speed of action and safety parameters.

2011-12-28T02:12:00.000-08:00

Tests That Determine Allergies’ Causes

A number of laboratory tests helps in determining causes of allergies. The tests identify the substance causing allergic reactions / allergens. Commonly used allergy tests include blood tests, elimination tests and skin tests.

Blood tests are conducted if patients are unable to undergo skin tests. Enzyme-linked immunosorbent assay (ELISA, EIA), a blood test, counts allergen-specific immunoglobulin (Ig) E antibodies found in the blood of the patient. Other examples of blood tests include absolute eosinophil count, immunoassay capture test (ImmunoCAP, UniCAP, or Pharmacia CAP) and radioallergosorbent (RAST) test.

Absolute eosinophil count test calculates the number of eosinophils, the white blood cells, as the cells become active when you have allergies and infections. If the result of a blood differential test is abnormal, absolute eosinophil count test is done. The eosinophil test helps in assessing severity of an allergic reaction. A high count of eosinophil may be ascribed to hay fever, asthma or leukemia. RAST method is used if the result of skin testing is inconclusive or skin testing cannot be done.

Elimination tests use an elimination diet to determine allergies to a food item. The diet means stopping consumption of foods causing allergic reaction for many weeks and re-introducing these food items one by one to observe and monitor allergy symptoms.

The most common allergy test is a skin test that is used to diagnose allergic contact dermatitis, food allergy, penicillin allergy, venom allergy and animal, mold and pollen allergies causing asthma and allergic rhinitis. Skin tests are preferred to blood tests as they are reliable, quicker and cheaper. There are different types of skin tests, such as intradermal skin test, patch testing and prick test.

During intradermal skin test, a small quantity of an allergen is injected into the skin and reaction signs are observed. The test is usually performed to determine whether patient is allergic to penicillin and bee venom. This test is done if a prick test fails. In the prick test, a small quantity of a likely allergen is placed into the skin surface through needle pricks or scratches and reaction to the allergen is watched for up to 20 minutes.

Patch testing means placing allergens on the skin and taping them to the skin for up to three full days. The test is carried out to diagnose contact dermatitis, a skin allergy caused due to chrome found in leather items, nickel used in coins, jewelry and watch buckles, and fragrances.

Can Animal-induced Allergens Cause Allergic Rhinitis?

2011-12-27T01:18:00.000-08:00

Can Animal-induced Allergens Cause Allergic Rhinitis?

Yes, animal-induced allergens may cause allergic rhinitis.

For instance, pet dander, small skin scales shed by the animals, may trigger perennial or episodic allergic rhinitis. As dander and hair exist in the air, pets living indoors cause more problems. Air borne dander can move within the home through the air-circulation system. Some times wool also contains tiny dander that may trigger allergy.

Some people are allergic to feathers or furs of the animals, while others are allergic to saliva of animals. If your pet licks you, you may be exposed to its saliva. If you touch objects chewed or licked by animals, it may increase chances of touching the saliva. Cats’ saliva, for example, has a protein that causes allergy.

Cats have more allergens than dogs. Wash pets at least once every week to get rid of allergic-substances. You may try dry shampoos that are easy to use to remove allergic substances from the fur and skin of the pets. Although cats and dogs are common source of allergies, ferrets, hamsters, horses and rabbits may also cause allergies.

Remove pets from the home. But if you do not want to do that, thorough cleaning of floors and carpets is necessary. Use vacuum cleaners with high-efficiency particulate air (HEPA) filter. Wash bedding and draperies frequently. Keeping pet food in closed containers will help in reducing cockroaches menace, because these pests are also a source of allergy. Clean humid areas of your home, such as garages, bathrooms and kitchens regularly, because cockroaches love damp places. Cockroaches may affect lung function and trigger asthma. Exterminate the pests. Do not keep food in bedrooms. Store food in closed containers. Use covered dustbins.

Another common allergen is house mice hairs, especially in urban areas. Exterminate the mice and remove dust that may have mouse dander and urine.

To treat pet-induced allergic rhinitis, allergen immunotherapy is useful. However, the best therapy is to avoid pet dander and other animal-induced allergens because it saves money and eliminates chances of side effects of medication. Many times, it is difficult to avoid the allergens.

If you suffer from animal-induced allergies and still love pets, keep the pets outdoor instead of indoors. Do not let them enter into bedrooms. Ensure that pets do not spend time on carpets and furniture covered with cloth. However, some research studies concluded that exposure to pet-specific allergens during early childhood may make children allergy resistant.

Chronic cough’s triad

2011-12-22T02:10:00.000-08:00

Chronic cough’s triad

Post nasal dripsyndrome (PNDS), gastro-oesophageal reflux (GOR) and asthma form the pathogenic triad of chronic cough. If the cough is ascribed to more than one factor, the pathogenic triad is used for complete diagnosis. If a non-smoker is suffering from chronic cough, but the patient’s chest radiograph is normal and patient is not administered angiotensin-converting enzyme (ACE) inhibitors, one of the triad conditions may be causing the cough.

PNDS-induced cough

Diseases affecting paranasal sinuses, pharynx and nasal fossae cause post nasal dripsyndrome. For example, chronic and / or acute sinusitis, rhinitis because of medication or environmental irritants, post infectious rhinitis, vasomotor rhinitis, allergic rhinitis, common cold or other upper respiratory tract disorders may cause PNDS. Since these upper respiratory tract conditions have some common symptoms, the diseases are collectively referred to as rhinosinusitis.

Various scientific studies concluded that the post nasal drip syndrome is one of the common causes of chronic cough, especially in patients who do not smoke. The number of PNDS incidences is high in the US as compared to that recorded in the European countries.

Since there are no distinct characteristics (pathognomonic) of PNDS, a number of factors are taken into account to diagnose the disease. For instance, interpretation of radiographic material, physical examination, symptoms and effect of the selected PNDS therapy are studied simultaneously for the diagnosis. The response to the therapy is considered as the most suitable diagnosis technique. A sinus coronal CT scan, 4-view sinus radiograph and nasolaryngoscopy may also be useful in the diagnosis.

Mechanical or chemical irritation of pharynx and / or larynx receptors may cause cough in the patients suffering from PNDS. When endpoints of pharyngeal branch nerve are stimulated, cough occurs in the upper respiratory system.

The patients suffering from PNDS-induced cough may have mucus in oropharynx, oropharyngeal mucosa resembling a cobblestone, nasal discharge and strong desire to clean throat frequently.

Nasal steroids, nasal cromolyn and oral antihistamines are effective in case of allergic rhinitis-induced PNDS. A saline nasal wash is also helpful.

Cough because of GOR

Gastro-oesophageal reflux (GOR) is also known as gastrooesophageal reflux disease (GERD). A number of patients having cough may have regurgitation, heartburn, sour taste and other gastrointestinal (GI) symptoms. If reflux is high, dyspnea, wheezing, purulent sputum or other pulmonary symptoms may occur. Patients may also complaint about hoarseness and sore throat, laryngeal disorders.

Asthma related cough is difficult to diagnose due to minimum wheezing or breathlessness. Atypical or bacterial bronchitis or a viral respiratory disorder may cause the cough in asthma patients. This nonproductive cough occurs during night and day.

4 types of nasal sprays

2011-12-21T03:41:00.000-08:00

4 types of nasal sprays

There are four types of intranasal medications, known as nasal sprays. The medication may contain cromoglycate- a nasal mast-cell stabilizer, ipratropium- anticholinergics and / or natural extracts from plants. For instance, grapefruit seed extract nasal spray is effective for both acute and chronic sinusitis. Colloidal silver is also used in the sprays prescribed for both the conditions.

A nasal decongestant spray reduces nasal tissue swelling in the patients suffering from acute sinus infection. The nasal spray offers immediate relief from the congestion. However, do not use the spray for more than five days because congestion rebounds due to excessive usage. During rebound, initially, the spray shrinks the nasal tissues but then swelling reappears. This condition is referred to as rhinitis medicamentosa. Do not use vasoconstrictive nasal sprays for long, because abuse of the spray results in the rebound.

Afrin, an oxymetazoline hydrochloride nasal spray, is used to treat acute sinusitis. Afrin is administered 20 minutes prior to endoscopic frontal sinusotomy. Xylometazoline, a sympathomimetic decongestant, is a major ingredient of the spray that effectively treats allergic rhinitis. Some physicians also prescribe a decongestant nasal spray prior to computed tomographic (CT) scan.

A nasal steroid spray reduces inflammation slowly in chronic sinusitis. The nasal spray delivers a strong dosage of steroids on the affected nasal tissue surface. Daily use of the spray is must to get the desired results, but effect of the spray will be visible after a week or so. The spray may be used twice a day. The spray is safe to use over a long period. A steroid spray is administered after endoscopic frontal sinusectomy.

The topical corticosteroid nasal spray causes irritation because of fluorocarbon used to propel the steroid. Even contact with the tip of the spray can cause irritation. Thus, use of fluorocarbon-based propellants in the nasal spray has been banned since late 1990s.

A nasal antihistamine spray reduces nasal membrane’s response to inflammatory cells, but the spray may have some side effects. Incorrect use of the spray may lead to nose bleeding. The azelastine nasal spray, an antihistamine spray, is an innovative anti allergy treatment. The Astelin N. S. spray is useful to treat seasonal allergic rhinitis. Levocabastine spray is another example of the antihistamine spray.

A nasal saline spray reduces congestion by moisturizing the nasal cavity. Irrigate the nose with these sprays to open up the nasal passage without any side effects. The spray is used after endoscopic drainage of a subperiosteal orbital abscess.

Since nasal sprays are addictive, avoid its overdose or wrong usage, and consult the doctor before using the spray.

Nasal polyps’ origin

2011-12-20T01:39:00.000-08:00

Nasal polyps’ origin

A nasal polyp is a mucosal sac filled with inflammatory cells, vessels, edema and / or fibrous tissues. Recently formed glands, changes in epithelial regrowth and presence of edema and eosinophilia are characteristic of the nasal polyps unlike the normal nasal mucosa. Eosinophilia is the most commonly found inflammatory cell in the polyps.

The polyps were observed and recorded even forty centuries ago in Egypt. Since then many developmental strides have been made to understand the polyps better and invent advanced treatments and techniques. For instance, now-a-days, microscopic and endoscopic surgical methods are popularly used to treat nasal polyps.

In the late nineteenth century, scientists suggested that the polyps began from the nasal wall located in the ethmoidal cleft region. Detailed studies of etiology, structure, histopathologic review, autopsy and surgeries of the polyps have revealed some unique features. However, the polyp origin is still a mystery.

Evaluation of functional endoscopic sinus surgery records concludes that the polyps commonly grow from the infundibulum, uncinate process and middle meatal. The second most common place from where polyps originate is the hiatus semilunaris and ethmoidal bulla. Autopsy studies found out that the most of the polyps were linked with ethmoidal clefts and recesses, and were unilateral.

The lifecycle of the polyps begins as solitary and small structures in the osteomeatal regions’ slim channels. Multiple factors initiate nasal polyp formation. The polyp size depends on a number of factors, such as level of edema and inflammation, age and growth rate of polyp. The meatus anatomy, available space and size and number of the existing polyps define its shape. A stalk connects the polyp apex or body to the polyp’s base. The length and thickness of the stalk also vary.

Each polyp consists of numerous tissues. The polyp stroma surrounds the amorphous substance featuring inflammatory cells, glands, blood vessels and fluid. An epithelium layer covers the polyp surface. Both epithelium layer and inflammatory cells may evolve as the polyp develops and grows.

Some nasal polyps may have scores of intraepithelial glands, the pathologic structures. Mucous glands found in the polyps play a crucial role in growth and pathogensis of the polyps. By examining the gland shape, you can decide whether the gland grew within the nasal polyp or in the nasal mucosa, because the glands form when the polyp is still in development and growth stage. As polyp length increases, the gland length also increases.

21 interesting facts about nasal treatments

2011-12-19T01:18:00.000-08:00

21 interesting facts about nasal treatments

The 1500 BCE records reveal that Egyptians mastered the art and skill of removing the cranial material through the nose to avoid any disfiguration of the face while mummifying the bodies.

Records of various rhinologic procedures practiced during 700 BCE are found in the Egyptian and Indian medical books.

In 5th century, Susruta, the famous Indian surgeon, invented nasal reconstructive flaps and rhinoplasty that are still used.

Do you know that physicians examined the anterior of the nose in candlelight until 16th century?

In 1744, Boerhaave introduced a ground-breaking idea: nasal polyps are elongated sinus membranes.

The German doctor Hirshberg reported aspirin sensitivity in 1899.

In 1933, Shenck and Kern suggested that nasal polyps were related to allergy. The polyps were commonly found in the ethmoid air cell system.

In 1940s, advancements in immuno-biology and immuno-histochemistry techniques enabled description of lymphocyte and eosinophil present in the polyps.

In 1959, Lurie discovered relationship between the polyps and cystic fibrosis for the first time.

In 1969, Beer and Samter threw light on the triad of asthma, nasal polyps and aspirin sensitivity.

In the end of the twentieth century, the first rigid and flexible fiber-optic endoscope was discovered. The invention changed the way upper aero-digestive tract was examined.

Since Hippocrates influence was strong during golden age of the Greek civilization, he is remembered as the father of medicine and rhinology. However, Susruta used highly advanced surgical techniques to treat nasal disorders. Hippocrates recorded disorders related to nasal polyps and fractures. He named the nasal growth as polypus, as it resembled to the polyps found in the sea. He defined polyps as “the sacs of phlegm that cause nasal obstruction and derange the sense of smell.”

Hippocrates knew that nasal polyps are recurrent in nature.

The world-famous physicians like Fabricius Hildanus, Paulus Aegineta and Claudius Galen also treated the polyps dexterously.

Egyptian physicians believed that a bad smelling nose confirmed presence of polyps.

Celsus said, “Large polyps dangled into the pharynx and on cold and damp days strangulate a man.”

A crude nasal speculum was used by Hippocrates, Haly Abbas- an eminent Islamic medicine expert, and the Indian Ayurvedic physicians in bygone eras. In fact, these speculums were an improvisation of the instruments employed for rectal and gynecological examinations.

Fabricius Hildanus invented an aural speculum, which resembles the modern speculum.

Alfred Kirstein pioneered use of artificial light for nasal examination. He invented first headlight that inspired the modern headlights.

In Greece, tampons and nasal packs soaked in copper salts and honey were used to prevent reoccurrence of polyps.

The Roman physicians used turpentine and other irritating substances, calf tallow, goose fat and oily products to treat the polyps.

2011-12-16T00:48:00.000-08:00

Sinusitis Surgery: Pre- and Post- Operative Care

Both pre- and postoperative precautions enhance the benefits of the sinusitis surgery. However, in many cases of sinusitis surgery, poor follow-up and improper post-operative care minimize or offset the benefits of the procedure, and create complications. To avoid all these problems, patients may follow the instructions listed below and their surgeon’s advices in letter and spirit:

Pre-operative Care

Prior to the surgery, an anesthesiologist must review medical history of the patient.

The surgeon may order pre-operative laboratory studies, which should be done in advance. Patients should carry all the studies on the day of the surgery.

Do not take any medication containing aspirin or nonsteroidal anti-inflammatory medications, or aspirin 7-10 days before the surgery. Consult your doctor before administering any drug.

In many cases, doctors advise not to drink or eat eight hours before the surgery.

Follow preoperative advice given by the doctor.

