Thursday, December 29, 2011

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.

Wednesday, December 28, 2011

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.

Tuesday, December 27, 2011

Can Animal-induced Allergens Cause Allergic Rhinitis?

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.

Thursday, December 22, 2011

Chronic cough’s triad

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.

Wednesday, December 21, 2011

4 types of nasal sprays

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.

Tuesday, December 20, 2011

Nasal polyps’ origin

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.

Monday, December 19, 2011

21 interesting facts about nasal treatments

21 interesting facts about nasal treatments

  1. 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.



 

  1. Records of various rhinologic procedures practiced during 700 BCE are found in the Egyptian and Indian medical books.
  1. In 5th century, Susruta, the famous Indian surgeon, invented nasal reconstructive flaps and rhinoplasty that are still used.

 

  1. Do you know that physicians examined the anterior of the nose in candlelight until 16th century?
  1. In 1744, Boerhaave introduced a ground-breaking idea: nasal polyps are elongated sinus membranes.

 

  1. The German doctor Hirshberg reported aspirin sensitivity in 1899.
  1. In 1933, Shenck and Kern suggested that nasal polyps were related to allergy. The polyps were commonly found in the ethmoid air cell system.

 

  1. In 1940s, advancements in immuno-biology and  immuno-histochemistry techniques enabled description of lymphocyte and eosinophil present in the polyps.
  1. In 1959, Lurie discovered relationship between the polyps and cystic fibrosis for the first time.

 

  1. In 1969, Beer and Samter threw light on the triad of asthma, nasal polyps and aspirin sensitivity.
  1. 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.

 

  1. 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.”
  1. Hippocrates knew that nasal polyps are recurrent in nature.

 

  1. The world-famous physicians like Fabricius Hildanus, Paulus Aegineta and Claudius Galen also treated the polyps dexterously.
  1. Egyptian physicians believed that a bad smelling nose confirmed presence of polyps.

 

  1. Celsus said, “Large polyps dangled into the pharynx and on cold and damp days strangulate a man.”
  1. 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.

 

  1. Fabricius Hildanus invented an aural speculum, which resembles the modern speculum.
  1. Alfred Kirstein pioneered use of artificial light for nasal examination. He invented first headlight that inspired the modern headlights.

 

  1. In Greece, tampons and nasal packs soaked in copper salts and honey were used to prevent reoccurrence of polyps.
  1. The Roman physicians used turpentine and other irritating substances, calf tallow, goose fat and oily products to treat the polyps.

Friday, December 16, 2011

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.

Thursday, December 15, 2011

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.

Wednesday, December 14, 2011

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.

Tuesday, December 13, 2011

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.

Monday, December 12, 2011

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.

 

Friday, December 9, 2011

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.

Wednesday, December 7, 2011

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.

Monday, December 5, 2011

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:

 




  • 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.

Friday, December 2, 2011

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.

Thursday, December 1, 2011

Symptoms of Sinus Headaches

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.

Tuesday, November 29, 2011

How to Treat Symptom of Sinus Infection

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.

Monday, November 28, 2011

Tips to Avoid Side Effects of Decongestants

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.

Friday, November 25, 2011

Herbal Treatment for Symptoms of Sinus Infection

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:

  1. tinctures – alcohol extracts,
  2. glycerites- extracts of glycerine and
  3. 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.

Thursday, November 24, 2011

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.

Wednesday, November 23, 2011

10 Principles of Sinus Surgery

10 Principles of Sinus Surgery

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

  1. 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.

 

  1. 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.
  1. Appropriate planning enhances success rate of the surgery. However, unanticipated pathology may appear while surgery is being done.

 

  1. 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.
  1. 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.

 

  1. 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.
  1. 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.

 

  1. 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.
  1. 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.

 

  1. 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.

Tuesday, November 22, 2011

Treatment for Sinus Pressure

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.

Thursday, November 17, 2011

Should you undergo a sinusitis surgery?

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.

Wednesday, November 16, 2011

How diseases, including sinusitis, affect senses of smell

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.

Tuesday, November 15, 2011

Sphenoid Sinusitis

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.

Monday, November 14, 2011

How diseases, including sinusitis, affect senses of smell

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.

Friday, November 11, 2011

Sinus Infection-Induced Meningitis

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.

Thursday, November 10, 2011

Sinusitis in the Elderly

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.

Wednesday, November 9, 2011

Use of Antibiotics in Treating Symptoms-Sinus Infections

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

Tuesday, November 8, 2011

Types of Fungal Sinusitis

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.