Thursday, December 27, 2012

strong scientific support

Nasodren: strong scientific support

Over the years, many studies to prove the efficacy and safety of Nasodren have been conducted, involving around 2,000 patients. Most of these articles have been published and many of them in journals indexed in PubMed.  
Last April, Rhinology (official Journal of the International Rhinologic Society) published the article “Cyclamen europaeum nasal spray, a novel phytotherapeutic product for the management of acute rhinosinusitis: a randomized double-blind, placebo controlled trial” by Oliver Pfaar et al. From this study we obtain the following key messages:

  • Nasodren is effective and safe for the treatment of patients with ARS assessed subjectively and objectively.
  • The specific symptom of facial pain/pressure significantly improved after 5 - 7 days treatment with CE. This is important since facial pain/pressure is undoubtedly one of the most severe symptoms affecting the patient’s quality of life in ARS.
  • Endoscopic evaluation showed that mucus oedema/nasal obstruction improved significantly with CE. Improvement (defined as a sum of endoscopy scores of 0) was significantly higher with CE than placebo at the end of the study.
  • Both patients and investigators reported signi­ficantly greater treatment satisfaction with CE than placebo
  • CE is a safe product for the treatment of ARS

In March, another unique and impressive study was accepted for publication in The Laryngoscope, (organ of the American Laryngological, Rhinological and Otological Society): “An exploratory Trial of Cyclamen Europaeum Extract for Acute Rhinosinusitis” by J. Ponikau et al.
The key messages learnt from this study are:
In patients with Acute Rhinosinusitis, Cyclamen extract (Nasodren / Sinuforte):
  • Improves objective outcomes compared to placebo
  • Produces a clinically relevant symptoms improvement
  • Is the only product marketed for Rhinosinusitis that has been tested in this way (CT); other products, such as corticosteroids, antibiotics or decongestants, measure only symptomatic improvement.
The results of these studies have led, as mentioned above, to the inclusion of Cyclamen europaeum, in the EPOS 2012, the European Guidelines on Rhinosinusitis. Therefore, we can claim to possess a unique product for the treatment of this prevalent condition.

Pfaar O, Mullol J, Anders C, Hormann K, Klimek L. Cyclamen europaeum nasal spray, a novel phytotherapeutic product for the management of acute Rhinosinusitis: a randomized double-blind, placebo-controlled trial. Rhinology. 2012 Mar;50(1):37-44. PMID: 22469604
Ponikau J, Hamilos D, Barreto A, Cecil J, Jones S, Manthei S.  An exploratory trial of Cyclamen europaeum extract for acute Rhinosinusitis. Accepted for publication  Laryngoscope, March, 2012. PMID: 22675486

Thursday, December 20, 2012

Review of traditional Chinese formula

Review of traditional Chinese formula Bi Yan Pian

There are several Chinese formulas that improve symptoms-sinus infections, but Bi Yan Pian is one of the most popular ones. The words “Bi Yan Pian” mean “nose inflammation pill.” The National Pharmaceutical Exhibition awarded Bi the “High Quality (Silver Medal) Seal.” The patented formula does not have side effects of antihistamines, such as dry mouth and drowsiness. 