Patients should not smoke before the surgery to minimize post-operative bleeding and coughing.

If patient has any illness like fever, it should be reported to the doctor prior to the surgery.

Do all paper work properly before the surgery.

Wear loose fitting clothes that can be removed easily. Do not wear jewelry and accessories like watches, earrings, etc. Neither apply cream nor make-up. Avoid hair clips. Wash the face with water and soap before the surgery.

Post-operative Care

A responsible person should be with the patient on the first night after the surgery.

The surgeon may advice use of saline irrigation and the suitable method of irrigation.

Mostly, patients are allowed to go home as soon as they recover from anesthetic. After reaching home, patient should rest in the bed. Use 2-3 pillows to elevate the head. Raised head will reduce swelling and edema.

Swelling around eyes and of cheeks, nose and upper lip is normal. It may take some days to subside. You can use ice pack on the face to reduce it. The ice pack will also reduce pain and edema if these symptoms appear after the surgery. Use ice pack for 15-minute, then take 15-minute break, then reuse it.

Some nose bleeding is normal. The bleeding will reduce slowly. Use gauze dressing in case of nose bleeding.

Do not take drugs containing aspirin or nonsteroidal anti-inflammatory medications, or aspirin unless prescribed by the doctor. Consumption of these drugs may slow blood clotting and increase bleeding.

Eat cool, soft, light food. Do not consume hot liquids for many days. Eat slowly to avoid postoperative vomiting and nausea.

Take adequate rest.

Complete the course of antibiotics if doctor has prescribed. Or, any other medicines prescribed by the doctor.

2011-12-15T02:58:00.001-08:00

Sphenoid Sinusitis

Development of the sphenoid sinus begins at the age of three years. The sinus sits in the sphenoid bone. Capacity, size and shape of the sinus vary from person to person. The sphenoid sinus walls are located next to the cavernous sinuses, dura mater, optic canals and pituitary gland. The walls can be ultra thin. The infection and / or obstruction of the sinus is called sphenoid sinusitis, which is not common. However, sphenoid sinusitis is generally misdiagnosed. This infection-sinus may lead to sub acute or acute sphenoid sinusitis.

Acute sphenoid sinusitis is uncommon. Acute sphenoid sinusitis generally occurs with pansinusitis. Central, frontal, occipital or vertical headache is common during acute sphenoid sinusitis. The headache may increase while bending forward. Staphylococcus aureus is the common cause of the acute sphenoid sinusitis. Chronic sphenoid sinusitis leads to uneasiness in retro-orbital area or a headache.

The sphenoid sinus is prone to neoplastic, infectious, inflammatory or expansile processes. The neoplastic process means abnormal growth of a tissue or a tumor. Accumulation of pus in the sinus is pyocele, which is infectious. The inflammatory process is referred to as Wegener granulomatosis. The sphenoid sinus inflammation accompanied by mucormycosis increases severity of the sinusitis.

Diagnosis

Patients of solitary sphenoid sinusitis may not have nasal problems, diagnosing becomes difficult. Generally, this infection-sinus is diagnosed when complications begin. CT scan is the most suitable method to diagnose sphenoid sinusitis.

Symptoms

Fever
Loss of vision
Purulent discharge
Sleep related problems
Progressive headache
Headaches in temporal region (bitemporal), back of the head (occipital) or eye-socket (retro-orbital) are characteristic to the isolated sphenoid sinusitis.
Headaches may become severe.
Headaches worsen with movement of the head and disturb sleep. Aspirin does not relieve these headaches.

Complications

If the infection-sinus is not diagnosed appropriately or treated properly, deadly complications may occur. Likely complications include orbital abscess, orbital cellulites, orbital edema, cerebral abscess, cavernous sinus thrombosis, meningitis, mucocele, pituitary insufficiency and superior sagittal sinus thrombosis. Although mucoceles are rare, they affect vision of the patient.

A mucocele is a kind of cyst containing mucus. Adhesions, tumors and polyps may obstruct drainage from the sinus system, resulting in formation of mucoceles. Continuous inflammation in sinus ostia for long time may also cause mucoceles. The mucoceles exert pressure on the walls of the sinus, eroding the surrounding bone and causing headaches.

2011-12-14T02:49:00.000-08:00

Are migraine & sinus headaches similar?

Migraine and sinus headaches have some common symptoms that create confusion and make diagnosis difficult. Proximity of the structures affected during migraine to the sinuses is another reason for the confusion. However, these two conditions also have some unique signs. Read on to know more about headache-sinus and migraine headache for correct diagnosis.

Headache-sinus may vary from mild to extremely painful, so that the patient feels physically weak. Sinus headache improves as the day progresses after severe pain in morning. Weather change, cold or beginning of menstruation usually causes sinus headaches.

A migraine headache generally occurs on one side of the head, but the patient may feel it on both the sides. The headache develops over a period of time through four phases: prodrome, aura, headache and postdrome (post headache). The dilation and constriction of the brain’s blood vessels result in a migraine headache. The head pain, throbbing in the temples and head, pressure in the facial sinus or back of eyes may aggravate the migraine headaches.

When the migraine headache is situated over the sinus area, the headache is confused with sinus headache. Since change in weather is also one of the main causes of migraine, a migraine headache is mistaken for headache-sinus.

In many cases, migraine and sinus headaches do not occur simultaneously. However, if pressure on the sinus cavity’s blood vessels builds, sinus headache may trigger migraine headache.

During sinus headaches, patients may also have migraine symptoms, such as sensitivity to noise and light, and / or nausea.

Migraine headaches generally respond to antihistamines treatment, therefore, these headaches may be confused with headache-sinus.

If sinus headache symptoms like purulent discharge and acute imaginative illness are absent, the headache is due to migraine.

Usually migraine specific symptoms like phonophobia, photophobia, pulsatile quality and vomiting do not occur during sinus headache.

Common symptoms of acute bacterial sinusitis or allergic rhinitis also occur during a migraine attack, thereby causing confusion in sinus and migraine headaches.

Some times sinus x-ray shows mucosal thickening in patients suffering from headache but not having rhinosinusitis symptoms. This is a migraine symptom, but it is mistaken for sinus headache.

Generally, other symptoms of sinus diseases also occur during sinus headache unlike the migraine headache. However, sinus disease symptoms may accompany the migraine headache that is a result of a sinus headache. Nasal sinus disorder may stimulate migraine headache. A patient suffering from both sinus disease and migraine may complaint about both types of headache symptoms, thereby confusing the patient about headache type.

Consult a doctor for correct diagnosis. Do not delay the headache treatment because the delay may aggravate the problems.

2011-12-13T01:52:00.000-08:00

Sinusitis Surgery: Pre- and Post- Operative Care

Pre-operative Care

Prior to the surgery, an anesthesiologist must review medical history of the patient.

The surgeon may order pre-operative laboratory studies, which should be done in advance. Patients should carry all the studies on the day of the surgery.

Do not take any medication containing aspirin or nonsteroidal anti-inflammatory medications, or aspirin 7-10 days before the surgery. Consult your doctor before administering any drug.

In many cases, doctors advise not to drink or eat eight hours before the surgery.

Follow preoperative advice given by the doctor.

Patients should not smoke before the surgery to minimize post-operative bleeding and coughing.

If patient has any illness like fever, it should be reported to the doctor prior to the surgery.

Do all paper work properly before the surgery.

Post-operative Care

A responsible person should be with the patient on the first night after the surgery.

The surgeon may advice use of saline irrigation and the suitable method of irrigation.

Some nose bleeding is normal. The bleeding will reduce slowly. Use gauze dressing in case of nose bleeding.

Eat cool, soft, light food. Do not consume hot liquids for many days. Eat slowly to avoid postoperative vomiting and nausea.

Take adequate rest.

Complete the course of antibiotics if doctor has prescribed. Or, any other medicines prescribed by the doctor.

2011-12-12T01:24:00.000-08:00

9 Factors Causing Infection-Sinus

Gunge accumulated in the sinuses is an ideal place for harmful germ growth. These germs cause infection-sinus. Acute sinus infection is attributed to a number of factors, which are discussed below:

Chronic medical conditions, including cystic fibrosis, HIV and diabetes, weaken the immune system, causing swelling of the airways. As a result, thick mucus may develop that in turn leads to infection-sinus.

Anatomical abnormalities, structural defects, such as cleaved palate, tumor, deviated septum and thin drainage channels, interfere with mucus drainage. Disease-spreading bacteria and viruses can easily grow in the mucus build up, setting the stage for infection.

Polyps, benign growths in the sinuses and the nose, may block the sinus spaces and thereby hinder mucus drainage. The mucus build up will lead to infection. If these growths obstruct the airway channels, headaches may develop.

Smoking is an irritant that may cause inflammation in the nose and make you more prone to infection-sinus. Indeed, smoking interrupts and disrupts natural cleaning process of the sinuses. More gunge, thus, gathers into the sinuses, blocking the nasal passages.

Fungi may even infect the sinuses of a healthy person. However, mostly people with a weak immune system get fungal sinusitis. Fungi grow easily in dark and damp environs, which are found in the sinuses. So weak immune system and right environment encourage growth of disease-causing fungi.

Frequent air travel may worsen the infection-sinus. Reduced air pressure in an airplane may build up pressure in the head. The pressure, especially during landing and takeoff, may clog the air passages and the sinuses, aggravating signs of cold and sinusitis.

Adventure activities like diving and swimming worsen symptoms of sinusitis in the people already suffering from the disease. Do not spend too much time in the swimming pools, because chlorine irritates the sinuses and the nasal lining. Water may enter into the sinuses due to pressure change while diving and inflammation of sinus tissues may occur.

Air-borne pollutants, including dust, perfume, and other strong odors, cause irritation in the nose and inflammation, making you more susceptible to sinusitis. Try to avoid these pollutants and reduce the risk of developing sinus infection.

A viral infection in the upper respiratory system may lead to sinus infection. The viral infection damages the sinus membrane cells, causing inflammation and thickening of the membrane. The thick membrane clogs the nasal passages connecting to the sinuses. In the absence of proper removal of bacteria, infection develops.

2011-12-09T01:32:00.000-08:00

Sinus

What is a Sinus?

Sinus is an air-filled cavity located behind cheeks, eyes and forehead in the cranial (skull) bones. A mucus membrane lines the sinus. The membrane has cells with very fine hairs, ciliated epithelium that pushes out the mucus from the cavity, enabling circulation of the air. The mucus traps pollutants, including dirt particles, found in the air that is inhaled. A healthy sinus is free from germs, including bacteria. Each cavity features an ostium, a channel opening into the nasal passages for easy exchange of mucus and air. The sinus grows into a walnut-size pocket from a pea-size space.

Types of Sinus

These cavities are found in pairs and also called “paranasal sinuses”. Ostia, a thin channel, connects the sinuses to the throat and nose. All sinuses are interconnected. Human skull features four pairs of sinuses: ethmoid, frontal, maxillary and sphenoid. The sinuses are named after the four skull bones in which they are located. The bones are referred to as the ethmoid, the frontal, the maxilla and the sphenoid.

The pyramidal ethmoid sinuses lie between the eyes, behind the nose bridge and at the nose root. All newborn babies have clearly demarked ethmoid that grows with age. The sinus cavities above the eyes in forehead are called frontal sinuses. The maxillary sinuses in cheekbones are located on the side of nostrils. The maxillary cavity, the largest sinus, develops before other sinuses. The cavity, generally filled with fluid at the time of birth, grows in two phases: up to three years of age and between seven and twelve years of age. The maxillary sinus resembles a pyramid in an adult. The sphenoid sinuses, situated behind the eyes and the ethmoid sinuses, are found deep in the skull. These cavities reach their full-size during adolescence. The ethmoid and maxillary sinuses are a birth feature whereas funnel shaped frontal develops at the age of five.

Functions of Sinuses

Sinuses reduce skull weight, particularly weight of the facial bones. So, if the cavities are blocked, the head becomes heavy and drowsiness and tiredness occur during sinusitis.

Sinuses add resonance to the voice.

Sinuses warm, moisten and filter the air that we inhale and remove redundant air particles.

Sinuses produce mucus that protects against microbiologic organisms, pollutants, dirt and dust.

Sinuses may facilitate pressure damping and air conditioning.

Sinuses increase the olfactory area.

Sinuses insulate eyes, dental roots and other sensitive structures against quick temperature changes in the nasal cavity.

2011-12-07T01:36:00.000-08:00

Types of Rhinitis

Nasal inflammations,
rhinitis, can take various forms depending on the symptom triggers, severity of the symptoms and time period for which the symptoms last. Read on to know more about different types of rhinitis:

Allergic rhinitis is also referred to as hay fever, which is seasonal. During fall, spring and summer seasons, the fever is common. People with sensitive immune system are prone to hay fever on inhaling dust, grass, mold spores, pollens, trees and other outdoor allergens. Release of antibody during the fever produces mucus and causes swelling and itching. Common symptoms of the fever include stuffy or runny nose, sneezing and watery eyes. The rhinitis is the most common form of allergy related disorders.

Infectious rhinitis caused by bacterial or viral infection includes bacterial sinusitis and common cold lasting more than one week. Thick yellow-green color nasal discharge increases and nasal congestion causes problems.

Hormonal changes trigger hormonal rhinitis. The disorder generally occurs during hypothyroidism, menses, puberty and pregnancy. Nasal congestion reaches a significant level.

Mechanical obstruction, a form of rhinitis, creates one-sided nasal obstruction. Enlarged adenoids and deviated septum are peculiar features of the disorder.

Non-allergic rhinitis means runny nose which is not because of allergy. It could be inflammatory and non-inflammatory. Not much is known about this type of rhinitis. The symptoms may resemble to that of allergic rhinitis. Nasal polyps may be associated with this ailment.

Ozena, primary atrophic rhinitis, is a chronic nasal disorder. Bone resorption, mucosal atrophy, nasal obstruction, strong fetid odor, thick crusts and anosmia are characteristic to the rhinitis.

Persistent rhinitis is a form of rhinitis that persists for a long-period of time. The symptoms may come and go in some cases. The symptoms are present on all days but not for the whole day in other cases. The symptom severity may vary from patient to patient. Persistent rhinitis may be allergic or non-allergic.

Cocaine consumption for recreation and over use of decongestant nasal sprays may cause rhinitis medicamentosa. Postnasal drip and nasal congestion are common symptoms of the disease. Rhinitis sicca is a form of rhinitis in which nose’s mucus membrane becomes extremely dry.

Vasomotor rhinitis is an example of non-allergic non-inflammatory rhinitis, but some times patients of allergic rhinitis may also suffer from vasomotor. Dust, fumes, strong smells- perfumes, smokes, emotional upsets, fluctuations in humidity and temperature and other non-allergic objects and conditions trigger vasomotor. The common symptoms of the rhinitis include postnasal drip and nasal congestion.

2011-12-05T00:58:00.000-08:00

How to Use Nasal Sprays Effectively

Nasal sprays are available in pressurized canisters and pump bottles. The effects of the spray may be visible within two weeks of its use. Saline nasal spray therapy is generally un-medicated, but medicated sprays are also available. The main purpose of the spray is to moisturize the nostrils and the cilia. Properly moistened cilia, thus, can perform its function of flushing out mucus and bacteria easily. The saline spray is simple and effective method to clear out the sinuses and nose congestion. The spray can also be used for infants and children. Since no medication is added to these sprays, it is safe. The spray is affordable. However, effects of the spray are short-lived. To maximize the benefits of nasal sprays, consider the following tips:

Clean the nose before using the nasal spray.

