Friday, April 29, 2011

Symptoms of Sinusitis

Symptoms of acute, sub-acute and chronic sinusitis are same, but the symptoms of chronic disorder are milder. Symptoms last up to 4 weeks in the case of acute disorder, 4-12 weeks in sub-acute and more than 12 weeks in chronic. Acute sinusitis is more painful than chronic that is uncomforting. Signs of the disease vary from patient to patient. Some may experience a few of the following symptoms while others have all the symptoms.

Common Symptoms

• A continuous feeling of being unwell.

• Low level of energy causes tiredness and weakness.

• Ability to smell reduces or is completely lost.

• Bad breath

• Blocked, congested or stuffy nose. It may be thus difficult to distinguish between sinusitis and simple nasal congestion associated with common cold that lasts between seven and fourteen days. However, acute sinusitis lasts longer.

• Chills and fever

• Itch in nose and eyes

• Pain is a common sign of sinusitis. Pain will be in the forehead if frontal sinuses are affected. Inflamed maxillary sinuses cause pain in teeth, especially upper jaw. If ethmoid sinuses are infected, eyelids and tissues surrounding the eyes may swell. Pain between the eyes may also occur. Infection of sphenoid sinuses causes earaches, neck pain and head aches. The patient may feel pain in the face on using an elevator or while bending forward.

• Some times patients suffer from postnasal drip, mucus secretion from the nose to the throat’s back. Thick nasal discharge of greenish, yellowish or white color is characteristic to acute sinusitis. Some times, it is blood tinged. Discharge during chronic sinusitis is thin and clear.

• Frequent throat cleaning is required.

• Sneezing

• Stubborn cough that generally worsens at night.

Less common Symptoms

• Face becomes tender. Sinusitis adds fullness to the face.

• Hoarse voice because of postnasal drip.

• Loss of taste

Sore throat • Some times, ear pops. Area behind the ear becomes tender and swells.

Rare symptoms

Acute sinusitis rarely causes some serious problems, such as brain infection.

• Vomiting is also uncommon.

Thursday, April 28, 2011


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, April 27, 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.

Tuesday, April 26, 2011

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.

Wednesday, April 6, 2011

Passive Smoking Could Lead to Chronic Sinus Problems

Today we bring an article brom about the effects of Passive Smoking on Sinusitis. You can read the full article here.

People are at increased risk for developing rhinosinusitis from exposure to secondhand smoke, a new study has found.

The Henry Ford Health System study is believed to be the first time researchers evaluated the association between secondhand smoke and chronic rhinosinusitis.
Chronic rhinosinusitis, or CRS, is a form of sinusitis in which the moist tissues of the nose and paranasal sinuses are inflamed for at least 12 weeks.

The findings are being published in the April issue of the Archives of Otolaryngology-Head and Neck Surgery.

"Our findings reaffirm the health hazards of secondhand smoke," says Amanda Holm, MPH, a co-author of the study and project manager in Henry Ford's Center for Health Promotion and Disease Prevention.

"The poisons found in secondhand smoke are quite an irritant to the sinus and nasal passages and are a major contributor to the development of rhinosinusitis."

Holm says primary care physicians and otolaryngologists should advise their patients to avoid secondhand smoke whenever possible.

Nasodren is a registered trademark by Hartington Pharmaceutical. We are not responsible of the articles published in this blog, as we merely provide useful information to our readers. The copyright of this article belongs to: 2011 - Designed & Content Managed by Medindia Health Network Pvt Ltd. Here you can read the full version.

Tuesday, April 5, 2011

Myserable symptoms mark chronic sinusitis (Part II)

ACPInternist brings another interesting article regarding sinusitis. Here you can read the full version.

From the January ACP Internist, copyright © 2011 by the American College of Physicians
By Kathy Holliman

Looking into the sinuses: What’s the preferred first-line diagnostic tool?

Diagnostic testing is recommended for chronic sinusitis, either computed tomography (CT) of the sinuses or a nasal endoscopy, but there is disagreement about which should be the first-line diagnostic tool.

Raymond G. Slavin, MACP, a professor of internal medicine and molecular microbiology and immunology at St. Louis University School of Medicine in Missouri, said that a diagnosis can be made without either of these tests, but “if there is any question, a limited CT scan can be helpful.” It is considered the gold standard for diagnosis.