Bi Yan Pian, the Chinese rhinitis tablet manufactured by Hankow-based Chung Lien Drug Works, helps in relieving symptoms-sinus infections and chronic and acute rhinitis. The tablet treats inflammation and clears nasal channels. The tablet helps in healing headaches secondary to sinusitis. Bi heals sinus congestion due to “wind heat” and “wind cold.”  Bi Yan is also indicated in nasal infections in which discharge resembles pus. Bi is commonly used to treat runny or stuffy nose due to flu and common cold.
According to the Chinese Pharmacopoeia, the principal components of the formula include Fructus Xanthii (Cang Er Zi) and Flos Magnoline Liliflorae (Xin Yi). Other ingredients are Radix Angelicae Dahuricae (Bai Zhi), Radix Platycodi (Jie Geng), Radix Glycyrrbizae (Gan Cao), Herba Asari (Xi Xin) and Herba Ephedra (Ma Huang). However, the composition of the tablets slightly vary from market to market, as, for instance in the European market, Xi Xin and Ma Huang are banned. The tablets sold in the market are thus devoid of these ingredients.
The tablet is also available in natural-food stores and supermarkets across the United States of America. Even acupuncturists sell the tablets and / or tea. The U.S. Food and Drug Administration (FDA), however, stated that Bi is a dietary supplement because it is an herbal formula and herbs cannot heal pathological disorders.
Scientific evidences
Due to very little scientific data supporting its effectiveness, the West doubts medical properties of the formula. For instance, Massachusetts-based Natural Standard Research Collaboration, engaged in evaluation of natural therapies, concluded that in the absence of evidences they could not even grade the formula. On the other hand, in 2009, a study published in the Journal of Alternative and Complementary Medicine stated that Bi Yan Pian tea treats chronic symptoms-sinus infections and severe inflammation of the nasal channels. The study was conducted at Atlanta-based Morehouse School of Medicine. During the study, a small group of patients was given tea containing the 11-herb formula. The researchers observed an improvement in sleep, nasal congestion and headache symptoms.
Although medical community is divided over efficacy of the formula, it is used to treat a number of symptoms. However, presence of some of the banned ingredients in the formula requires a consultation with your doctor before administering it.

Wednesday, December 19, 2012

Which herb helps in treating sinus/ear congestion?

Which herb helps in treating sinus/ear congestion?

Ligusticum porteri (Osha) helps in relieving sinus/ear congestion.

The plant
Ligusticum porteri, a native to the Rocky Mountains, grows at an altitude ranging from 1,970 to 3,500 meters (6,500-11,500 feet) in the mountain bioregion stretching between Mexico and Canada.  The Hispanics call it osha.   The word “osha” is derived from the Spanish word “oso” which means “bear.” Perennial osha belongs to the Apiaceae / Parsley family of plants. Osha bears pink or white flowers during June-August. The fern –like leaves are triangular and dark green. The brown root is furry, oily, spicy and warm. Osha grows in coniferous forests in moist mountainous areas. The plant can be grown from seeds.
The herb root is used in the bear medicines made by the American Indians and several other cultures, whereas the plant is used as forage. The herb has some properties that are similar to that of angelicas but osha acts differently. The herb is source of bitters, glycosides, resins, silicon and volatile oils.

The herb resins promote expectoration, mitigate inflammation and aid in clearing the lungs. Thus, the herb is used to treat coughs and overcome capillary congestion in catarrh and bronchitis.

The herb is also used for treating allergies to dairy products, excessive mucus, intestinal lymphatic congestion and pancreas problems.
The herb is used for depression and atrophy tissue states. The tissue states used in herbal medicines refers to general pathophysiology and physiology.

The herb with anti-inflammatory and carminative properties improves digestion and nervous system because it imparts tone to the adrenal cortex’s glucocorticoid side. Carminative means expelling gas from the intestines and stomach, relieving flatulence.
The herb is also used for the following conditions:
  • Amenorrhea, dysmenorrhea
  • When senses and mind are dull, and mucus congestion causes problems in the bronchial tree and sinuses.
  • Poor cough reflexes and chronic bronchial problems with severe congestion
  • Colds
  • Emphysema
  • Gastroenteritis, colitis
  • Influenza
  • Measles
  • Pharyngitis
  • Retained placenta
  • Silicosis
  • Tuberculosis
  • Upper gastric spasm

How to use it
Extracts of the dried roots or its decoction is administered in the above conditions. Quantity of the dosage depends on the symptoms. Pregnant patients should avoid the abortifacient herb, which means osha may cause abortion. Thus, it is advisable that you consult the doctor before using the herb for sinus/ear congestion or any other condition. You may also find throat sprays and salves containing the herb and osha syrups in the market.