You should be able to sniff before using the spray. If you are unable to sniff, medicine will be released deep into the nose, causing irritation.

Exhale slowly and move the head in proper position. If using the bottle, tilt the head forward. If using the canister, keep head upright. If the spray drips down the throat’s back or from the nose, the spray container was not in proper position.

Shake the bottle or canister prior to spraying. Adjust the canister to ensure it is firmly placed in the holder.

If you have bought the pump bottle spray, squirt it until a spray of mist is released before using it.

Avoid blowing your nose or sneezing immediately after spraying.

Clean the canister spray regularly.

Follow the physician’s prescription. Read the instruction on medicine and spray package.

Do not store the nasal spray under sunlight.

Do not use the spray up to two days, if you have stinging feeling in the nose, nosebleed has started or the spray is hurting the nose.

Nasal steroid sprays are mainly used for chronic sinusitis treatment. Some sprays are also used for acute conditions. The spray helps in reducing nose congestion and sinus inflammation. However, these sprays are not a permanent cure. Generally, the symptoms will return after stopping the application of the spray. The long-term use of the spray may cause dryness, itching, irritation and burning inside the throat and nose. It may also trigger nosebleeds, headaches and sneezing.

Nasal saline spray is an over-the-counter medication. The saline used in the spray increases moisture level, facilitating removal of infection. The saline sprays are non-addictive.

2011-12-02T04:00:00.001-08:00

8 Things You Should Know about Infections-Sinus

Timely Examination

Germs may cause various types of skull infections. The infections-sinus, affecting air-filled spaces in the cranial bones, impact lives of millions of people across the world. To treat these infections, the sinuses should be examined well in time.

Cause of Infection

Allergies, bacteria, fungi, structural deformities and viruses trigger signs of sinus infections. Haemophilus influenzae and Streptococcus penumoniae bacteria are responsible for more than 65% of cases of acute sinusitis. Most of the patients suffering from extreme asthma conditions also suffer from chronic rhinosinuisitis. Numerous eosinophils, the white blood cells with strong inflammatory properties, reside in the tissues lining the nasal passages and the sinuses of the patients suffering from chronic rhinosinusitis, particularly the patients with polyps.

Appropriate Diagnosis

Distinguishing between infections-sinus and non-sinus infections is necessary for appropriate diagnosis that ensures timely healing. Identify cause of sinus infections, as different sinus symptoms require different therapies. For instance, viral sinusitis does not respond to antibiotics, whereas bacterial sinusitis may respond to a course of antibiotics. Acute sinusitis, a short-term disorder, lasts up to 28 days. However, chronic sinus infection may drag on until three months.

Do not Abuse Nasal Sprays

Nasal sprays give you quick relief from sinus infections. However, continuous and overuse of nasal sprays result in rebound congestion and addiction. Swelling of nasal lining may reappear even though infection signs might have subsided.

Do not Take Medicines without Prescription

Since some of the medicines used to treat sinus problems may react with other drugs, patients, especially those suffering from other diseases, should consult their doctor. During physical checkup, doctor will examine ear, nose and throat for accurate diagnosis. The doctor will also examine the face for redness and swelling if any.

When is Surgery Required?

If the best medications fail to cure the sinusitis, you may need surgery. With the help of doctor, you can choose from traditional and endoscopic surgeries.

Home Remedies

Warm compresses may relieve pain in the sinuses and the nose. Inhale steam, warm moist air, to clear sinus congestion. Use humidifiers with clean filters. Avoid contact with allergens and irritants causing signs of sinus infections.

Impact of Untreated Sinus Infections

Untreated sinus infections will cause discomfort and pain. The sinus infections may lead to bone infection or meningitis in rare cases. So, why take chances? Visit the doctor as and when symptoms appear.

Symptoms of Sinus Headaches

2011-12-01T01:39:00.001-08:00

Symptoms of Sinus Headaches

Inflamed sinuses cause sinus headaches, which are generally confused with other types of headaches. For instance, vascular headache symptoms are similar to that of sinus headaches, causing confusion. Most of the people who believe that they have headache of the sinus origin are in fact suffer from vascular headaches. Therefore, consult the doctor to confirm that the headache is because of infected sinuses. Some of the common symptoms of the sinus headaches are explained below.

Constant, deep and dull pain in the sinus region, comprising bridge of the nose, forehead and cheekbones, denotes headaches. The pain, the main symptom of the headache, increases with straining, sudden movement of the head, leaning over or bending down. The pain may be accompanied by facial swelling, fever, fullness / sensation in the ears and nasal discharge. The pain may increase during damp and cold weather. Sudden changes in temperature further worsen the pain. The pain during sinus headaches feels like pressure. Sinus pain and other nasal signs may accompany the headache.

Intensity of pain may vary from person to person. It could range between minor nagging pain and unbearable pain that hinders normal sleep process.

The pain in the head may resemble to a tension headache.

Pressure sensation in affected area increases.

Local swelling, redness and tenderness in the facial area may occur. Tenderness over the infected sinus is associated with sinus headaches.

The headaches generally occur in the morning and improve by afternoon. The pain is severe in the morning because of overnight mucus collection.

Symptoms associated with sinusitis, such as sore throat, postnasal drip, green or yellow discharge from the nose, nasal congestion, fever and fatigue may also appear.

In some cases, sinus headaches may not be accompanied by sinusitis signs.

Fever with sinus headache is a quite common sign.

Purulent or pus-like nasal discharge may lead to sinus headaches.

Rarely, sinus headaches may be associated with pain in the back or the top of the head.

Sinus headaches may be felt on both sides of the head or on either side of head.

Neck is generally not affected during the headache.

Headaches with congestion

Feeling of ache in the upper teeth

Cold shivers

Coughing or throat irritations

Light-headedness

Achy muscles (myalgias)

Lymph nodes in the neck may swell.

How to Treat Symptom of Sinus Infection

2011-11-29T01:36:00.000-08:00

How to Treat Symptom of Sinus Infection

Main purpose of the sinusitis treatment is to get rid of symptom of sinus infection. The treatment drains off the sinuses, removes infection and reduces swelling, keeping sinuses unclogged. Although home remedies can be helpful, consult the doctor for reliable and quick treatment.

Acute Sinusitis Treatment

If symptom of sinus infection ranges from mild to moderate, expectorants, antihistamines and decongestants can be taken for seven to ten days. These patients should not take antibiotics, especially during the first week.

Chronic Sinusitis Treatment

Chronic sinusitis is an offshoot of acute sinus infection that was not treated in timely manner. The anaerobic and aerobic bacteria present in acute and chronic conditions are different. The objective of chronic sinusitis treatment is to enhance quality of life of the patient, if it is not curable.

Patients suffering from chronic sinusitis may need therapy for longer period. Antibiotics may be helpful for these patients. If the condition improves within two months, antibiotics can be discontinued. However, saline nasal solutions and steroids should be continued. If the condition does not improve even after two months, surgery is required.

Doctors may prescribe oral corticosteroids for patients with nasal polyps or patients not responding to nasal corticosteroids. Oral corticosteroids are also administered to patients suffering from allergic fungal sinusitis.

Generally, regular saline nasal irrigation is required.

To identify main trigger of chronic symptoms of sinus infection, a thorough diagnosis is necessary. Diagnostic check up should rule out any associated conditions, such as structural problems in any of the nasal passages, gastro esophageal reflux disorder, ailments related to immune system, asthma and allergies. If the trigger is found, it should be controlled or treated at the earliest.

Some of chronic sinusitis patients, especially the patients with associated medical disorders that can worsen the symptoms, may require intravenous antibiotic therapy. The therapy is generally given two weeks prior to surgery and one month after the surgery.

Mild symptoms other than acute infection signscan be treated with home remedies. For instance, hydration keeps the sinuses open. Drink lot of water to lubricate the mucus membranes. Alternatively, hot beverages like chicken soup, hot tea with lemon and honey, and ginger tea may relieve aches and congestion. Steam inhalation for two to four times a day will be very useful. A nasal wash helps in draining of the mucus. Regular nasal passage irrigation with hypertonic saline solution reduces symptoms and minimizes use of antibiotics.

Treatment for Sinus Infection Spread Beyond the Sinuses

If the infection has spread beyond the sinuses and entered into parts of the skull such as brain and bone, emergency treatment is required. Emergency surgery may also be required. Antibiotics may be given intravenously.

Tips to Avoid Side Effects of Decongestants

2011-11-28T02:10:00.000-08:00

Tips to Avoid Side Effects of Decongestants

Decongestant is a medication that relieves stuffy nose and helps in breathing easily. Decongestants remove mucus from the clogged nose, but the drugs may harm some patients. For instance, the medication may increase blood sugar level of diabetics and blood pressure of patients suffering from high blood pressure. So consult a doctor before administering a decongestant, especially to people already suffering from blood vessel diseases, diabetes, heart problems, glaucoma, high blood pressure, mental illness, prostate diseases or thyroid disorders.

Oral decongestants may cause anxiety, breathing problems, convulsions, difficulty in passing urine, fear, hallucinations, pale skin and tightness in the chest. Consulting a physician is thus must before using the drug.

Decongestants when taken with some other medicines may cause severe problems, so do not administer them together. For example, do not use Monoamine oxidase inhibitors with decongestants.

Repeated use of decongestant nose drops and nasal sprays for several consecutive days may result in rebound congestion. Nasal congestion persists or worsens with every dose of decongestant during the rebound congestion. Stop the drops or sprays and contact the physician. Congestion may go away in a week or so after stopping the use of the decongestants.

Nasal sprays should be administered for just three days, while oral decongestants should be taken for a week only. If fever occurs with the congestion or the congestion remains, consult a physician instead of continuing to use the decongestants.

Check expiry date of decongestant nasal drops and sprays, and oral decongestants before using. Discolored and / or cloudy decongestants should not be used.

Do not share spray bottles and droppers to ensure that the infection does not spread. Bottle tips and droppers should not touch any surface.

Some decongestants cause sleepiness, so do not drive after taking the drug. Or, do not do anything or use machines that may be dangerous.

Administer smaller doses of decongestants to the older patients, as they are more sensitive to the medication. Do not use decongestants of long-acting forms for them.

Some decongestants are very strong for children who are also more sensitive to the drugs. Read and follow instructions on the decongestant’s label carefully. Ensure that they do not swallow nasal sprays and nose drops.

Some people are allergic to decongestants, so physicians’ advice is required. Some of the scientific studies concluded that decongestants affect fetuses. So, women who are in the family way should take decongestants under the supervision of a physician. Decongestants may also contaminate breast milk causing side effects in infant, so breast-feeding women should consult a physician.

Herbal Treatment for Symptoms of Sinus Infection

2011-11-25T00:54:00.000-08:00

Herbal Treatment for Symptoms of Sinus Infection

Several herbs are used to treat symptoms of sinus infection. For instance, antimicrobial herbs stimulate immune system. Anticatarrhal herbs eliminate the buildup affecting the sinuses. Astringent herbs decrease mucus production. Diaphoretics are recommended for the fever associated with the infection. Analgesic herbs give temporary relief from pain. Lymphatic herbs improve drainage and the immune system.

Herbs, minerals and vitamins supply useful nutrients at the cellular level. These substances can kill disease producing viruses and disrupt their growth and development, strengthening the immune system and protecting you against various diseases. Herbs are used in three forms:

tinctures – alcohol extracts,
glycerites- extracts of glycerine and
dried herbs- teas, powders and capsules.

Some herbs help in treating the sinus infection directly, whereas others have indirect benefits. For instance, eyebright reduces sinus inflammation and congestion, while coneflower strengthens immune system. Wild indigo helps in controlling symptoms of sinus infection. Antibacterial and antiviral properties of goldenseal root heal the infection. Licorice has antiviral properties, but the herb should not be used if patient has high blood pressure.

Ginger tea with garlic improves drainage and immune system. Ginger root extracts thin the drainage associated with sinus infections. Ginger compresses placed over the infected sinus area give relief. St. John’s wort and Jamaican dogwood relieves pain.

Camphor, thyme, lavender, pine, rosemary, peppermint and eucalyptus –essential oils- are useful in treating the infections of the upper respiratory system. The oils also relieve congestion of the sinus. Oregano oil extracts have antifungal, antibacterial and antioxidant properties that help in treating the infection.

Olive tree leaf extracts boost the immune system and maintain healthy level of blood pressure. The leaf has oleuropein that disrupts reproduction of viruses, stopping their growth. Pills or teas of the olive leaf extracts are helpful for the sinus infection.

Other useful herbs include turmeric extracts, kudzu, Echinacea and fenugreek. Echinacea promotes immunity while fenugreek reduces mucus. A combination of bayberry, burdock root, ginger root, goldenseal root, white willow bark, parsley, white pine, cloves, horehound, althea root, cayenne, yerba santa, feverfew and fenugreek seeds relives pain, pressure, congestion and stuffiness associated with the sinus. But, do consult a doctor, health service provider or physician for the right combination and dosage of the herbs.

2011-11-24T01:29:00.000-08:00

Lasers for Surgery-sinus

Lasers are commonly used for all kinds of surgeries. However, lasers are not the main surgical tool for surgery-sinus. In some pathologies, the laser is very helpful and a perfect choice, whereas it may produce edema and trauma in other cases.

While using the laser, doctor should consider a number of factors, including expected results, safety, instrumentation and pathology type. An array of lasers is available for surgery-sinus. The most commonly used lasers are carbon dioxide, holmium:yttrium aluminum garnet, neodymium:yttrium aluminum garnet and potassium titanyl phosphate lasers.

A carbon dioxide (CO2) laser is cumbersome equipment due to its stiff articulating arm. Precision, hemostasis, surgical access and handpiece quality of the laser are poor.

If a holmium:yttrium aluminum garnet (Ho: YAG) laser is used with water medium, the laser minimizes charring and thermal reaction. If used with air medium, surgery becomes difficult due to tiny explosions.

The neodymium:yttrium aluminum garnet (Nd: YAG) laser is ideal for ostiomeatal and turbinate dysfunction surgery. However, the laser is difficult to use. Its well-defined thermal reaction leads to edema of the tissue. Handpiece quality of Nd: YAG, Ho: YAG and CO2 lasers are poor. Absorbing chromophobe, absorption length, power range and wavelength vary from laser to laser.

A potassium titanyl phosphate (KTP/532) laser has a flexible handpiece. Fibers of the laser facilitate access to the spaces and recesses of the sinuses. Since this efficient laser is easy to use, it is an ideal choice for the surgery of the vascular tissues, including paranasal sinus mucosa. The laser is also suitable for turbinate dysfunction. Precision, hemostasis, surgical access and handpiece quality of the laser are excellent.

Safety Precautions

The laser operator and the surgeon should be familiar with the laser. They should be well versed in instrumentation, fiber management, energy dosage and safety aspects of the laser. During surgery, communication between the operator and surgeon should be frequent and consistent to ensure the status (on/off) of the laser, exposure time and wattage. This communication will reduce chances of errors.

Information about the laser wavelength and eye protection for doctors should be mentioned on the door of the room where laser surgery is in progress. For patients’ safety, eye protection is necessary. Goggles are used if local anesthesia or monitored sedation is given. Moistened eye pads are used if general anesthesia is administered. An eye safety filter is placed between the camera and endoscope while aligning the laser with the endoscope before using within the sinuses.

