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Sinusitis simply means your sinuses are infected or inflamed, but this gives little indication of the misery and pain this condition can cause. Health care experts usually divide sinusitis cases into :
- Acute, which last for 3 weeks or less
- Chronic, which usually last for 3 to 8 weeks but can continue for months or even years
- Recurrent, which are several acute attacks within a year
- Sinusitis is a leading cause of morbidity and poor quality of life issues.
WHAT ARE SINUSES?
Sinuses are hollow air spaces in the face. When people say, "I'm having a sinus attack," they usually are referring to symptoms in one or more of four pairs of cavities, or sinuses, known as paranasal sinuses . These cavities, located within the skull or bones of the head surrounding the nose, include the :
- Frontal sinuses over the eyes in the brow area
- Maxillary sinuses inside each cheekbone
- Ethmoid sinuses just behind the bridge of the nose and between the eyes
- Sphenoid sinuses behind the ethmoids in the upper region of the nose and behind the eyes
Each sinus has an opening into the nose for the free exchange of air and mucus, and each is joined with the nasal passages by a continuous mucous membrane lining. Therefore, anything that causes a swelling in the nose an infection, an allergic reaction, or another type of immune reaction also can affect the sinuses. Air trapped within a blocked sinus, along with pus or other secretions, may cause pressure on the sinus wall. The result is the sometimes intense pain of a sinus attack. Similarly, when air is prevented from entering a paranasal sinus by a swollen membrane at the opening, a vacuum can be created that also causes pain. This kind of pain is often experienced in an air journey during the descent.
- Headache when you wake up in the morning is typical of a sinus problem.
- Pain when your forehead over the frontal sinuses is touched may indicate that your frontal sinuses are inflamed.
- Infection in the maxillary sinuses can cause your upper jaw and teeth to ache and your cheeks to become tender to the touch.
- Since the ethmoid sinuses are near the tear ducts in the corner of the eyes, inflammation of these cavities often causes swelling of the eyelids and tissues around your eyes, and pain between your eyes. Ethmoid inflammation also can cause tenderness when the sides of your nose are touched, a loss of smell, and a stuffy nose.
- Although the sphenoid sinuses are less frequently affected, infection in this area can cause earaches, neck pain, and deep aching at the top of your head. Most people with sinusitis, however, have pain or tenderness in several locations, and their symptoms usually do not clearly indicate which sinuses are inflamed.
Other symptoms of sinusitis can include :
- A cough that may be more severe at night
- Runny nose (rhinitis) or nasal congestion
- In addition, the drainage of mucus from the sphenoid or other sinuses down the back of your throat (postnasal drip) can cause you to have a sore throat. Mucus drainage also can irritate the membranes lining your larynx (upper windpipe). Not everyone with these symptoms, however, has sinusitis.
The 1996 diagnostic criteria, as defined by the RTF, required 2 or more major factors or 1 major factor and 2 minor factors.
Symptoms Associated with the Diagnosis of Chronic Sinusitis
- Facial pain/pressure
- Facial congestion/fullness
- Nasal obstruction/blockage
- Nasal discharge/purulence /postnasal drip
- Dental pain
- Ear pain/pressure/fullness
When this swelling involves the adjacent mucous membranes of your sinuses, air and mucus are trapped behind the narrowed openings of the sinuses. When your sinus openings become too narrow, mucus cannot drain properly. This increase in mucus sets up prime conditions for bacteria to multiply.
Most healthy people harbor bacteria, such asStreptococcus pneumoniae, moraxella catarrhalis andHaemophilus influenzae , in their upper respiratory tracts with no problems until the body's defenses are weakened or drainage from the sinuses is blocked by a cold or other viral infection. Thus, bacteria that may have been living harmlessly in your nose or throat can multiply and invade your sinuses, causing an acute sinus infection.
Sometimes, fungal infections can cause acute sinusitis. Although fungi are abundant in the environment, they usually are harmless to healthy people, indicating that the human body has a natural resistance to them. Fungi, such as Aspergillus , can cause serious illness in people whose immune systems are not functioning properly. Some people with fungal sinusitis have an allergic-type reaction to the fungi. On rare occasions, acute sinusitis can result in brain infection and other serious complications.