Tuesday, December 18, 2012

Elder flower for sinusitis and earache

Elder flower for sinusitis and earache

Elder flower, the deciduous shrub that is used in both summer and winter, relieves sinusitis and earache.

The plant

The botanical community call it Sambucus mexicana and nigra. The yellow flowers are fragrant. The indigenous European shrub has been admired for its medicinal properties for ages. Our ancestors even believed that it shoos away the witches. Therefore, the Europeans planted the shrub near their houses.
The easy to grow shrub requires sunny area. Well-composted soil is the best choice to plant elder. During spring, you can propagate elder from the stem cuttings. Clip it in winter to check its sprawling growth.
The dark purple berries are a rich source of vitamins C and A. The herb has vulnerary (wound healing), demulcent (pain relieving), anti-inflammatory, anti-catarrhal (relief from the mucous membranes’ inflammation) and alterative (system nourishment and improvement) properties. Elder flower also acts as an expectorant. Kaempferol (antioxidant) and diaphoretic (encourage perspiration production), flavonol glycosides found in the herb, help in relieving fever.
Sambucus nigra is found in Central and North America, North Africa, Western Asia and Europe.  The Africans use it as a medicinal and ornamental plant.

The flowers are used for tea that heals several symptoms like runny nose, cold, post nasal drip, sore throat, sinusitis and earache.
The flowers are also added to summer drinks like lemonade. The fruits are eaten raw and used to make pies, jams, wines and brandy.
The fruit extracts are used as an antiviral agent, whereas the inner bark has emetic, purgative and diuretic properties.  Both dry and fresh leaves act as purgative.
The flowers act as a decongestant for the mucosa of the respiratory tract and prevent allergies. The anti-catarrhal herb also moderates excessive mucus and create a balance.
The quercetin-rich flowers with anti-inflammatory properties relieve symptoms of hay fever and sinusitis. The quercetin also aids in mitigating cancer activity.
The flowers heal burns, bruises, sunburns and swelling, and soothe and soften the skin. The flowers are also used for a face wash that improves complexion.
The berry syrups and wines have been produced to heal bronchitis, colds and coughs.
The antiviral herb strengthens immune system and protects against flu and fevers.
The flowers tone the throat and nose mucous membranes.
Elder encourages urine production, sweating, and circulation, helping in removing toxics and harmful acids from the body.
The studies concluded that the flowers kill the Herpes simplex virus, facilitating treatment of cold sores or fever blisters.

Monday, December 17, 2012

15 facts that indicate sinusitis and otitis are related

15 facts that indicate sinusitis and otitis are related

Sinusitis and otitis are related because various reviews, research studies and clinical trials have highlighted the following similarities between the two:

  1. Cause of both is Streptococcus pneumonia, Staphylococcus aureus, Moraxella catarrhalis and Haemophilus influenza.
  2. An influenza virus infection may cause both the conditions.
  3. Children are prone to infections of the upper respiratory tract. These infections lead to bacterial problems like sinusitis and otitis media.
  4. Antibiotics are administered in both the conditions.
  5. Although action of azithromycin in treating acute infections of the upper respiratory tract is not completely understood, but the antibiotic is used in the treatment of acute cases of sinusitis and otitis media. In fact, these acute symptoms even resolve spontaneously, requiring no antibiotics.
  6. The studies found out that most of the otitis media and sinusitis infections are due to virus. Thus no need for antibiotics. Moreover, not all the cases of the bacterial infections require antibiotics.
  7. Evidence-based guidelines are in place for management and diagnosis of both the diseases to prevent excess usage of unnecessary medicines and reduce the treatment cost without compromising on the quality and effectiveness.
  8. The use of conjugate penumcoccal vaccine reduced occurrences of pneumococcal otitis media and acute bacterial rhino sinusitis. The pathogens have also changed. Read the full report Acute bacterial rhinosinusitis and otitis media: Changes in pathogenicity following widespread use of pneumococcal conjugate vaccine by Michael S. Benninger.
  9. Acute otitis media and acute bacterial rhino sinusitis are the infections of the respiratory tract. Both are quite common.
  10. Sinusitis as focal sepsis is one of the primary causes of continuous discharge in the patients suffering from chronic otitis media active mucosal disease
  11. The triad of recurrent bronchitis, sinusitis and otitis media is a syndrome that indicates a systemic problem.
  12. Both the disorders commonly occur in childhood.
  13. Otitis Media and Sinusitis in Children Role of Branhamella catarrhalis, the review by Bluestone, Charles D. stated that the recent clinical trials advise for an antibacterial therapy to treat these infections to avoid any complications. Read the review.
  14. Microbiology of acute bacterial sinusitis and acute otitis media is similar.
  15. In view of the above, there is no doubt that sinusitis and otitis are related. In fact, information available about acute otitis media treatment can be applied to the acute bacterial sinusitis treatment. Especially, this extrapolation could be useful in deciding the best antibacterial and antimicrobial therapy.