10 Principles of Sinus Surgery

2011-11-23T03:54:00.000-08:00

10 Principles of Sinus Surgery

Thorough understanding and correct implementation of the following principles of sinus surgery will enhance chances of success.

Accurate diagnosis is the first step in a sinus surgery. Sinus pathology, imaging reports, endoscopic nasal studies and clinical history should be taken into account for the diagnosis prior to the surgery.

Sinus surgery timing: The surgery should be recommended only if a traditional medical treatment fails. In fact, the medical treatment helps in reducing the problems and makes surgery easier.

Appropriate planning enhances success rate of the surgery. However, unanticipated pathology may appear while surgery is being done.

Integrated treatment of the sinus and nasal disorders in one-stage surgery is recommended. It reduces cost and eliminates chances of second round of surgery. The nasal cavity’s structural abnormalities like concha bullosa and septal perforations and deviations should be corrected during same surgical process if possible.

Combined management of sinus disorders: Patient should be informed about medical treatments required before and after surgery well in advance. Because even medical community does not understand some sinus diseases completely and in some cases, post surgery therapy is required to control symptoms and reduce chances of reappearance of the disease.

What the surgery can do? Sinus surgery does not provide solution for all types of sinus disorders. For instance, the surgery is not useful for the inflammatory sinus problems due to various factors involved. The factors include environmental pollution, genetic characteristics, systematic disorders and allergies. The surgery can help in correcting structural abnormalities of the sinus and nose and removing infected tissues, restoring ventilation and drainage.

Complete knowledge of paranasal and nose anatomy is necessary. Surgeons need lots of practice to identify anatomical variations in these areas, as the variations are large.

Minimize bleeding and correct visualization are two basic principles of the surgery. Endoscope and microscope, the optical instruments used for the surgery, help in visualizing the area to be operated. Local vasoconstriction reduces bleeding. Remove infected tissues carefully from the sinuses to minimize the trauma. Normal mucosa should not be touched.

Ventilation and drainage in the operated sinuses should be restored to normal levels because the surgery may affect and interrupt the airflow. If drainage and ventilation are not restored, patient may have other complications, some of which could be dangerous.

Until the patient is fully recovered, regular follow-up after the sinus surgery is necessary. Thick mucus, blood clots and crusts should be removed during endoscopic examination.

Treatment for Sinus Pressure

2011-11-22T02:35:00.001-08:00

Treatment for Sinus Pressure

Sinus Pressureis a result of sinus ailments, allergies, flu, colds and many other factors.

During these conditions, membranes of the sinuses and the nose may swell, and mucus may build up in the ostia, hindering airflow. The air traps within the sinus and dissolves into the mucosa of the sinus. The pressure of the air within the sinus, therefore, falls to levels lower than the pressure level outside. This is perceived as pressure in face. However, generally, these pressure changes cause only temporary discomfort. If germs grow in the mucus, resulting infection may aggravate sinus pressure. The pressure may also be accompanied by pain in the teeth, forehead, nose and eyes. The frontal sinus region may become tender. Sinus pressure may cause headache due to under ventilated sinuses.

Treatment

To relive the pressure, mucus build up blocking the passages should be cleaned up. Several over-the-counter (OTC) drugs for sinus pressure are available in the market. Most of which consists of an antihistamine or a decongestant and acetaminophen or other painkillers. The OTCs play fourfold role: clear nasal passages, reduce nasal congestion, relieve symptoms of pressure, and minimize chances of complications.

Inhalers, nasal sprays and steam may relieve the pressure temporarily. Breathing the vapors or eucalyptus, menthol or other aromatic substances ease up the congestion within the sinuses and nasal passages. Sipping peppermint tea containing menthol may also help. Drink more fluids, but avoid caffeine-based beverages.

Constant change in air pressure of the cabin within airplane causes sinus pressure even in healthy travelers. This pressure increases in travelers suffering from sinus disorders. The dry air within the airplane also has a direct impact on the sinuses, especially on already infected ones. Doctors generally advise people suffering from sinus infection not to travel by air. However, if flying is unavoidable, take medicine before take-off to reduce the pressure. Use saline nasal spray to moisten the nose during the flight.

If you do not have sinus infection but pressure is an issue while flying, chew a gum during take-off. Swallow water when the airplane levels out. After landing, try “valsalva maneuver” technique to relieve the pressure. However, follow the correct technique, otherwise it may damage eardrums or sinuses.

Use earplugs to minimize impact of pressure change while flying. The earplugs ensure that change in air pressure occur slowly. Use hot compresses while flying.

Should you undergo a sinusitis surgery?

2011-11-17T01:25:00.000-08:00

Should you undergo a sinusitis surgery?

Although sinusitis surgery is useful, the surgery is not a panacea for all kinds of sinus diseases. The type and severity of the symptoms should be taken into account while weighing pros and cons of the surgery option. Here is a list of main symptoms that need surgery:

If sinusitis symptoms do not disappear after complete medical treatment, patients having nasal polyposis and rhinosinusitis should consider sinusitis surgery. In such cases, congestion and hyposmia symptoms may reappear even if topical treatment is continued.

If previous surgery on sinus did not work, a second thought is required before recommending another round of sinus surgery. Doctors must review surgical history of the patient in detail. If second round of surgery is required, doctor should ensure that sinus ostia are fully functional and residual disease signs do not occur. However, the patients who have already gone under the knife generally have slightly thick mucosal lining of the sinus even though sinus ostia are open. This thickening is visible in CT scan, but thickening does not always imply presence of sinus infection. Thus, before recommending second round of surgery, doctor should carefully review patient’s response to the treatment and history.

Nasal obstruction is the cardinal symptom for the surgery that ensures complete relief. However, if the nasal obstruction is not a primary symptom, reconsider the surgery decision. Do not operate patients complaining about nasal stuffiness if airflow is not poor.

Patients having pressure and / or pain in the head and / or in the face should be examined carefully to identify the cause of the pain before operation, because pain and pressure may not be attributed to sinusitis. Do not operate these patients, if nasal endoscopy is normal and nasal symptoms are insignificant. If patients having facial pain report purulent discharge during endoscopy, they may require surgery. Surgery may also be useful if nasal obstruction, loss of smell sense or pain worsening during skiing, flying or cold season occurs.

If sense of smell improves after administering oral steroids and then worsens again, surgery may be beneficial. If systemic steroids are administered to a patient who has undergone a sinus surgery and is having anosmia, the patient may not regain smell sense. However, anosmia patient who was never operated and was not benefited by steroids either, ethmoidectomy may be helpful.

The patients may complain about postnasal drip- sensation of extra mucus flowing in the throat- and their inability to clear the throat. This may happen due to normal mucus’ hyperawareness. In such a condition, surgery is of no use.

How diseases, including sinusitis, affect senses of smell

2011-11-16T01:19:00.000-08:00

How diseases, including sinusitis, affect senses of smell

The nerve tissue enabling sense of smell sits in the nasal cavity’s roof and near superior and middle turbinates. Even a small blockage in this area, therefore, affects the sense of smell. Complete loss of sense of smell is called anosmia. Partial loss of sense of smell is referred to as hyposmia.

If you loose smell sense, you may also loose sense of taste because taste and smell senses are linked. The food, thus, may taste bland. Alternatively, you may not be able to distinguish between spoiled and edible food. Complete loss of sense of taste is ageusia, whereas partial loss is known as hypogeusia.

Ability to smell and taste are essential, because these natural gifts let you enjoy pleasing aromas and yummy food. These abilities have another important role: warning against deadly substances like venomous goods, lethal gases and fires.

There are diseases and infections that may impair your sense of smell and / or sense of taste. For instance, sinusitis prevents air from entering into the nose parts where cribriform plate, featuring smell receptors, is located. Nasal tumors, nasal polyps and nasal septal deformities may block the airflow to the receptors. Thus, patients suffering from sinusitis may loose sense of smell. When the nose is blocked, even your favorite food tastes dull and bland because you are unable to smell. This inability may affect your appetite as well and you may feel depressed. Allergic rhinitis may also lead to temporary loss of smell sense. However, temporary loss of smell due to sinus disorders can be treated with antibiotics, corticosteroids and other medicines, and surgery.

Aging also affects the smell abilities due to wear and tear of the nerves controlling smell and taste sensations. Other causes include smoking, structural deformities of the nose, infection of the upper respiratory system and deficiency of zinc and vitamin B12. Even some people are born without sense of smell; this condition is referred to as congenital anosmia.

Structural deformities prevent the aromas from reaching the receptors where sense of smell originates. Irritation of the nasal mucosa obstructs and causes swelling of the sinuses and nasal passages, leading to complete or partial anosmia. Damaged olfactory neuroepithelium or partial damage to the olfactory nerve leads to anosmia.

Sphenoid Sinusitis

2011-11-15T01:28:00.001-08:00

Sphenoid Sinusitis

Diagnosis

Symptoms

Fever
Loss of vision
Purulent discharge
Sleep related problems
Progressive headache
Headaches in temporal region (bitemporal), back of the head (occipital) or eye-socket (retro-orbital) are characteristic to the isolated sphenoid sinusitis.
Headaches may become severe.
Headaches worsen with movement of the head and disturb sleep. Aspirin does not relieve these headaches.

Complications

How diseases, including sinusitis, affect senses of smell

2011-11-14T01:59:00.000-08:00

How diseases, including sinusitis, affect senses of smell

Sinus Infection-Induced Meningitis

2011-11-11T01:25:00.000-08:00

Sinus Infection-Induced Meningitis

Meningitis is an infection of the membranes surrounding the spinal cord and the brain. These membranes are called meninges. Sinus infections are one of the main causes of deadly meningitis, but sinus infection-induced meningitis is rare. This type of meningitis may start with symptoms like change in behavior, fever, headache, loss of concentration and stiff neck. Other symptoms of meningitis include vomiting and nausea. The infections may travel to the brain because of the following reasons:

If the bone between the brain and the sinuses is fractured, the infection may spread into the brain and near by tissues, causing meningitis. Even a micro-fracture can initiate spread of the infection.

People who suffer from sinus infections frequently are prone to meningitis, because the same bacteria can cause the infections and meningitis. The ethmoid sinus’s roof is the brain’s floor and the frontal sinus is located in front of the brain. Thus, infection of these sinuses may affect the brain easily.

The sphenoid sinus is located next to the carotid artery, which supplies blood to the brain.

The veins draining deoxygenated blood from the brain open into the cavernous sinus, which sits at the rear of the sphenoid sinus. Proximity of the major arteries and veins to the sphenoid sinus increases chances of spreading the sinus infections to the brain. The sphenoid sinus infection may also cause thrombosis.

Since the nose veins do not feature valves, infections can spread upwards. The nose infection has chances to travel to the brain because blood vessels supplying to the brain and the nose are interconnected.

Treatment of Meningitis

Meningitis could be bacterial or viral. The treatment of the disease depends on organisms causing the meningitis symptoms. Bacterial meningitis is cured with antibiotics, including intravenous (IV) antibiotics, but the type of antibiotic depends on the bacteria responsible for the symptoms. Some times hospitalization is necessary. In some cases like brain swelling, intravenous fluids and other medications may be required. Patients of bacterial meningitis may require hospitalization. They should ensure that their blood pressure and breathing are normal. A breathing tube may help in improving patients’ breathing.

Some types of bacterial meningitis are communicable. The exchange of throat and respiratory secretions during sneezing, kissing and coughing can spread the bacteria.

Steroids may reduce disease’s severity. Corticosteroids help in releasing pressure within the brain due to meningitis. Medication is also prescribed to bring down the fever. Improvement in room ventilation, cooling pads and fluids reduces the fever. Consult your doctor and start the treatment during the early stage of the disease.

Sinusitis in the Elderly

2011-11-10T01:39:00.000-08:00

Sinusitis in the Elderly

According to the American Academy of Otolaryngology-Head and Neck Surgery, 14% of the Americans who are 65+ suffer from chronic sinuses’ symptoms. However, this percentage slightly decreases in Americans in 75 + age group. Since the symptoms affect sleep and create fatigue in aged population, timely treatment will ensure better quality of life.

Chronic Sinusitis in Old People

Patient having chronic sinuses’ symptoms complain about thick smelly drainage, facial pressure, nasal obstruction and headaches. Redness in nasal region and pus drainage may occur. With computed tomography scan (CT scan), chronic conditions can be diagnosed.

Geriatric Rhinitis

Aged people suffering from rhinitis may experience reduction in sense of taste and smell. They may complaint about facial pressure, nasal crusting, nasal stuffiness and persistent need for throat clearing.

Both function and physiology of the nose change with aging process. Length of nose increases. The nasal tip droops as the cartilage weakens. As a result, airflow in the nose reduces, especially in the area where lower and upper lateral cartilages join. Thus, the nasal valve area reduces, causing nasal obstruction. This condition is called geriatric rhinitis. The patients have a sense of nasal obstruction on lying down. Nasal crusts form in the winter. Facial pressure happens in patients on diuretics. Patients suffering from geriatric rhinitis will have dry nose causing irritation.

Treatment for geriatric rhinitis varies from individual to individual, as metabolism of the patient in old age may be slower and chances of side effects may be high due to interaction with medicines administered for other age old-specific problems. Sometimes surgery is also recommended to old patients.

Allergic Rhinitis in Old People

Some old people may have symptoms of allergic rhinitis, including soft pale nose bones, runny nose, watery eyes and sneezing. They should consult an otolaryngic allergist.

According to a research report, sinuses’ symptoms vary with age of the patient. Chances of nasal polyposis and dysosmia are high in elderly patients than in their younger counterparts. Like other body parts, the nose also ages. Decline in submucosal glands with the age thickens mucus. Reduced blood flow in the nose may cause crusting and dryness in the sinuses and the nose. Antihistamines and decongestants prescribed to young sinusitis patients may not be effective for elderly. Surgery of the sinus and nose can be helpful. The elderly population is at greater risk because of weak immune system, poor gag and cough reflexes, dry nasal passages and weak cartilage of the passage.

Use of Antibiotics in Treating Symptoms-Sinus Infections

2011-11-09T04:07:00.000-08:00

Use of Antibiotics in Treating Symptoms-Sinus Infections

Antibiotics, soluble substances extracted from bacteria or molds, inhibit microorganisms’ growth. There are two types of antibiotics: broad-spectrum and narrow-spectrum. Broad-spectrum antibiotics work against several bacteria, whereas narrow-spectrum antibiotics protect against very small number of bacteria. Antibiotics given to patients of sinusitis kill bacteria causing symptoms-sinus infections. The sinus infection is one of the most common disorders for which antibiotics are administered. However, various research studies proved that inappropriate use of antibiotics is common. Excessive use of antibiotics, in fact, has resulted in bacterial resistance to frequently prescribed antibiotics.

Antibiotics should mainly be used for patients highly prone to bacterial infections, as in most of the cases symptoms heal on their own within fortnight. Indeed, doctors wait until two weeks before initiating an antibiotic’s course. However, antibiotics are prescribed at the earliest if symptoms-sinus infections are severe. Antibiotics are administered to kids having nasal discharge accompanied with a cough persisting up to three weeks. If fever is over 39 degree Celsius and facial pain and headache occur, and areas around the eyes swell badly, antibiotics are required.

During acute sinus infection, antibiotics are generally not used, as the symptoms heal on their own. If antibiotics are administered, they may reduce period of sickness slightly. The type and dosage of antibiotic depends on general health condition of the patient and severity of symptoms. Amoxicillin, Trimethoprim-sulfamethoxazole antibiotics are administered to patients suffering from acute bacterial sinusitis. Consult doctor before starting a course of antibiotics.