Chronic inflammation of the nasal passages also can lead to sinusitis. If you have allergic rhinitis or hay fever, you can develop episodes of acute sinusitis. Vasomotor rhinitis, caused by humidity, cold air, alcohol, perfumes, and other environmental conditions, also may be complicated by sinus infections.
Acute sinusitis is much more common in some people than in the general population. For example, sinusitis occurs more often in people who have reduced immune function (such as those with primary immune deficiency diseases or HIV infection) and with abnormality of mucus secretion or mucus movement (such as those with cystic fibrosis).
If you have an immune deficiency disease or an abnormality in the way mucus moves through and from your respiratory system (e.g., primary immune deficiency, HIV infection, and cystic fibrosis) you might develop chronic sinusitis with frequent flare-ups of acute sinusitis due to infections. In otherwise normal individuals, sinusitis may or may not be infectious. In addition, if you have severe asthma, nasal polyps (small growths in the nose), or a severe asthma attacks caused by aspirin and aspirin-like medicines such as ibuprofen, you might have chronic sinusitis.
The latest definition of sinusitis is as follows:
Chronic rhinosinusitis is now defined as a multi-factorial group of disorders characterized by inflammation involving
- The mucous membranes of the nasal cavity and paranasal sinuses
- The fluids contained within these spaces, and
- Possibly the underlying bone.
- s / s of at least 12 weeks' duration
- In association with persistent changes on the CT scan four weeks after medical treatment without intervening acute infection.
Acute sinusitisIf you have acute sinusitis, your doctor may recommend :
- Decongestants to reduce congestion
- Antibiotics to control a bacterial infection, if present
- Pain relievers to reduce any pain
You should, however, use over-the-counter or prescription decongestant nose drops and sprays for only few days. If you use these medicines for longer periods, they can lead to even more congestion and swelling of your nasal passages. This causes an addiction to the topical drops, called RHINITIS MEDICAMENTOSA. This is a remarkably difficult condition to treat.
If bacteria cause your sinusitis, antibiotics used along with a nasal or oral decongestant will usually help. Your doctor can prescribe an antibiotic that fights the type of bacteria most commonly associated with sinusitis.
Many cases of acute sinusitis will end without antibiotics. If you have allergic disease along with sinusitis, however, you may need medicine to relieve your allergy symptoms. If you already have asthma then get sinusitis, you may experience worsening of your asthma and should be in close touch with your doctor.
In addition, your doctor may prescribe a steroid nasal spray, along with other treatments, to reduce your sinus congestion, swelling, and inflammation.
Chronic sinusitisDoctors often find it difficult to treat chronic sinusitis successfully, realizing that symptoms persist even after taking antibiotics for a long period. As discussed below, many doctors treat with steroids such as steroid nasal sprays. Many doctors do treat chronic sinusitis as though it is an infection, by using antibiotics and decongestants. Other doctors use both antibiotics and steroid nasal sprays. Further research is needed to determine what is the best treatment.
Some people with severe asthma are said to have dramatic improvement of their symptoms when their chronic sinusitis is treated with antibiotics.
Doctors commonly prescribe steroid nasal sprays to reduce inflammation in chronic sinusitis. Although doctors occasionally prescribe these sprays to treat people with chronic sinusitis over a long period, doctors don't fully understand the long-term safety of these medications, especially in children. Therefore, doctors will consider whether the benefits outweigh any risks of using steroid nasal sprays.
If you have severe chronic sinusitis, your doctor may prescribe oral steroids, such as prednisone. Because oral steroids are powerful medicines and can have significant side effects, you should take them only when other medicines have not worked.
Although home remedies cannot cure sinus infection, they might give you some comfort :
- Inhaling steam from a vaporizer or a hot cup of water can soothe inflamed sinus cavities.
- Saline nasal spray, which you can buy in a drug store, can give relief.
- Gentle heat applied over the inflamed area is comforting.
When medical treatment fails, surgery may be the only alternative for treating chronic sinusitis.Research studies suggest that the vast majority of people who undergo surgery have fewer symptoms and better quality of life.