A CT scan can be most useful if the symptoms are vague, the physical findings are equivocal, or there has been a poor response to the initial management, according to 2005 guidelines from the American Academy of Allergy, Asthma and Immunology (AAAAI). One study cited in the guidelines found, however, that more than 50% of patients with a strong history of chronic sinusitis had a normal CT scan.

According to 2007 guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF), patient symptoms and quality of life “do not necessarily correlate with the extent of disease seen on CT,” but the CT does offer an objective method for monitoring chronic disease, and it can quantify the extent of the inflammation.

Dr. Slavin, chief editor of the AAAAI guidelines, said that if a patient is not responding to therapy, a fiberoptic endoscopy, or rhinoscopy, is a valuable option. “Rhinoscopy can be useful to see the drainage from the middle meatus, and you can also appreciate the nasal polyps that don’t show up that well on the routine nasoscopic exam.”

Nasal endoscopy, less expensive than a CT scan, can often provide a diagnosis, thus sparing the patient the radiation from a CT scan, said Neil Bhattacharyya, MD, one of the authors of the AAO-HNSF guidelines and associate professor of otology and laryngology at Harvard Medical School. “If I scope and see small polyps or purulence in the nose, I don’t need to order a CT scan. I know the patient has chronic sinusitis so I’m going to start treating aggressively. You don’t always have to order the gold standard test,” he said. The ability to potentially avoid a CT scan is important given recent concerns about the effects of cumulative radiation exposure from medical imaging.

Research published by Dr. Bhattacharyya and a colleague in the July 2010 Otolaryngology-Head and Neck Surgery found that nasal endoscopy improved the diagnostic accuracy of chronic sinusitis. The odds ratio of a true diagnosis of chronic sinusitis among the 202 adult patients in the study improved from 1.1 with use of CT to 4.6 (95% CI, 2.3 to 9.2) with use of endoscopy. Dr. Bhattacharyya said that endoscopy should be emphasized as an early diagnostic tool and that CT could be reserved for patients who have not responded to treatment.

Nasodren is a registered trademark by Hartington Pharmaceutical. We are not responsible of the articles published in this blog, as we merely provide useful information to our readers. The copyright of this article belongs to: January ACP Internist, copyright © 2011 by the American College of Physicians. Here you can read the full version.

Monday, April 4, 2011

Miserable symptoms mark chronic sinusitis (Part I)

ACPInternist brings another interesting article regarding sinusitis. Here you can read the full version.

From the January ACP Internist, copyright © 2011 by the American College of Physicians
By Kathy Holliman

Chronic sinusitis, an illness that can feel as symptomatically miserable as congestive heart failure or rheumatoid arthritis, is often misdiagnosed or underdiagnosed.

“I recently saw a patient who had been diagnosed with allergic rhinitis for the past 14 months. You just had to look at her to know that she was miserable. She had bags under her eyes, she hadn’t been sleeping well, and she had been waking up three and four times a night because her nose was so blocked up. She had seen an allergist and two internists in that time who never considered that it could be chronic sinusitis,” said Neil Bhattacharyya, MD, associate professor of otology and laryngology at Harvard Medical School.

Not picking up on the distinctive clues that point to chronic sinusitis can lead to misdiagnosis. “An internist may label a condition allergic rhinitis because allergies are more common, but the treatment and the outcomes are completely different. The problem that confronts internists is understanding how to determine which subset of patients with sinonasal symptoms truly have chronic sinusitis or have that in conjunction with other conditions,” Dr. Bhattacharyya said.

There is no one objective measure of chronic sinusitis, or chronic rhinosinusitis, the term many now prefer. Even though it is one of the most common illnesses in the United States, afflicting approximately one in seven adults each year, little is written about it, treatment is controversial, and guidelines related to its diagnosis and management are based on consensus rather than definitive clinical trials and research, some experts said.
“The biggest issue, as with many things in medicine, is that if you don’t think about something, then you aren’t going to consider it as one of the possibilities.”
—Wellington S. Tichenor, ACP Member

“The disease is consistently ignored, and it’s an illness that makes clinicians somewhat uncomfortable because the opinions on it vary widely,” said Alexander C. Chester, FACP, clinical professor of medicine at Georgetown University Medical Center in Washington, D.C. “What happens to a patient depends on which doctor they visit.”