Macrolide, cephalosporin and amoxicillin-clavulanate antibiotics are prescribed in complicated cases of sinus infection. Doctors may use different types of antibiotics, such as levofloxacin, clarithromycin, cefpodoxime, cefuroxime, azithromycin and amoxicillin-clavulanate, if patients’ condition does not improve even after twenty-eight days of medication. If oral antibiotics were not helpful, intravenous antibiotics may be recommended.

However, antibiotics have side effects that should be taken into account while prescribing the antibiotics. Side effects may vary from antibiotic to antibiotic. Some of the common side effects include:

Sulfa, penicillin and other antibiotics may create allergy, such as skin rashes.
Some drugs if taken with antibiotics may cause allergy. So, check with doctor about right combination of medication.
They may increase risk of vaginal infection in female patients.
They create gastrointestinal problems.
A bad taste
Diarrhea may continue for a long period.

Some antibiotics like levofloxacin may damage or rupture tendons

Types of Fungal Sinusitis

2011-11-08T02:05:00.000-08:00

Types of Fungal Sinusitis

Although fungi are not a common cause of sinus infection, incidences of fungal disorder are increasing. Up to 10% patients suffering from rhino sinusitis may have fungal sinus infection. Fungal sinusitis is common in patients suffering from disorders that weaken the immune system, such as AIDS, diabetes and leukemia. The sinusitis is also referred to as eosinophilic mucinous rhinosinusitis (EMRS) or eosinophilic fungal rhinosinusitis (EFRS). Fungal sinusitis is divided into three categories: allergic fungal sinusitis, fungus ball, and acute and indolent / chronic invasive fungal sinusitis.

Allergic Fungal Sinusitis

Allergic fungal sinusitis is the most common fungal infection. It is an allergic reaction to fungus belonging to the Dematiaceous family. The fungi may grow in the sinus, blocking nasal passage and eroding the bones. Thick drainage and nasal polyps may occur, hindering the airflow to the sinus. Sinus surgery is necessary to remove the nasal polyps. Since allergens are involved, allergic fungal sinusitis may reoccur. In several cases, thus, patients may have to take medication regularly throughout life and undergo surgery.

Fungus Ball / Mycetoma

A fungus ball generally develops in one sinus, especially the maxillary sinus. However, it is treatable and does not penetrate into the sinus mucosa. The CT scan of the sinuses, head or teeth may show opacification. Some patients may complain about facial fullness, nasal obstruction and / or rhinorrhea while others may not have any symptoms. Aspergillus that cause mold in the bread triggers mycetoma. Endoscopic sinus surgery, a minimally invasive surgery with high success rate, is required to remove the ball. Recurrence of the ball is a rare phenomenon.

Acute & Indolent / Chronic Invasive Fungal Sinusitis

Acute invasive fungal sinusitis expands quickly into the sinus bones and tissues whereas chronic invasive fungal sinusitis grows slowly. Patients with weak immune system and suffering from severe diabetes are at high risk to get acute invasive fungal sinusitis. Chronic invasive fungal sinusitis generally occurs in atopic and immunocompetent hosts. The granulomatous chronic infection in indolent condition expands beyond the walls of the sinus. A biopsy is required to confirm the diagnosis of chronic condition. Indolent fungal sinusitis is common in parts of India and Sudan. The fungal infection is associated with fungi common in the environment: Aspergillus, Mucor and Rhizopus. Both acute and indolent invasive forms of fungal sinusitis require immediate attention. A combination of anti-fungal medications and sinus surgery will heal the symptoms.

Treatment for Sinus Pain

2011-11-07T03:54:00.000-08:00

Treatment for Sinus Pain

Pain in the sinuses could cause distraction and huge discomfort, so do not ignore it. Choose an appropriate treatment to recover fast. Here is a glimpse of possible treatments.

Over-the-Counter Medications

Several over-the-counter (OTC) medications are available to treat pain-sinus. Generally, OTCs are a combination of a decongestant and painkiller or an antihistamine and a painkiller. OTCs, sold in different forms, are administered to relieve the pain, minimize chances of complications, reduce nasal congestion and clear up the nasal passages. Take medicines that kill bacteria causing pain-sinus.

Homeopathy

Homeopathy also offers safe options to alleviate pain-sinus. Burning and throbbing pain in the sinus can be treated with arsenicum album. The pain that extends to the teeth can be healed with mercurius. However, consult a qualified homeopathy doctor before administering these medicines.

Relaxation

In some cases, different relaxation techniques may reduce the pain. For instance, meditation, hypnotherapy, yoga, deep breathing and guided imagery methods will help in relaxing.

Humidity

Dry mucus in the sinus passages and the nose create crusts, hindering the drainage and causing congestion, which is a source of pain. Moisten your nose by increasing humidity. Steamy showers, hot liquids, humidifiers and avoiding dry and cold air will help in retaining moisture and increasing humidity.

CranioSacral Therapy

Basic concept of the therapy is that an experienced therapist can identify patterns within the body with a light touch and release and relax the tissues. This non-invasive therapy can be used to relax tissues around the nasal and facial bones, relieving the associated pain.

Surgery

Surgery may be the option if pain is due to structural deformities and growth of polyps that block the nasal passages.

Other Therapies

Nasal irrigation with homemade or OTC saline opens up your nasal passages, relieving the pain.

Use cold and hot compresses alternatively to dissolve the crusts, reducing pain.

In some cases, spicy foods help in opening the blocked passages.

Continuous humming may also relieve the pain in some cases, as it improves airflow to the sinuses.

Aromatherapy with eucalyptus or peppermint may help in reducing the pain.

Last but not least, avoid all those agents that cause the pain. The agents, for instance, include bacteria, viruses and allergens.

When to Seek Medical Help

If the pain is accompanied by a feeling of sickness, confused behavior, high fever and swelling or redness of the forehead, cheeks or area around the eyes, consult your doctor.

If pain persists even after using painkillers and nasal wash for a day, visit doctor.

What Causes Nasal Polyps

2011-11-03T02:44:00.000-07:00

What Causes Nasal Polyps

Nasal polyps, an abnormal growth of tissues within the sinuses and the nasal passages, can be of pink, grey or yellow color. The fully-grown nasal polyps resemble to grapes on the stem, but the size of the teardrop polyps may vary. Big-size polyps may plug up the nasal passages and cause runny nose or stuffy nose and loss of both taste and smell. The nasal blockage may cause difficulty in breathing. Small-size polyps are neither detected and nor cause any visible symptoms. The polyps are more common in men than in their female counterparts. The polyps generally appear in 40+ people. The polyps are soft. The polyps do not disappear unless treated. The nasal polyps growing within sinus areas may trigger symptoms of sinus infection. However, the polyps are benign. They do not increase chances of nasal cancer.

What exactly causes the polyp formation is still a mystery. They may be an outcome of constant swelling and redness of the mucus membrane – the nasal passageways’ lining. However, cause of inflammation is not known yet. A number of factors may increase chances of nasal polyp formation. Some of the factors follow:

Aspirin intolerance, which means aspirin may lead to persistent coughing, itchy skin and other allergy related symptoms, and painkiller intolerance.

Cystic fibrosis may cause polyps. During cystic fibrosis, a sticky fluid clogs up digestive system and lungs.

Polyps may develop in the patients suffering from allergic rhinitis that is ascribed to allergy to animal fur and dust mites.

Asthma may promote polyp formation.

Churg-Strauss syndrome, blood vessels’ inflammation, may also encourage growth of polyps.

Inflammation of the mucus membrane set the stage for a fluid build up within the membrane cells. Gravity pulls down the cells filled with the fluid over a period of time, causing polyp formation. Inflammation may be attributed to various factors, including bacterial, fungal or viral infection, exposure to pollutants, genes, disorders of nervous system and weak immune system. One of these factors or combination of these factors may trigger inflammation.

During some studies, it is found out that people with polyps have different types of chemical markers in the mucous membrane.

In many cases, people with polyps may not have any other associated symptoms. Treatment is not required in such cases. But, their size can be reduced by medication. The polyps can be eliminated by medication and / or surgery.

2011-11-02T08:24:00.000-07:00

Symptoms of Nasal Drip

Nasal drip, the large quantity of mucus dripping in the back of the throat from the nose, is also referred to as postnasal drip. Peculiar signs associated with the drip are listed below:

The most common sign of the drip is an annoying feeling and a need to clear the throat constantly. The mucus collected in the throat area may also make your voice hoarse.

A cough may occur, because the dripping liquid in the throat may contain inflammatory particles causing irritation. The cough may aggravate at night. The mucus may be of light brown, green or yellow color.

The drip is the main cause of chronic cough.

A sore throat may happen, but it does not become an illness. Since the drip hinders functioning of the cilia, crust of mucus may form on the lining of the throat and the nose, causing irritation and inflammation. This condition is referred to as sore throat in medical terminology. Itchiness and burning sensation in the throat may develop.

Swallowing constantly

The throat tissues and the tonsils may swell, causing a feeling of a lump in the throat. White patches or pus may cover the throat or tonsils. Tonsil stones may develop. In patients already having the stones, size of the stones may increase.

When excessive mucus clogs the Eustachian tube, connecting the middle ear to the back of the nose, ear infection may develop. If the mucus plugs up the sinus pathways, sinus infection develops.

If you have difficulty in swallowing and breathing, seek medical advice.

Extreme symptoms like sudden swelling of the throat or the tongue, sinus headache, pain in the upper throat need immediate attention.

Intermittent plugging of nostrils may happen.

Bad breath may occur with the drip.

The dripping mucus cause unpleasant taste.

The nasal dripmay be accompanied by the signs of another condition. For instance, the drip associated with allergies may result in itchiness of the eyes and the nose, headaches and teary eyes. In case of asthma, breathing will become more difficult.

Lymph nodes in the throat may enlarge.

Body aches and fatigue interfere with day-to-day chores.

Chills, fever and heartburn may occur.

The drip may cause nasal congestion in people who breathe from the mouth or are unable to breathe from the nose.

Pain in stomach, dizziness, nausea and vomiting may occur.

Other symptoms include tension in face, runny nose and a desire to spit repeatedly.

Causes and Remedies for Nasal Congestion

2011-10-27T03:25:00.000-07:00

Causes and Remedies for Nasal Congestion

A stuffy nose is called nasal congestion in medical terminology. The stuffiness interferes with airflow from and outside of the nose. The congestion mainly occurs due to swelling of the tissues lining the nose. The swelling is attributed to inflammation of the blood vessels. And, in some cases, excessive secretion of thick mucus may be the culprit. Sometimes, structural deformities also lead to the congestion. One side stuffiness may occur due to a foreign substance inserted into the nose. The congestion is associated with sinus infection, flu, common colds, vasomotor rhinitis, pregnancy, nasal polyps, over use of nasal drops or sprays, and hay fever. In some cases, people suffer from congested nose without any reasons. This is referred to as non-allergic rhinitis.

Nasal congestion in infants can affect nursing. Although a stuffy nose is an annoyance in adolescents and older children, sometimes it may result in serious problems. For instance, congestion may hinder the sleep and lead to problems related to speech development and hearing. The congestion may cause snoring as the patients having stuffy nose breathe from the mouth instead of the nose while sleeping. During breathing from the mouth, negative pressure behind the soft palate and uvula develops, increasing the vibrations.

Generally, a stuffy nose heals itself within one week. However, you may try the following remedies for better healing:

Put saline nose drops into both nostrils to remove the mucus.

Consume sugar-free fluids. Keep the sinuses and nasal passages moist. Vaporizers and humidifiers will retain room air moisture. Irrigate the nose with saline.

Warm compresses will reduce the congestion. Use a warm, wet clean cloth for the compresses. Inhale steam.

Over-the-counter (OTC) drugs- antihistamines, decongestants and painkillers- may give some relief. Decongestants may relieve congestion by reducing the swelling, whereas antihistamines bring down the level of mucus. However, seek help of a doctor in choosing a right OTC.

Keep the head raised, as the stuffiness aggravates when you lie down. Sleeping with raised head will ensure comfortable breathing.

Do not swim in chlorinated pools.

Use neti pot to clear away the congestion.

Do consult the doctor if the congestion is accompanied by persistent coughing, yellow-green / gray mucus, pain in the throat, blurred vision and swelling of the cheeks, eyes, forehead and the nose.

If you want supplements, consult the doctor.

If medications do not help, surgery, especially in the case of chronic nasal congestion, may be required.

Pungent and spicy foods may help in relieving the congestion.

Treatment for Sinusitis Headache

2011-10-26T02:28:00.000-07:00

Treatment for Sinusitis Headache

Scuba diving, swimming, air travel and other activities during which air pressure changes may trigger the sinusitis headache, requiring an appropriate treatment. Medication given for sinusitis headache has twofold role: treating the sinus infection and relieving the sinus symptoms. Doctors may prescribe antibiotics for less than two weeks to alleviate the infection. Decongestants or antihistamines may be administered for short period to get rid of the symptoms. However, decongestants may worsen your headache if it is not because of sinusitis. Thus, do not take any medicine without consulting your doctor. Decongestants constrict headache causing blood vessels, relieving the symptoms. However, decongestants are addictive.

Pain relievers (analgesics) are a part of the sinusitis headache therapy. If the pain relievers do not reduce the pain, corticosteroids are administered to bring down the inflammation. If an allergen is causing the sinus disorder, allergy medication is required.

Avoid over use of decongestants or analgesics, as overuse will lead to rebound headache.

Nasal sprays with steroids and antihistamines may be useful to treat headaches associated with allergic sinusitis.

Vasoconstrictors may be given to reduce nasal congestion.

Detailed medical examination and review of medical history is required to treat the headache. Doctor may advise for CT, MRI scans or X-rays for precise diagnosis. Physical examination of the nose and ear may help in identifying the signs.

If prescription is not followed properly, the headache may persist.

Do not self-diagnose and self-treat. However, adequate intake of water and other fluids ensures proper drainage of secretions. Alternate cold and hot compresses may give some relief. Nasal irrigation helps in clearing the congestion. Consult the physician if headache persists. If symptoms last for more than 10 days, visit a doctor.

To reduce sinus headache, inflammation of the sinuses and swelling of the mucus membrane should be reduced, and drainage of materials trapped in mucous area should be improved. Breathe in humidified air to encourage drainage. With improved drainage and reduced inflammation, headache will subside.

If headache is not treated in timely manner and properly, some complications may develop. Untreated sinus infection may seep into the walls of the sinuses and spread in the adjacent areas, including the orbit. As a result redness, swelling and pain of the eyes may occur. The infection may enter into the blood vessels in the surrounding areas and produce blood clots and inflammation.

Treatment for Mastoid Sinus Infection

2011-10-25T01:49:00.000-07:00

Treatment for Mastoid Sinus Infection

Mastoiditis, a mastoid sinus infection, was fatal prior to invention of antibiotics. Now-a-days, mastoiditis is uncommon and a less dangerous disease. Thanks to antibiotics!

However, treating mastoiditis is still difficult because medication may not reach the affected area. The curable condition may reappear after the treatment. Thus, it may need long-term therapy or treatment more than once. Initial antibiotic injections are followed by a course of oral antibiotics. Antibiotics are given through an intravenous (IV) catheter to children. Most of the cases, including chronic conditions, can be treated by effective antibiotics.