In children, problems often are eliminated by removal of adenoids obstructing nasal-sinus passages.
PolyposisAdults who have had allergic and infectious conditions over the years sometimes develop nasal polyps that interfere with proper drainage. Removal of these polyps and/or repair of a deviated septum to ensure an open airway often provides considerable relief from sinus symptoms.
The most common surgery done today is functional endoscopic sinus surgery, in which the natural openings from the sinuses are enlarged to allow drainage. This type of surgery is less invasive than conventional sinus surgery, and serious complications are rare.
How does Endoscopic Sinus Surgery differ from Traditional Surgeries?If the quality of life fails to improve after sufficient medication, your doctor may suggest surgery. This may involve:
Septoplasty : Correction of the central partition of the nose.
Turbinoplasty : Reduction in the size of the bones in the sides of the nose.
There are other types of surgeries that can correct blockages in the nose and sinuses, but endoscopic sinus surgery is becoming the procedure of choice for more and more doctors.
Compared to other more traditional methods, endoscopic sinus surgery :
- Is less painful
- Leaves no visible scars
- Causes less bleeding
- Creates less discomfort after surgery
- Requires less packing in the nose after surgery
- Has a faster recovery period
- Has a higher success rate
When sinus surgery was first performed, surgeons would have to reach the sinuses by entering through the cheek area. This often caused scarring and possible disfigurement. In another traditional procedure, surgeons enter the sinus through the upper jaw.
In the past, it was thought that the damaged sinus tissues could never function normally again and had to be removed. Now, it is believed that as long as enough room is created for air to properly pass through the nose, the sinuses can once again do their job. Therefore, the objective of endoscopic sinus surgery is to do as little as necessary to restore the normal function of the sinuses.
How is Functional Endoscopic Sinus Surgery performed?This gentle, modern therapeutic method is the current state-of-the-art method for treating sinus disease.
This operation is performed under local anesthesia. Using sophisticated endoscopes and precise instrumentation, the structural variations leading to chronic inflammation and / or recurrent disease are removed in order to improve the ventilation of the sinuses. The openings of the sinuses (ostia) are precisely widened in order to prevent recurrent obstruction.
The narrow spaces of the ethmoidal labyrinth are widened and the diseased bony partitions (septae) removed.
Care is taken to only address the diseased tissue, preserving the normal mucosa for quick healing.
In addition the septum is straightened if required and the swollen tissues of the turbinates trimmed. This allows the patient to have an improved airflow.
Preventing Future Sinus ProblemsIt is important to prevent sinusitis symptoms from returning so that the regained sinus health can be preserved.
At the onset of a cold or allergy symptoms:
- Increase your water intake.
- Keep the nostrils moist with salt-water nasal rinses, humidifiers or steam, and saline nasal sprays.
- Avoid excessive forceful nose blowing.
- Discontinue eating dairy products until symptoms subside.
- Consult a doctor immediately if a fever or thick yellow or green mucus are present.
PREVENTIONAlthough you cannot prevent all sinus disorders—any more than you can avoid all colds or bacterial infections—you can do certain things to reduce the number and severity of the attacks and possibly prevent acute sinusitis from becoming chronic.
- You may get some relief from your symptoms with a humidifier, particularly if room air in your home is heated by a dry forced-air system.
- Air conditioners help to provide an even temperature.
- Electrostatic filters attached to heating and air conditioning equipment are helpful in removing allergens from the air. STOP SMOKING!
If you suspect that your sinus inflammation may be related to dust, mold, pollen, or food—or any of the hundreds of allergens that can trigger an upper respiratory reaction—you should consult your doctor. Your doctor can use various tests to determine whether you have an allergy and its cause. This will help you and your doctor to take appropriate steps to reduce or limit your allergy symptoms. In the case of allergy attacks, it is important to avoid allergens if at all possible, staying away from any foods, fabrics, smoke, or animals that cause symptoms. If the culprit is in the air, allergy shots or medications may have to be taken regularly to prevent a recurrence of chronic sinusitis or acute sinusitis attacks that could again create sinus blockages.