Dr. Chester wrote in the August 2010 Ear, Nose & Throat Journal that information for internists about chronic sinusitis is “scant and occasionally inaccurate.” Internists who rely on traditional sources of information “may conclude that [chronic sinusitis] is not an illness that is often associated with significant morbidity.”

Wellington S. Tichenor, ACP Member, an allergist in private practice in New York City, agreed. “The biggest issue, as with many things in medicine, is that if you don’t think about something, then you aren’t going to consider it as one of the possibilities.”

And because some clinicians don’t consider chronic sinusitis a potential diagnosis, treatment can go far afield of what is needed. “A great number of patients who are referred to my clinic have been on several different antibiotics for months and months without finding any relief,” said David R. Andes, ACP Member, associate professor in the department of medicine and medical microbiology and immunology at the University of Wisconsin in Madison.

“Internists need to recognize that it is a multifactorial disorder and that it requires a diagnostic and therapeutic approach. There is no one panacea therapy that will work for every patient,” he said.
Guidelines define disease

Chronic sinusitis is associated with several symptoms cited in the two most recent consensus guidelines, one from the American Academy of Allergy, Asthma and Immunology (AAAAI) in 2005 and the other from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) in 2007:

* duration of symptoms (the AAAAI guidelines specify at least eight weeks; the AAO guidelines, 12 weeks or longer),
* vague or insidious symptoms,
* persistent sinus inflammation,
* nasal obstruction or congestion with purulent drainage,
* facial pain, pressure or fullness,
* decreased sense of smell,
* impact on well-being, with negative effect on mood, pain, energy, and physical functioning, and
* headache, fever, cough, halitosis and dental pain.

Dr. Tichenor, who operates a website for physicians and patients, said several important clues may indicate chronic sinusitis rather than an allergy. “These include drainage that is colored and very thick, a significant amount of pressure or fullness, particularly between the eyes, and a decreased sense of smell. Sense of smell is a particularly important thing to address, and it is often not addressed.”

For some patients, fatigue and malaise are their primary complaints, with facial pressure a secondary one. “Sometimes the nasal symptoms are not dramatic and can be relatively minor compared with the patient’s general symptoms of feeling ill,” Dr. Chester said.

Dr. Tichenor added that many patients may be unaware of the chronic nature of their symptoms until closely questioned. Patients will often ignore a little nasal obstruction or small amounts of drainage.
Etiology complicates diagnosis

Determining the etiology of the condition is a complicating factor in diagnosis, according to Dr. Andes, one of the authors of the AAO-HNSF guidelines. “There is debate about whether clinicians should determine whether the condition is an allergic or infectious or other inflammatory disorder. Most of us agree that there are some diagnostic studies that should be undertaken in each of those areas, and it typically does require subspecialty collaboration, someone to perform an endoscopy, someone to do allergy tests and someone to do immunological work.”

Other underlying conditions can also complicate diagnosis. According to Raymond G. Slavin, MACP, a professor of internal medicine and molecular microbiology and immunology at St. Louis University School of Medicine in Missouri, internists should consider the possible presence of common variable immune deficiency; cystic fibrosis, which can be diagnosed for the first time in patients aged 20 to 30; gastroesophageal reflux disease, which has been linked with recurrent or resistant chronic sinusitis; and a fungal sinusitis that will not respond to antibiotics.

Anatomical problems can also sometimes be a factor in sinusitis, and surgery is occasionally indicated in these cases, Dr. Tichenor said. But, he cautioned, almost everyone has some septal deviation or a bone spur. Obstruction of the ostiomeatal complex must occur for sinusitis to develop, he said.

Other than complications of sinusitis, the reason for surgery is if a patient fails medical treatment, but that is poorly defined, Dr. Tichenor said; it can vary from a week of antibiotics to an extended course of treatment over many months. And, he added, the latest Cochrane Review states that surgery offers no advantage over medical treatment.

A significant number of patients with chronic sinusitis can have aspirin-exacerbated respiratory disease. Also known as Samter’s triad, the condition includes asthma, aspirin sensitivity and nasal polyps. After these patients are desensitized to aspirin and then maintained on aspirin therapy, there can be a decrease in the recurrence of polyps and a decrease in need for repeat surgery, Dr. Slavin said.