If antibiotic does not heal the symptoms, mastoidectomy-surgery of the mastoid- may be required. During the surgery, infected part is removed and the mastoid is cleaned. Acute mastoid sinus infection may require immediately after surgery. During myringotomy, a surgical technique, a small opening is made to drain the infected fluid out from the middle ear, relieving pressure on the ear. Fluid draining process restores hearing ability in the patient.

Appropriate treatment of ear infections in timely fashion can prevent mastoiditis or reduce the chances of mastoiditis. If antibiotics are used to treat ear infections, chances of developing mastoiditis will be less. Consult a doctor if ear infection persists. Patient specific treatment, determined by doctor, depends on a number of factors, such as overall health of the patient, age group, medical history, level / stage of disease, patient’s tolerance to therapies, procedures or medications, and guardians’ preferences.

Although some times young patients may be hospitalized for the treatment, most of the mastoiditis incidences can be treated successfully within one and a half week. However, if symptoms of mastoid sinus infection are ignored or not treated properly, complications may occur, such as

It may damage the mastoid bone.
Patients may feel vertigo or dizziness.
Epidural abscess, pus accumulated between the bones of the spine or skull and the outer membrane of the brain, may develop.
Paralysis of the face may occur.
The infection may lead to meningitis.
Loss of hearing may be complete or partial.
The infection may spread to the whole body or the brain.
Untreated acute mastoiditis may also cause blood poisoning and deafness.
Other complications include thrombosis, citelli abscess and osteomyelitis. For instance, thrombosis of the lateral or transverse sinus may occur.

So do not ignore signs of mastoiditis.

Infection of Mastoid Sinuses: Causes and Symptoms

2011-10-24T01:54:00.001-07:00

Infection of Mastoid Sinuses: Causes and Symptoms

Mastoiditis, a bacterial infection of mastoid air cells, could be acute or chronic. Acute otitis media’s complication is referred to as acute mastoiditis. Acute otitis media, an infection and inflammation of the middle ear, is common in children. Acute disorder can be diagnosed clinically, but sometimes computed tomography (CT) scan is required. Chronic mastoiditis is usually ascribed to chronic suppurative otitis media. Chronic mastoiditis is middle ear’s infection affecting the mastoid bone comprising several interconnected air-cells. Infected cells contain fluid that supports bacteria growth. Since the mastoid is middle ear cleft’s extension, all patients of chronic middle ear inflammation or acute otitis media suffer from mastoiditis. The middle ear infection may rupture eardrums and infect mastoid air cells.

The infection may damage honeycomb structure of the mastoid sinuses. Chronic inflammation of the middle ear may result in tissue growth that may reach the mastoid bone and antrum. Coalescent mastoiditis occurs when inflammation and other symptoms of the disease persists over 2-4 weeks. This infection may obliterate mastoid sinusesand destroy lining around the bone. Cholesteatoma, a skin cyst in the middle ear, can also disrupt the ear drainage system, causing mastoiditis.

Mastoiditis generally occurs in infants and young children whose eardrums are ruptured and not treated. Ears are irreplaceable assets. Take care of your kids’ ears. The condition generally develops in children of 1-2 years old. Some times, it may be found up to age of 8 years. Children who have history of middle ear infections that reoccur and ear infections are prone to mastoiditis. However, incidences of mastoiditis in adults are very less in number.

Common Symptoms

Discomfort or pain in the ear may occur.
Discharge from the ear is common. The source of discharge may be located in the perforated eardrum.
Entire ear or back of the ear may become red.
Swelling may occur behind the ear. A tender and painful abscess may occur due to mastoid bone’s damaged cortex. Abscess may burst. Swelling may push the ear downward and forward. The ear lobe may also swell.
Patients may suffer from high fever, which may increase suddenly.
Mastoiditis affects ability to hear.
Headache and irritability are two other common symptoms of the disease.

2011-10-21T03:04:00.000-07:00

Inflammation of Mastoid Sinus

The mastoid process, one of the four integral parts of the temporal bone, is the prominent rounded knob behind the ear. The knob occurs behind both the ears. The temporal bones are located on the sides of the human skull. The mastoid process is found on the inferior and the posterior border of the bone.

The process features scores of air-filled spaces, which are called mastoid air cells or mastoid sinus. The spongy air cells are located on the back of the middle ear. The middle ear is a small cavity within the temporal bone. The size and the number of the cells differ from person to person. A mucous membrane lines the mastoid sinus. Small cells may be filled with bone marrow, whereas the big one contains air. The sinus, connected to the middle ear, improves resonance in the ear and sound amplification and perception. The mastoid process also helps in maintaining balance of the head.

The skin over the process is smooth and fine. The skin does not have hairs either. The process is more prominent in adults than in children. It is less prominent in men than in women. The knob in old people is the largest. The most interesting fact about the process is that a blow or fall cannot fracture it. However, there are cases of bullet-induced fractures in the process.

Mastoiditis

Inflammation / infection of mastoid sinus or the mastoid bone is called mastoiditis that develops in five stages:

hyperemia of the mastoid sinus’ mucosal lining,
exudation and transudation of pus and / or fluid within the sinuses,
bone necrosis,
loss of the cell wall and
spreading of inflammation to bordering areas.

Diagnosing Mastoiditis

An x-ray of skull, a CT scan of the head or CT scan of the ear will help in diagnosing mastoid sinus infection if no symptoms were found during the examination of patient’s head. If signs of intracranial problems or brain abscess are found, doctor may ask for a computed tomography scan (CT scan) or magnetic resonance imaging (MRI). Doctor may also recommend blood and culture tests.

Doctor may use otoscope to examine eardrums and outer ears of children. S/he may also perform a physical examination and go through medical history of the patient. So carry all records while visiting the doctor.

Doctors may perform tympanometry test to check functioning of the middle ear, including pressure changes. The test requires patients to sit still. Thus, it is difficult to perform the test on children.

3 Decongestants Recalled in 2010

2011-10-20T01:24:00.000-07:00

3 Decongestants Recalled in 2010

A decongestant is useful in treating symptoms of sinus infection. However, consult a doctor before using a decongestant to ensure that you take approved and safe medication. Recently, some decongestants were voluntarily recalled from the U.S. market considering customers’ safety. This article focuses on three of these decongestants.

PediaCare Decongestant 4oz.

After consulting with the U.S. Food and Drug Administration (FDA), Blacksmith Brands, Inc. voluntarily recalled its four PediaCare products, designed for children, in May 2010. The products include PediaCare Decongestant 4oz., PediaCare Allergy and Cold 4oz, PediaCare Long Acting Cough 4oz. and PediaCare Multi-Symptom Cold 4oz. All the four products were exclusively distributed within the United States of America. McNeil Consumer Healthcare, a part of Johnson & Johnson Company, manufactured these products for Blacksmith. Recall was a precautionary measure in response to FDA’s inspection report that concluded that McNeil Consumer Healthcare Fort plant in Washington (Pennsylvania) was not following the latest production standards.

VapoSpray 4-Hour Decongestant Nasal Spray by Sinex

In June 2010, the Procter & Gamble Company (PG) recalled its VapoSpray, which was sold in the U.S. market. This voluntary recall was a precautionary measure, as the product formulation was not pursuant to the expiry date stamped on the spray package. The company offered refund or replacement coupons for recalled products. PG was selling VapoSpray as Sinex Nasal Spray in Ultra Fine Mist and spray forms before June 2009.

Over-the-Counter Cold Decongestant Tablets

Reese Pharmaceutical Company, based in Ohio, recalled lot#091612 of 60-count size bottles of cold decongestant tablets in December 2010. These tablets contained 325 mg of acetaminophen, 2 mg of chlorpheniramine maleate and 5 mg of phenylephrine. However, they were mislabeled. The faulty labels read that the tablets contain 200 mg of guaifenesin. The voluntary recall was initiated to ensure that consumers do not ingest the tablets and do not get any side effects of either of three ingredients. As faulty labels did not carry a warning that acetaminophen may damage the liver. High dose of acetaminophen can damage the liver. Chances of liver damage increase in patients who are already suffering from liver disorders.

The recalled tablets included Leader Cough Tabs Expectorant, QC Medifin Expectorant, Refenesen Expectorant and Select Brand Mucus Relief Expectorant. The tablets were sold in the United States of America. The recall decision was taken after consulting the U.S. Food and Drug Administration.

Next time, when you buy a decongestant ensure that you do not use banned products that may aggravate your problems.

Tests That Determine Allergies’ Causes

2011-10-19T02:33:00.000-07:00

Tests That Determine Allergies’ Causes

Can Animal-induced Allergens Cause Allergic Rhinitis?

2011-10-18T02:31:00.000-07:00

Can Animal-induced Allergens Cause Allergic Rhinitis?

Yes, animal-induced allergens may cause allergic rhinitis.

Another common allergen is house mice hairs, especially in urban areas. Exterminate the mice and remove dust that may have mouse dander and urine.

How to Use Nasal Sprays Effectively

2011-10-11T07:28:00.000-07:00

How to Use Nasal Sprays Effectively

Clean the nose before using the nasal spray.

You should be able to sniff before using the spray. If you are unable to sniff, medicine will be released deep into the nose, causing irritation.

Exhale slowly and move the head in proper position. If using the bottle, tilt the head forward. If using the canister, keep head upright. If the spray drips down the throat’s back or from the nose, the spray container was not in proper position.

Shake the bottle or canister prior to spraying. Adjust the canister to ensure it is firmly placed in the holder.

If you have bought the pump bottle spray, squirt it until a spray of mist is released before using it.

Avoid blowing your nose or sneezing immediately after spraying.

Clean the canister spray regularly.

Follow the physician’s prescription. Read the instruction on medicine and spray package.

Do not store the nasal spray under sunlight.

Do not use the spray up to two days, if you have stinging feeling in the nose, nosebleed has started or the spray is hurting the nose.

Nasal steroid sprays are mainly used for chronic sinusitis treatment. Some sprays are also used for acute conditions. The spray helps in reducing nose congestion and sinus inflammation. However, these sprays are not a permanent cure. Generally, the symptoms will return after stopping the application of the spray. The long-term use of the spray may cause dryness, itching, irritation and burning inside the throat and nose. It may also trigger nosebleeds, headaches and sneezing.

Nasal saline spray is an over-the-counter medication. The saline used in the spray increases moisture level, facilitating removal of infection. The saline sprays are non-addictive.

Causes of Headache-Sinus

2011-10-10T02:42:00.000-07:00

Causes of Headache-Sinus

Sinusitis, the inflammation and congestion of the sinuses, causes pain in the head and the face. This pain is referred to as headache-sinus. Factors causing sinus headaches can be divided into four categories: respiratory, environmental, physical and other.

Respiratory Factors

Since sinus headaches are an outcome of another condition, these are called secondary headaches. Generally, the underlying condition associated with the sinus headaches is common colds. Other infections of upper respiratory system may also lead to sinus headaches.

When the ducts connecting the sinuses with the back of the nose swell, the sinus functioning ability reduces and pressure builds in the infected sinus. Production of inflammatory fluid increases. Ability to drain fluid falls. This leads to pain of a headache-sinus.

Environmental Factors

Allergies and respiratory infection may lead to sinusitis, but do not result in sinus headaches. Allergies may cause sinus congestion that may in turn create headache pain. Patients prone to allergies should seek separate treatments for allergy and headache.

Malignancy, an infection or allergy reaction, may cause the headache. Allergy associated headaches are seasonal. Exposure to allergens – cigarette smoke, pollens and mold- may worsen the headache-sinus and increase its frequency.

Allergic rhinitis may lead to the sinus headache. Allergic rhinitis (hay fever), hormonal rhinitis, inflammatory rhino sinusitis and non-allergic rhinitis contribute to the headache. Hormonal rhinitis associated with pregnancy is nasal stuffiness and congestion due to hormones. The headache disappears after the delivery.

Sinus headache intensifies during winter or fall, the cold and cooler weathers respectively.

Sudden and rapid changes in air pressure may also worsen sinus symptoms, causing sinus headache.

Physical Factors

Nasal deformities and bone injuries may also trigger the sinus headaches. Chronic sinus infections, deviated septum and nasal polyps cause frequent sinus headaches. Deviated septum hinders airflow from the nose and interferes with drainage and breathing. A person with deviated septum is more prone to sinus congestion and infection that results in frequent sinus headaches.

A tumor of the sinuses may also plug up the sinuses, resulting in the headache pain.

Swollen nasal turbinates cause a feeling of nasal stuffiness and sometimes pressure, resulting in the headache.

Other Factors

Some times dental infection may reach the maxillary sinus, which is located within the cheekbones, and cause the headache.

In some cases, the headache aggravates on lying down or bending forward.

Sinus headaches are accompanied by nasal discharge, sore throat and postnasal drip.

Complications and Risks Associated with Surgery-Sinus

2011-10-05T04:24:00.000-07:00

Complications and Risks Associated with Surgery-Sinus

Avoiding contact with allergens and proper treatment of allergies are the best options to prevent or treat sinusitis. Patients should remember that surgery-sinus is not a substitute for allergy controls. No surgical process is completely safe. There is thus always a chance of complications, which may develop during and / or after surgery-sinus. Some of which are discussed here.

Blood transfusion or blood products may rarely be needed to offset the impact of bleeding during the surgery. Advance arrangement for blood will be useful in case an emergency arises. Patients shall seek advice of their surgeons and physicians well in advance.

Crusts may form in the nose.

The nose may become excessively dry.

Chronic nasal drainage may become a cause of concern.

The surgery-sinus may not resolve the problem of sinus infection. Another round of surgical procedures may be required. A failed surgical attempt may obstruct the nose.

Sinus problems and polyps may reoccur even after the surgery.

The surgery may not resolve cough, bronchitis, asthma or other respiratory illnesses.

Headaches associated with sinuses may not be resolved.

Help of a neurologist and other medical specialists may be required.

The surgery may damage the eye and related structures.

Spinal fluid may leak or brain abscess may develop due to injuries to the skull during the surgery. The membrane covering the brain may swell.

Palate or upper teeth permanently becomes numb.

Impaired healing and lingering pain may lead to hospitalization of the patient.

The sense of taste or smell may worsen and may be completely lost.

A sudden increase in the nose bleeding requires doctor’s attention.

A fever higher than 38.6 degree Celsius may occur after the surgery.

Redness or swelling of the eyes or nose may increase after the surgery.

Heavy bleeding may occur.

During ethmoidectomy, the optic nerve and the muscle controlling eye movement may damage, as the ethmoid sinuses are located near the eyes. These damages are difficult to repair. If bleeding into the eyes happen, it will affect the vision.

Maxillary antrostomy may cause injury to the tear ducts. Tear production may increase. Nose may bleed.

Complications and risks may aggravate if the patient already has other medical problems. So, while discussing surgery-sinus with your doctor, do not hide your medical history and current medical conditions.

In rare cases, blindness or death may occur.

Types of Sinus Surgeries

2011-10-04T01:44:00.000-07:00

Types of Sinus Surgeries

When antibiotics, drugs and other medication do not reduce symptoms of chronic sinusitis and complications develop, patients may be benefited by sinus surgery. The surgery removes mucosal tissue that creates obstruction and cleans up the sinus-nasal channels, ensuring drainage of the sinus cavities. Surgeons may also remove nasal polyps and straighten defected nasal septum for better airflow. However, patients may be administered antibiotics periodically and nasal steroids even after the surgery. There are two types of sinus surgeries: endoscopic and traditional.

