MEDICAL CONDITIONS
Sinusitis
What is sinusitis?
Sinusitis, inflammation of the paranasal sinuses, is one of the more common diseases that may afflict people throughout their lives. It is estimated that the average adult has three to four upper respiratory infections each year and that about 1% of these infections are complicated by sinusitis. In addition to sinusitis associated with these viral respiratory infections, many more people suffer inflammation of the sinuses as a result of seasonal allergic problems or hay fever . Other sources of irritation of the nasal passages which may lead to sinusitis include the use and /or abuse of over the counter nasal sprays and illegal substances that may be snorted through the nose.
What are the paranasal sinuses?
The paranasal sinuses are air-filled cavities in the dense portions of the bones of the skull, which were formed to decrease the overall weight of the skull. These air filled cavities are formed essentially in four left and right pairs. The frontal sinuses are positioned behind the area of the forehead, while the maxillary sinuses are behind the cheeks. The sphenoid and ethmoid sinuses are found deeper in the skull behind the eyes and maxillary sinuses. The sinuses are lined by mucous secreting cells. The air gets into the sinuses through small openings in the bones that allow connection to the nasal passageways, called ostia. If any of these openings become blocked, air can't properly pass into the sinuses and likewise the mucous produced by the cells lining the sinuses can't drain out.
What causes sinusitis?
Sinusitis may be caused by anything that interferes with air- flow into the sinuses and the drainage of mucous out of the sinuses. The sinus openings, called ostia, may be obstructed by anything which causes swelling of the tissue lining the ostia and adjacent nasal passage tissue, for example colds, allergies, and tissue irritants ( OTC nasal sprays, "coke", cigarette smoke.) Sinuses can also become obstructed by tumors or growths which are in the proximity of the sinus ostia. The drainage of mucous from the sinuses can be impaired by thickening of the mucous secretions, by decrease in hydration (water content) of the mucous brought on by disease ( cystic fibrosis ), drying medications ( antihistamines ), and lack of sufficient humidity in the air. The mucous producing cells have small hair-like fibers, called cilia, which move back and forth to help the mucous move out of the sinuses. These small cilia may be damaged by many irritants, especially smoke, which then prevents them from assisting the mucous from draining from the sinuses. Stagnated mucous then provides a perfect environment for bacteria and in some circumstances (i.e.: AIDS ) fungus to grow in the sinus cavities.
What are the types of sinusitis?
Sinusitis may be classified in at least two ways, based on the time span of the problem (acute, subacute, or chronic) and the type of inflammation (either infectious or non-infectious). Acute sinusitis is usually defined as being of less than thirty days duration; subacute sinusitis as being over one month but less than three months; and chronic sinusitis as being greater than three months duration. Infected sinusitis is usually caused by bacterial growth while non-infectious is caused by irritants and allergic conditions. Acute sinusitis is most commonly secondary to either allergic rhinitis (hay fever) or a viral infection of the nasal passages. Subacute and chronic forms of sinusitis usually are the result of incomplete treatment of an acute sinusitis.
What are the symptoms of sinusitis?
Commonly the symptoms of sinusitis are headache, facial tenderness or pain, and fever. However, as few as 25% of patients may have fever associated with acute sinusitis. Other common symptoms include cloudy, discolored nasal drainage, a feeling of nasal stuffiness, a sore throat, and a cough. Some people notice an increased sensitivity or headache when they lean forward. In allergic sinusitis other associated allergy symptoms of itching eyes and sneezing may be common.
How is sinusitis diagnosed?
Sinusitis is most often diagnosed based on a history and examination made by your doctor. Because plain x-ray studies of the sinuses may be misleading and procedures such as CT scans and MRI scans, which are much more sensitive in their ability to diagnose sinusitis, are so expensive, most cases of sinusitis are initially diagnosed and treated based on clinical findings on examination. These physical findings may include redness and swelling of the nasal passages, purulent (pus like) drainage from the nasal passages, tenderness to percussion (tapping) over the cheeks or forehead region of the sinuses, and swelling about the eyes and cheeks. If sinusitis fails to respond to the initial treatment prescribed, then more in depth studies such as the above scans may be performed. Rhinoscopy, a procedure for directly looking in the back of the nasal passages with a small flexible fiber optic tube, may be used to directly look at the sinus openings and check for obstruction of these openings by either swelling or growths. It may sometimes be necessary to perform a needle aspiration of a sinus to confirm the diagnosis of sinusitis, and to get infected material to culture to determine what bacteria is actually causing the sinus infection. Cultures of the nasal passages are rarely helpful in determining what bacteria or fungus is causing a sinus infection.
How is sinusitis treated?
Acute sinusitis is usually treated with antibiotic therapy aimed at treating the most common bacteria known to cause sinusitis, since it is unusual to be able to get a reliable culture without aspirating the sinuses. The five most common bacteria causing sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Streptococcus pyogenes . The antibiotics that are effective treatment for sinusitis must be able to kill these bacterial types. Amoxicillin (Amoxil) is an acceptable first antibiotic for an uncomplicated acute sinusitis. In the penicillin allergic patient, cefaclor (Ceclor), loracarbef (Lorabid), clarithromycin (Biaxin), azithromycin (Zithromax), trimethoprim-sulfamethoxazole (Bactrim, Septra) may be used as first choices. If a patient is not improving after five days of treatment with amoxicillin, the patient may be switched to one of the above drugs or amoxicillin-lavulanate (Augmentin). Generally an effective antibiotic needs to be continued for a minimum of 10-14 days. It is however not unusual to need to treat sinusitis for 14-21 days. Taking decongestants (pseudoephedrine) and mucolytics ( guaifenesin ) orally may be helpful in assisting drainage of sinusitis. In general antihistamines should be avoided unless it is felt that the sinusitis is due to allergy, such as from pollens, dander, or other environmental causes. It is likely that the use of a topical nasal steroid spray will help reduce swelling in the allergic individual without the drying that is caused by using antihistamines. The treatment of chronic forms of sinusitis require longer courses of drugs such as Augmentin and may require a sinus drainage procedure.
What are complications of sinusitis?
While serious complications do not occur frequently, it is possible for sinusitis to cause a direct extension of infection into the brain, creating a life threatening emergency.
Conclusions
Sinusitis, when treated in an appropriate manner early in the course of the illness, can usually be treated effectively. It is important to seek the advice and evaluation of your physician if you suspect that you have sinusitis. If you are prone to recurrent bouts of sinusitis it may be important for you to consider allergy testing to see if this is the underlying cause of your recurring problem. - Sinusitis is inflammation of air cavities (sinuses) in the skull.
- Sinusitis can be caused by impaired drainage of mucous out of the sinuses.
- Sinusitis can be either infectious or non- infectious.
- Sinusitis can cause pain in the face, teeth, or head.
- Acute sinusitis is usually treated with antibiotic therapy.
|
DISCLAIMER:
Information on this site is provided for informational
purposes and is not meant to substitute for the advice
provided by your own physician or other medical professional.
You should not use the information contained herein
for diagnosing or treating a health problem or disease,
or prescribing any medication. You should read carefully
all product packaging. Not all Canadian drugs, Canada
prescription and Canadian prescription medicine is available
at discount Canadian on line pharmacies. If you have
or suspect that you have a medical problem, promptly
contact your health care provider. Information and statements
regarding diet supplements have not been evaluated by
Health Canada and are not intended to diagnose, treat,
cure, or prevent any disease. All trade and service
marks mentioned on this site are recognized as belonging
to their respective owners.
|
|
|
|