Chronic sinusitis is not an explanation for chronic headache, but that misdiagnosis is often made, he said. Some patients with chronic headaches are misdiagnosed with chronic sinusitis, but the reverse often occurs.
Providing some relief

Controversy remains about the role of antibiotics in patients with chronic sinusitis, but there is uniform agreement that they are often overused. According to the AAAAI guidelines, an acute exacerbation of chronic sinusitis may require antibiotics, with amoxicillin potassium clavulanate a good choice. Other choices include trimethoprim-sulfamethoxazole and levofloxacin, among others.

Antibiotic treatment should generally last for three weeks, along with ancillary treatment, Dr. Slavin said. This can include intranasal corticosteroids, a mucus thinner, saline irrigation, and a lot of fluids.

“Successful therapy will require a multipronged approach, which is usually a combination of correcting anatomic problems, treating inflammation and treating for symptom relief. If there is infection, diagnosing the specific pathogen and treating it with the optimal antibiotic is key,” Dr. Andes said.

“Some of the common pathogens we commonly see in acute sinusitis can play a role, but there are additional pathogens that can contribute to exacerbations in chronic sinusitis. So it is important to know which one is there and then to determine a treatment,” he added.

Patients report some relief and thinning of secretions with saline irrigation. “It does seem fairly innocuous, safe and inexpensive,” Dr. Andes said. “This vicious cycle of obstruction and inflammation is a big part of the illness, and if you can keep things open by just thinning secretion and decreasing obstruction, you will go a long way to improving someone’s symptoms.”

According to Dr. Tichenor, treatment can take a long time. It is not unusual to have patients on antibiotics for six to eight weeks. Any antibiotic regimen, he said, should be based on endoscopically directed cultures, not nasal swabs. “If you are not going to use cultures, it becomes much more difficult to assess and treat the problem.”

One type of chronic sinusitis has no evidence of actual direct infection and is often treated with multiple courses of antibiotics that prove to be ineffective. “The big controversy is whether there is possibly a fungal origin,” said Dr. Slavin. “There is no question that there is a noninfectious, inflammatory chronic rhinosinusitis that is very difficult to treat.”

Also called chronic hyperplastic eosinophilic rhinosinusitis, it is often diagnosed at the time of surgery. “It will respond to oral corticosteroids, but that’s a big price to pay,” he said. “Nothing has been shown [to be] all that effective. These patients are very difficult to treat and are often the ones who go back again and again to the operating room, even though they don’t respond to surgery.” Internists should refer such patients to an allergist to look for an immune deficiency, GERD or other condition. Surgery isn’t needed, he added.

Dr. Andes noted that the debate also centers on whether antifungal therapy, either topical or systemic, is beneficial. The therapy can be associated with side effects and no good data indicate whether it is effective. “It hasn’t been investigated to the degree where we should be commonly recommending this therapy,” he said. The AAAAI guidelines concur, stating that the role of antifungal agents has been not established, due to lack of convincing evidence.

But, Dr. Tichenor countered, the Cochrane review would disagree. “Topical antifungal therapy does not have side effects and is not expensive,” he said, and many studies that have shown no effect were poorly designed.

Functional endoscopic sinus surgery (FESS) is another treatment strategy that can be used for patients who have not responded to medical treatment. An outpatient procedure, FESS can lead to results that are “much more gratifying than in the old days when you had to do an invasive procedure,” Dr. Slavin said.

“There is nothing blinded about it, and now that it’s computer assisted, you can go into areas you never would have considered before,” he added. “It has revolutionized the field.” This surgery is generally recommended for localized persistent disease with mechanical blockage in the osteomeatal complex.

For patients suffering with chronic sinusitis, the internist can play a major role in diagnosis, collaboration with other clinicians and management. “The bottom line is that the disease has to be treated aggressively, and the internist has to be very aware of the general symptoms that relate to it,” Dr. Chester said. “There is not enough attention paid to the effect that these nasal symptoms have on a person’s health.”

Nasodren is a registered trademark by Hartington Pharmaceutical. We are not responsible of the articles published in this blog, as we merely provide useful information to our readers. The copyright of this article belongs to: January ACP Internist, copyright © 2011 by the American College of Physicians. Here you can read the full version.