Endoscopic Surgery

Mostly endoscopic method is used for the sinus surgeries, because it enables accurate visualization of the sinuses and the pathways without any external incision. Thus, bleeding, discomfort and swelling will be less. Recovery period will be shorter. This less expensive surgery has smaller chances of complications. The surgery may remove materials, including bone plugging the openings of sinuses. An endoscope, a slim lighted instrument, is inserted through the nose during the surgery for spotting the problem and removing the material. A set of surgical tools are also inserted to remove polyps and blocking material. Sometimes blocking material is burnt with the laser. A rotating burr may be used to scrape away the tissue. The surgery lasts between ½ hour and 1 ½ hours. It improves sinus symptoms in 90% patients. However, some times a second surgery is required. Some complications may occur during the surgery. Swelling or bruising around the eyes may occur in some patients. Incidences of brain and eye injuries or heavy bleeding are rare.

Image Guided Endoscopic Surgery

Since the sinuses are located near major arteries, eye and brain, insertion of a fiber optic tube into the sinus area is a cause of concern. To alleviate this concern, image guided endoscope technique is developed. The technique is used to treat extreme case of chronic sinusitis. The image guidance utility uses infrared signals to inform about precise real time location of the surgical tools used with the help of 3D images and CT scans.

Traditional Surgery

Traditional surgery is recommended if brain abscess occurs, pus develops in the sinus or infection spreads into the facial bones. The surgeon will make an incision through the face skin or inside the mouth to access the sinus and remove the blocking material. The surgery approach may vary from doctor to doctor and location of the sinus infection. In extensive procedures, the opening (incision) may be left open for infection drainage. The surgery may require hospitalization of the patient. Traditional surgery, an effective technique to treat chronic sinusitis, is recommended if endoscopic surgery was not successful and medications were of no use. However, risk associated with the surgery includes blindness, death, inflammation of membrane covering the brain, fluid leakage and heavy bleeding.

Sinusitis Surgery: Pre- and Post- Operative Care

2011-10-03T02:40:00.000-07:00

Sinusitis Surgery: Pre- and Post- Operative Care

Pre-operative Care

Prior to the surgery, an anesthesiologist must review medical history of the patient.

The surgeon may order pre-operative laboratory studies, which should be done in advance. Patients should carry all the studies on the day of the surgery.

Do not take any medication containing aspirin or nonsteroidal anti-inflammatory medications, or aspirin 7-10 days before the surgery. Consult your doctor before administering any drug.

In many cases, doctors advise not to drink or eat eight hours before the surgery.

Follow preoperative advice given by the doctor.

Patients should not smoke before the surgery to minimize post-operative bleeding and coughing.

If patient has any illness like fever, it should be reported to the doctor prior to the surgery.

Do all paper work properly before the surgery.

Post-operative Care

A responsible person should be with the patient on the first night after the surgery.

The surgeon may advice use of saline irrigation and the suitable method of irrigation.

Some nose bleeding is normal. The bleeding will reduce slowly. Use gauze dressing in case of nose bleeding.

Eat cool, soft, light food. Do not consume hot liquids for many days. Eat slowly to avoid postoperative vomiting and nausea.

Take adequate rest.

Complete the course of antibiotics if doctor has prescribed. Or, any other medicines prescribed by the doctor.

Symptoms of Sinus Headaches

2011-09-27T02:01:00.000-07:00

Symptoms of Sinus Headaches

Constant, deep and dull pain in the sinus region, comprising bridge of the nose, forehead and cheekbones, denotes headaches. The pain, the main symptom of the headache, increases with straining, sudden movement of the head, leaning over or bending down. The pain may be accompanied by facial swelling, fever, fullness / sensation in the ears and nasal discharge. The pain may increase during damp and cold weather. Sudden changes in temperature further worsen the pain. The pain during sinus headaches feels like pressure. Sinus pain and other nasal signs may accompany the headache.

Intensity of pain may vary from person to person. It could range between minor nagging pain and unbearable pain that hinders normal sleep process.

The pain in the head may resemble to a tension headache.

Pressure sensation in affected area increases.

Local swelling, redness and tenderness in the facial area may occur. Tenderness over the infected sinus is associated with sinus headaches.

The headaches generally occur in the morning and improve by afternoon. The pain is severe in the morning because of overnight mucus collection.

Symptoms associated with sinusitis, such as sore throat, postnasal drip, green or yellow discharge from the nose, nasal congestion, fever and fatigue may also appear.

In some cases, sinus headaches may not be accompanied by sinusitis signs.

Fever with sinus headache is a quite common sign.

Purulent or pus-like nasal discharge may lead to sinus headaches.

Rarely, sinus headaches may be associated with pain in the back or the top of the head.

Sinus headaches may be felt on both sides of the head or on either side of head.

Neck is generally not affected during the headache.

Headaches with congestion

Feeling of ache in the upper teeth

Cold shivers

Coughing or throat irritations

Light-headedness

Achy muscles (myalgias)

Lymph nodes in the neck may swell.

Sinusitis Understood: Smoking and sinusitis

2011-09-20T04:36:00.000-07:00

Sinusitis Understood: Smoking and sinusitis: Smoking is one of the most important causes of head and neck cancer . Another important untoward result of active and second hand smoke expo...

8 Things You Should Know about Infections-Sinus

2011-09-19T03:57:00.000-07:00

8 Things You Should Know about Infections-Sinus

Timely Examination

Cause of Infection

Appropriate Diagnosis

Do not Abuse Nasal Sprays

Do not Take Medicines without Prescription

When is Surgery Required?

If the best medications fail to cure the sinusitis, you may need surgery. With the help of doctor, you can choose from traditional and endoscopic surgeries.

Home Remedies

Impact of Untreated Sinus Infections

How to Use Nasal Sprays Effectively

2011-09-13T02:03:00.000-07:00

How to Use Nasal Sprays Effectively

Clean the nose before using the nasal spray.

You should be able to sniff before using the spray. If you are unable to sniff, medicine will be released deep into the nose, causing irritation.

Exhale slowly and move the head in proper position. If using the bottle, tilt the head forward. If using the canister, keep head upright. If the spray drips down the throat’s back or from the nose, the spray container was not in proper position.

Shake the bottle or canister prior to spraying. Adjust the canister to ensure it is firmly placed in the holder.

If you have bought the pump bottle spray, squirt it until a spray of mist is released before using it.

Avoid blowing your nose or sneezing immediately after spraying.

Clean the canister spray regularly.

Follow the physician’s prescription. Read the instruction on medicine and spray package.

Do not store the nasal spray under sunlight.

Do not use the spray up to two days, if you have stinging feeling in the nose, nosebleed has started or the spray is hurting the nose.

Nasal steroid sprays are mainly used for chronic sinusitis treatment. Some sprays are also used for acute conditions. The spray helps in reducing nose congestion and sinus inflammation. However, these sprays are not a permanent cure. Generally, the symptoms will return after stopping the application of the spray. The long-term use of the spray may cause dryness, itching, irritation and burning inside the throat and nose. It may also trigger nosebleeds, headaches and sneezing.

Nasal saline spray is an over-the-counter medication. The saline used in the spray increases moisture level, facilitating removal of infection. The saline sprays are non-addictive.

Diet Tips to Prevent and Heal Sinus Infection

2011-09-05T04:48:00.000-07:00

Diet Tips to Prevent and Heal Sinus Infection

Be careful while planning your daily menu, as food choices may aggravate the sinus infection. Here are some useful diet tips for controlling and healing the infection.

Eat small frequent meals.

Avoid even second-hand smoke.

Use olive oil for cooking, as the oil keeps your intestine healthy and fit.

Add brown rice and other whole grains to your meals.

Eat lots of steamed and raw vegetables, including onions and cayenne pepper, and some fruits. One of the studies suggests that bromelain present in pineapple may heal the sinus infection. Anti-inflammatory properties of bromelain reduce swelling and inflammation.

Fresh vegetable juices, herbal teas, soups and other hot liquids will keep your body hydrated. Adequate fluid intake regulates mucus flow and helps in relieving sinus pressure and congestion.

Do not eat fast, junk and refined foods like white rice, white flour, soft drinks and sugar. Yeast, gluten and sugar substitutes present in biscuits, cakes, chocolate candies, cupcakes, doughnuts and frosting may cause sinus related problems.

Dairy products form thick mucus, so avoid dairy products. However, you may use yogurt made from sheep and goats’ milk. People suffering from chronic sinus infections may avoid dairy produce.

Use rice milk instead of dairy products. Soy products fortified with calcium will protect against sinus infection.

Identify materials and products that cause allergies to you. Find out the foods for which you have poor tolerance level. A blood test may help in identifying both allergies and food intolerances. Yeast, eggs, citrus fruits, dairy and wheat are common source of allergies.

You may take nutrition supplements after consulting a qualified dietician.

Food items rich in vitamin C have antioxidant properties. Dark green leafy vegetables, grapes and citrus fruits are good source of vitamin C. Foods those are rich in vitamin A helps in preventing common cold, flu, sore throat and other respiratory disorders. Pumpkins and carrots are rich in vitamin A. Horseradish, garlic and onion facilitate reduction of inflammation and keep respiratory channels free of obstructions.

The plant pigment quercetin, an antihistamine, gives color to foods like berries, beets, celery, apples, apricots and Brussels’ sprouts. Antihistamine properties of the food help in reducing the sinuses’ inflammation.

Sinusitis patients doing an antibiotics course may eat yogurt, as it has probiotic lactobacillus that prevents and reduces symptoms of sinus.

Avoid spicy foods, as they create problems related to the throat, nose and ears. According to a theory, stomach acid’s regurgitation causes inflammation and irritation in the nasopharyngeal region. The inflammation blocks the drainage pathways, a symptom of sinusitis.

Tips for Nasal Irrigation

2011-08-29T02:04:00.000-07:00

Tips for Nasal Irrigation

Nasal irrigation, nasal wash or nasal douche, probably an Ayurvedic practice, uses saline to rinse the nasal cavity and treats colds, sinus disorders and nasal allergies. A neti pot, a specially designed container, is used for nasal wash. Regular nasal irrigation using a neti pot is more beneficial than the over-the-counter drugs. The pots are available in stainless steel, molded plastic and ceramic. However, steel pots are expensive. Fill the pot with over-the-counter saline nasal solution or warm salty water. Place the pot’s spout in the nostril and pour the water into the nostril. Repeat the process for both the nostrils.

While pouring water into the nostril, breathe through mouth. The water will come out from other nostril. After it drains fully, exhale and clean your nose with tissue.

Thoroughly clean the pot after every use.

Do not use extremely hot or cold water for the irrigation.

Generally, one pint of lukewarm water is mixed with one teaspoon of salt to make saline for the pot. Sinus Rinse systems are also available in the market.

Tilt the head at about 45 degree while using the pot.

Do not put too much of pressure to pour water inside the nostril. Be gentle.

Daily make fresh solution.

Some times saline may reach your throat, you can spit it.

In rare case, the nose may bleed or a feeling of stinging and irritation may occur.

Neti pot thins the mucus and thereby flushing out is easier.

You may consult your physician before using the pot.

If you do the wash vigorously, it may cause ear pain or gagging.

Initially you may not found it as easy as using a nasal spray or taking a pill. But, with little effort and practice, you will be comfortable with the pot. Various studies have confirmed that the nasal irrigation reduces the sinus infection symptoms.

A bulb syringe is used for nasal irrigation in babies.

The irrigation removes congestion and reduces pressure and pain in the face. Regular nasal wash can reduce the usage of nasal sprays and antibiotics. Nasal douche removes debris and excess mucus from the sinuses and the nose. Nasal wash clears up the nasal passages when polyps develop or crusts form and block the nose.

The wash used with standard medication can be very useful in treating the sinus disorders. Nasal wash may also give relief to chronic sinusitis patient.

Saline enhances speed of cilia movement and cilia coordination that enable removal of allergens, bacteria and other substances causing the sinus diseases.

9 Factors Causing Infection-Sinus

2011-08-22T07:10:00.000-07:00

9 Factors Causing Infection-Sinus

Gunge accumulated in the sinuses is an ideal place for harmful germ growth. These germs cause infection-sinus. Acute sinus infection is attributed to a number of factors, which are discussed below:

Chronic medical conditions, including cystic fibrosis, HIV and diabetes, weaken the immune system, causing swelling of the airways. As a result, thick mucus may develop that in turn leads to infection-sinus.

Anatomical abnormalities, structural defects, such as cleaved palate, tumor, deviated septum and thin drainage channels, interfere with mucus drainage. Disease-spreading bacteria and viruses can easily grow in the mucus build up, setting the stage for infection.

Polyps, benign growths in the sinuses and the nose, may block the sinus spaces and thereby hinder mucus drainage. The mucus build up will lead to infection. If these growths obstruct the airway channels, headaches may develop.

Smoking is an irritant that may cause inflammation in the nose and make you more prone to infection-sinus. Indeed, smoking interrupts and disrupts natural cleaning process of the sinuses. More gunge, thus, gathers into the sinuses, blocking the nasal passages.

Fungi may even infect the sinuses of a healthy person. However, mostly people with a weak immune system get fungal sinusitis. Fungi grow easily in dark and damp environs, which are found in the sinuses. So weak immune system and right environment encourage growth of disease-causing fungi.

Frequent air travel may worsen the infection-sinus. Reduced air pressure in an airplane may build up pressure in the head. The pressure, especially during landing and takeoff, may clog the air passages and the sinuses, aggravating signs of cold and sinusitis.

Adventure activities like diving and swimming worsen symptoms of sinusitis in the people already suffering from the disease. Do not spend too much time in the swimming pools, because chlorine irritates the sinuses and the nasal lining. Water may enter into the sinuses due to pressure change while diving and inflammation of sinus tissues may occur.

Air-borne pollutants, including dust, perfume, and other strong odors, cause irritation in the nose and inflammation, making you more susceptible to sinusitis. Try to avoid these pollutants and reduce the risk of developing sinus infection.

A viral infection in the upper respiratory system may lead to sinus infection. The viral infection damages the sinus membrane cells, causing inflammation and thickening of the membrane. The thick membrane clogs the nasal passages connecting to the sinuses. In the absence of proper removal of bacteria, infection develops.

Prevention of Headaches-sinus

2011-08-02T02:39:00.001-07:00

Prevention of Headaches-sinus

Headaches-sinus is associated with sinus disorders. The headaches are generally accompanied by other sinus congestion symptoms. To prevent and reduce chances of the headaches-sinus, do the following:

Avoid smoking.

Ensure that you do not catch respiratory infections, colds and influenza. Good hygiene habits protect against these ailments. If you suffer from these disorders, visit the doctor for quick and reliable treatment. Avoid contact with people suffering from these contagious diseases. Reduce stress and live active life to strengthen your immune system, so you do not catch infectious diseases. Balanced diet and regular exercise will strengthen your immune system.

Avoid exposure to allergens that trigger sinusitis symptoms and associated headaches. Treat all allergies in timely manner as allergies may cause swelling of the sinuses and result in headaches. In case of severe allergies, consult the doctor and follow the prescription.

Avoid strong gases, dust, fumes and odors as they lead to irritation and may cause headaches.

Drink enough fluids and keep body hydrated. Fluids will thin the mucus, allowing proper drainage of the mucus and ensuring clear sinuses, as congested sinuses are prone to infection that cause headaches.