Drinking alcohol also causes nasal and sinus membranes to swell.
If you are prone to sinusitis, it may be uncomfortable for you to swim in pools treated with chlorine, since it irritates the lining of the nose and sinuses.
Divers often get sinus congestion and infection when water is forced into the sinuses from the nasal passages.
You may find that air travel poses a problem if you are suffering from acute or chronic sinusitis. As air pressure in a plane is reduced, pressure can build up in your head blocking your sinuses or eustachian tubes in your ears. Therefore, you might feel discomfort in your sinus or middle ear during the plane's ascent or descent. Some health experts recommend using decongestant nose drops or inhalers before a flight to avoid this problem.
A project supported by NIAID is developing an advanced "sinuscope" that will permit improved airway evaluation during a medical examination especially when surgical intervention is contemplated.
Scientific studies have shown a close relationship between having asthma and sinusitis. As many as 75 percent of people with asthma also get sinusitis. Some studies state that up to 80 percent of adults with chronic sinusitis also had allergic rhinitis. NIAID conducts and supports research on allergic diseases as well as bacteria and fungus that can cause sinusitis. This research is focused on developing better treatments and ways to prevent these diseases.
Scientists supported by NIAID and other institutions are investigating whether chronic sinusitis has genetic causes. They have found that certain alterations in the gene that causes cystic fibrosis may also increase the likelihood of developing chronic sinusitis. This research will give scientists new insights into the cause of the disease in some people and points to new strategies for diagnosis and treatment.
Another NIAID-supported research study has recently demonstrated that blood cells from patients with chronic sinusitis make chemicals that produce inflammation when exposed to fungal antigens, suggesting that fungi may play a role in many cases of chronic sinusitis. Further research, including clinical trials of antifungal drugs, will help determine whether, and for whom, this new treatment strategy holds promise.
Medications :Please inform our staff 1 week in advance if you are taking the following medications:
- Pain killers & anti-inflammatory drugs including Brufen, Combiflam
- Anti-platelet agents such as Disprin or Clopidogrel
- Anti-epileptic medications
- Anti-diabetic medications
- Anti-hypertension medications
- Anti-depressants or psychiatric medications
If you have any doubts regarding your medications, please show your personal physician this list or call us.
Do not take any aspirin containing medication including cold formulas for at least one week prior to surgery. These compounds have a tendency to decrease the average clotting capacity and increase bleeding during surgery. Crocin or Calpol may be used instead as it does not have these untoward effects.
Smoking and alcoholSmoking and alcohol significantly increases the risk of complications, bleeding and wound healing problems. Therefore, DO NOT SMOKE for at least two weeks before and six weeks after surgery . This also applies to second hand smoke; therefore do not stay in the room with cigarette smokers.
DO NOT DRINK ALCOHOL for at least 1 week before and 1 week after surgery.
Pre-operative LabsPreoperative blood investigations must be obtained and reviewed prior to surgery. You will be asked to visit the hospital where you will meet with the doctors.
Soap for BodyUse Dettol soap (over-the-counter antibacterial skin cleanser) in the shower instead of soap for three days prior to surgery.
Shampoo your hair and wash your face on the morning of the operation.
DO NOT OIL YOUR HAIR.
In case you are having a throat operation, please brush your teeth.
In case you are having a nose operation, males should trim their moustache.
Notification of IllnessesNotify our office promptly if cold, fever, or any illness appears before surgery. Call in any allergies, medications, or conditions which you may have forgotten to tell us about.
The Night Before SurgeryDo not eat or drink anything after midnight the night before surgery. This includes gum, chocolate, milk, tea, coffee and water.
If you are diabetic and take insulin you will be instructed how to take your medication and discuss this with your anesthesiologist during the preoperative visit.
FAILURE TO COMPLY WITH THESE INSTRUCTIONS MAY RESULT IN CANCELLATION OR DELAY OF YOUR OPERATION.
IF YOU HAVE ANY DOUBTS OR QUESTIONS, PLEASE CONTACT US FROM 4:00PM TO 11:00PM ON ANY WORKING DAY.