Breathe in humidified air at work and home, because ample moisture in the air prevents sinusitis. However, excessive use of humidifiers is not good, as high humidity may encourage growth of dust mites.

A hot shower or bath increase humidity and steam opens up your sinus cavities. The clean sinuses are less prone to pain.

Keep your sinuses healthy. Wash your hands with water and soap often to avoid catching infections of upper respiratory system that may cause sinusitis. Avoid irritants causing swelling of the sinus membrane. Washing hands will prevent viruses and bacteria from spreading. Wash the hands after touching someone. Do not shake hands. Sneeze and cough into the crook of your arm instead of the hand. Public doorknobs and telephones are storehouse of germs, so washing hands after using them is necessary.

Since dairy products may thicken mucus, reduce the intake of the products.

You may take over-the-counter painkillers that generally subside the sinus pain.

In case of stubborn sinusitis, surgery may relieve the symptoms and prevent headaches.

Find out the cause of sinus pain and treat accordingly.

How to use Nasodren

2011-07-27T04:10:00.001-07:00

How to use Nasodren?

The new video of how to use Nasodren, for sinusitis treatment is available now. It is a detailed step-by-step explanation of the correct product application from when beginning to the end. In the video you can find the correct instructions, contents, preparation, application, storage and more.

Have a look for yourself now and recommend it to anyone who could be interested in Nasodren.

What Causes Symptoms of Sinus Infection

2011-07-20T04:24:00.001-07:00

What Causes Symptoms of Sinus Infection

Acute sinusitis is generally ascribed to the bacterial infection. Most of the patients suffering from colds have mild sinus inflammation that last for a short period. A few patients with colds may develop typical sinusitis conditions. Flu and colds may create nasal congestion and inflammation, obstructing the sinuses and creating an environment conducive for bacterial growth. Thus, symptoms of sinus infection develop.

Causes for Recurrent or Chronic Sinusitis Conditions

Acute sinusitis that was not treated in time may damage mucus membranes and cause recurrent or chronic infection.

During some chronic disorders, such as Wegener's granulomatosis, Kartagener's syndrome, cystic fibrosis, hypothyroidism, immune system related diseases, AIDS and diabetes, airways may swell or thick stagnant mucus may occur continuously. These ailments may also cause chronic sinusitis.

Structural abnormalities may block the nasal passage, causing chronic sinusitis conditions. Common abnormalities include small benign structures (polyps) in the nasal passage. Polyps obstruct air and mucus flow. Polyps may result due to previous untreated sinusitis. Enlarged adenoids may cause sinusitis. Adenoid is a mass of lymphatic tissue on the pharynx’s posterior wall. Other structural abnormalities include cleft palate, deviated septum, nasal bone spur and tumors.

Allergic reaction to fungus may also create symptoms of sinus infection. Alternaria, Aspergillus, Bipolaris and Curvularia fungi trigger sinusitis. However, fungi are not common cause for sinusitis. Fungi may colonize sinuses of chronic sinusitis patients. These patients may need anti-fungal treatment.

Some chronic sinusitis may occur due to continuous inflammation instead of presence of bacteria.

Bacteria play a direct or an indirect role in chronic sinusitis, but, in some cases, bacteria may not play any part at all. They may thrive in the sinuses but do not cause the infection. This condition is referred to as colonization. Moraxella catarrhalis causes sinusitis in children. H. influenzae and Streptococcus pneumoniae bacteria trigger sinusitis in both children and adult.

Other Causes

Airborne chemicals, irritants and other pollutants cause symptoms of sinus infection.

A weak immune system may also lead to sinusitis.

Malfunctioning sinus cilia may result in sinusitis. Malfunctioning could be because of medical disorders.

Allergies and colds may increase the mucus that may obstruct sinus opening.

Infected teeth may infect sinuses.

During cystic fibrosis, a genetic disorder, sticky thick mucus gathers within the body. As a result, patients become prone to infections.

Diagnostic Tests for Sinusitis

2011-07-12T02:53:00.000-07:00

Diagnostic Tests for Sinusitis

Doctors may perform a complete physical examination and medical history review to diagnose symptoms of sinus infections. Other scientific diagnostic methods may also be used. For instance, x-ray, computerized tomography (CT), ultrasound and cultures.

X-ray uses invisible electromagnetic energy beams to capture images of internal bones, organs and tissues. Quality and accuracy of x-ray depends on doctors’ ability and technique to read the images correctly. In many cases, x-ray of sinuses does not capture symptoms of sinus infections.

CAT or CT scan, a noninvasive reliable medical test,uses computer technology and X-rays to generate multiple vertical and horizontal slices (cross-sectional images) of affected body part. It generates real time pictures. These scans reveal more details of the body as compared to the X-rays. The facial CT scan produces pictures of paranasal sinus cavities. Sinus CT is performed to identify inflammatory diseases, gather anatomical information for sinus surgery to remove tumors in sinuses or nasal cavities, and identify sinuses filled with fluid and thick sinus membranes. CT is an easily available service requiring lesser time than magnetic resonance imaging (MRI). This cost-effective, accurate and painless method can capture pictures of blood vessels, soft tissues and bones simultaneously. Quick and simple CT scans are a good choice for emergency cases.

Ultrasound, a noninvasive tool, is also used to identify symptoms of sinus infections. The tool is reliable, quick and less costly than a CT scan. However, results of ultrasound are not as good as that of the CT scan. Ultrasound is generally not used for sinusitis diagnosis.

Cultures of sinus or nose fluid are prepared in the laboratory to help in diagnosis.

Doctors may also conduct blood tests.

Physicians may recommend a visit to an ear, nose and throat (ENT) specialist if sinusitis recurrent and severe. The specialist may conduct more tests. ENT specialists use nasopharyngoscope, a flexible fiberoptic tube, to examine the passage into the sinuses (OMC) and the nasal passages. The tube inserted in the nose helps in visualizing structural deformities like tonsils, enlarged adenoids, nasal polyps and deviated nasal septum. The specialist may drain the sinus to examine the organisms. Sinus draining is an invasive procedure. It requires a needle, which is inserted into the sinus through gum or skin to extract the fluid. The fluid is sent to the laboratory for culture preparation and identify bacteria. However, it is uncommon because of high level of discomfort.

How to Prevent Symptoms of Sinus

2011-06-28T04:39:00.001-07:00

How to Prevent Symptoms of Sinus

Preventing symptoms of sinus is better than cure. Follow the tips given below to reduce chances of sinus problems:

Eat well and exercise regularly to avoid contagious colds and flu. If these diseases occur, do not delay the treatment as untreated colds and flu can cause sinusitis.

Strengthen your immune system, increasing body resistance to infections. Consumption of vegetables and fruits loaded with antioxidants will help in boosting immune system. Adequate sleep is also essential for a good immune system that protects you against symptoms of sinus. De-stress regularly.

Drink enough fluids to hydrate the body. Try a humidifier to enhance moisture content in sinuses and nose. Humidifier will especially be helpful in case of a dry forced-air system used to heat the room air.

Ensure that the offices and houses are free from allergens. Air conditioners and heating equipment may help, as both feature electrostatic filters to remove allergens from the air.

Keep hands clean. Regular washing, especially after handshake, will control spread of viruses. Handshake is a common source of disease transmission, particularly colds and flu. Use an ordinary soap. Alcohol-based gel hand cleaners without water may kill viruses of flu and cold. Wipe surfaces with the solution consisting of 10% bleach and 90% water to kill viruses.

Avoid air pollutants and cigarette smoke. Do not smoke.

Since alcohol consumption may cause swelling of sinus and nasal membranes, avoid it.

Chlorine irritates membranes of sinuses and nose, so swimming in the pools treated with chlorine will be uncomfortable for people prone to sinusitis.

Generally, divers suffer from sinus infection and congestion if water from the nasal passages reaches to sinuses. Take care!

Use nasal sprays prescribed by the doctor.

Patients suffering from infection of the upper respiratory system may use decongestants.

Quick and appropriate treatment of allergies is necessary. If food, pollens, mold, dust or any other allergen triggers infection in upper respiratory system and inflames sinuses, consult your physician immediately.

Administer influenza vaccine during October or November. Since influenza viruses change with time, vaccines are enhanced or improved pursuant to new viral strains. Healthy children between 6 months and 18 years, and adults >=65 years can also take the vaccine. Pneumococcal vaccines prevent respiratory infections caused by S. penumoniae bacteria.

Air travel may be uncomfortable for passengers suffering from chronic or acute sinusitis, because air pressure in the airplane falls. Resulting pressure build- up in the head may block your Eustachian tubes or sinuses. Consult your physician to use a decongestant.

Types of Headaches

2011-06-23T03:27:00.001-07:00

Types of Headaches

There are two types of headaches: primary and secondary. Primary headaches are ascribed to a neurological disorder. For instance, headaches associated with tension and migraine. These two primary headaches are generally misdiagnosed as sinus headache, making epidemiology of sinus headache complex.

Many common symptoms of sinus headache and a primary headache make it difficult to distinguish between the two. However, sinus headache has the following unique symptoms:

Continuous nasal congestion or obstruction that is not because of phonophobia, photophobia, auras, vomiting or nausea associated with migraine.
Dull pressure-like pain, which is generally periorbital. The pain worsens in the morning, thereafter it improves.
Pain concentrates over the infected sinus during Mueller sign test.

Sinus headache, the most common form of secondary headache, is mainly caused by acute rhino sinusitis. As per International Classification of Headache Disorder (ICHD)-II symptoms of the headaches ascribed to rhino sinusitis include:

As soon as acute exacerbation of the disease starts, facial pain and headache begins.
Evidence of acute-on-chronic or acute rhino sinusitis is found in magnetic resonance, nasal endoscopic, clinical and Computed Tomography (CT) images.
Facial pain or headache disappears within a week after curing acute-on-chronic or acute rhino sinusitis.
Pain in teeth, ears or face and frontal headache

Sinus Headache vs. Migraine

An acute headache or an acute exacerbation indicates sinus headache, whereas recurrent headaches are symptom of migraine.

Self-limited headaches of short duration accompanied by nasal discharge are a sign of migraine.

Migraine is aggravated by bright light or noise unlike sinus headaches.

Sinus headache creates dull deep achy feeling, fullness and heaviness. Pain increases while lying down and bending forward. Nasal discharge may have blood or be of yellow-green color.

Doctors may conduct the following tests to find out whether you are suffering from sinusitis or not:

Imaging tests include MRI or CT scans. MRI uses radio waves and magnetic field to generate cross sectional pictures of the brain. CT produces images of the brain and sinuses with the help of a computer. CT captures details, like level of air-fluid, clouding, scarring, swelling of sinus surface, on the images.

During mucus testing, a sample of mucus from nose is examined to check for fungal or bacterial infection.

Nasal endoscopy uses an endoscope (a thin tube with a light) for examining nasal passages. With the endoscope, doctors can visualize condition of the nasal passages and nose, and confirm or rule out presence of infection.

Post Nasal Drip: Causes, Harmful Effects, Treatments

2011-06-21T01:58:00.001-07:00

Post Nasal Drip: Causes, Harmful Effects, Treatments

Post nasal drip is excess mucus build-up dripping in the throat and the nose’s back.

Causes

Blood pressure, birth control, nasal sprays and some other medications
Bright lights, cold temperatures
During winter, heated homes and buildings become dry. This dryness thickens the mucus.
Foreign particles blocking the nose, especially in children
Head injuries
Hormonal changes and pregnancy
Sinusitis and / or chronic rhinitis trigger post nasal drip. It may also occur because of allergies, asthma, colds, flu and gastro-oesophageal reflux disease.
Some spices and food items
Sometimes structural problems, such as abnormal nasal septum, cause the drip.

Harmful Effects

It may cause chronic cough or sore throat. The cough worsens at night.
Secretions may block the Eustachian tube connecting the ear and the nose, creating pain and infection in the ear.
The drip may block the sinus passages.
Runny and blocked nose
Bad breath (halitosis) and hoarseness
“Tickle” in the throat

Treatment

If you know what caused the drip, treatment is easier. First, try to find out the reason / factors for the drip. Consult your physician before administering any medicine. A thorough ENT examination may also be required.

You may need antibiotics to treat bacterial infections that may produce yellow or green mucus.

The drip caused by viral infections and sinusitis may be treated with decongestants and antihistamines. Although antihistamines reduce the level of mucus, some of these medications may make you sleepy.

Nasal sprays and steroid medications may be used for allergy- associated post nasal drip.

Since thick secretion creates discomfort, the mucus thinning is essential. Thin mucus will reduce chances of sinus and ear blockage. Drink lot of water and fluids to thin the mucus. Alternatively, try mucus-thinning medicines. You may use nasal irrigation or saline nasal sprays to drain out the excessive discharge and other irritating particles. Moisturize room air by switching on humidifier or vaporizer. Try special HEPA air filters for your home.

You must contact a doctor if

the drip has foul order.
The drip is one-sided.
Mucus color is neither yellow nor white.
The drip is caused by head injury.
The drip lasts for over three weeks.
Children under three years of age are suffering from the drip for over ten days.
Fever accompanies the drip.

Allergies: Allergens, Symptoms

2011-06-17T01:56:00.000-07:00

Allergies: Allergens, Symptoms

Allergies are common. But, what is an allergy? An abnormal or unpleasant reaction of human immune system to allergens is called allergy. Allergens are substances that trigger allergies. Allergens are broadly divided into the following categories:

Airborne allergens: animal dander, dust mites, mold, pollens and other pollutants.
Food allergens: eggs, fish, including shellfish, milk, peanuts, soy, tree nuts (walnuts) and wheat
Insect stings: wasp and bee stings are common allergy triggers.
Penicillin-based antibiotics may cause allergy.
Latex and other substances that touch the skin may cause allergy.

When human body is exposed to any of the allergens, the body produces immunoglobulin E (IgE), an antibody that binds the allergen. Antibodies (proteins) are attached to the blood cells that are called mast cells and found in all parts of the body, including airways and gastrointestinal tract (GI). The mast cell attached to IgE releases various chemicals, including histamine, into blood. Histamine creates allergy symptoms. Both the body parts airways and GI featuring mast cells are highly vulnerable to allergen attacks. Risk associated with allergies increases in patients with family history of hay fever and asthma.

Common Symptoms of allergies

Face may become red. Eyes, face and / or tongue may swell. If allergy is ascribed to an insect sting, the sting site may also swell (edema).

Patients suffering from allergies feel ill, tired or week.

Rashes are common during allergies. A rash with elevated red patches is called hive. Generally, hives appear on the face and the neck.

Runny and itchy nose and sneezing may irritate the patient. Nose may become stuffy. Patient may have problem in breathing and swallowing. Coughing, wheezing or shortness of breath may cause discomfort.

Tightness or discomfort in chest may occur.

Other common symptoms include anxiety, dizziness, fear, light headedness, nausea, palpitation, red watery eyes and vomiting.

Food Allergy Symptoms

Food allergies are result of hypersensitivity to a food item. For example, peanuts cause anaphylaxis. The blood pressure of the patient suffering from anaphylaxis falls suddenly, which is fatal. Anaphylaxis may tighten and constrict airways. You may feel a lump in throat, thereby making breathing difficult. A shock may occur. Pulse may race.

Common symptoms of food allergies include:

Diarrhea
Eczema, hives, itching
Fainting
Itching or tingling in the mouth
Stomach cramps
Swelling of throat, tongue, face, lips…
Vomiting