Friday, December 14, 2012

herbs for sinus congestion

5 Chinese herbs for sinus congestion

In China, herbs are used in two different ways to treat the sinus problems. Firstly, the herbs are used for purifying the blood within the lungs and stomach, dispelling the heat. These herbs are used with the herbs that aid in digestion to clear the paranasal sinuses and passages. Secondly, the herbs mitigate the cold, restoring the healthy blood and ensuring permanent relief. A number of ready to use herbal formulae are available in the market. This article focuses on some of the herbs that improve paranasal sinus symptoms.

  1. The roots of Huang Qin (skullcap, Scutellaria baicalensis) prevent tissue contraction during allergic reactions. The roots contain antioxidants and flavonoids that stimulate the immune system. Scutellaria baicalensis is native of Russia and China. The herb is traditionally used to treat headaches, cancers, inflammation, infections and allergies. The Chinese skullcap is available in powder form. The plant bears purple or blue flowers.

Diabetics should not take the Chinese skullcap without consulting the physician, as it may reduce the level of blood sugar, increasing chances of hypoglycemia. The skullcap can raise the effects of sedatives, such as anticonvulsants and tricyclic antidepressants.
  1. Bai Zhi (Chinese Angelica / wild angelica / Angelica dahurica) is used to clear sinus congestion and infections. The herb is specially relives discomfort caused due to blocked paranasal sinuses located above the eyes. Aka mitigates swelling, clears nasal passages and helps in draining pus secondary to sinus infections. The herb maintains a balance between histamines. The herb is found in China, East Siberia, Japan and Korea. Its roots are used in medicines.

  1. Since ages, Xho Yi Hua, magnolia flower, has been an integral part of traditional Chinese medicine used to relieve sinusitis-induced headaches and clear blocked nasal passages. Xho, known as Magnolia liliiflora in botany, is also used in fragrances.  The plant with white and pink flowers grows in China and North and South America.
  1. The Chinese have been using the Chinese cucumber (Gua Lou / Trichosanthes kirilowii) for treating ailments of the respiratory system since antiquity. The roots and fruits are used for medicines. The herb bears white flowers.

  1. Cang Er Zi (Xanthium fruit / Xanthium sibiricum), grown in China, is used to open blocked nose. Xanthium is used with other herbs to treat chronic naso-sinusitis and allergic rhinitis.
The herbs for sinus congestion may interact with other medicines. So visit the physician and follow the advice to make the most of the selected herbs for sinus congestion.

Thursday, December 13, 2012

What is oxymetazoline?

Oxymetazoline nasal spray 

What is oxymetazoline?

The synthetic adrenergic agonist acts directly and stimulates alpha one and two adrenergic receptors. The vasoconstrictor is also used for the eye drops that treat redness due to contact lens, colds or swimming. The systemic circulation absorbs the agonist. Since the agonist stimulates the receptors present in the sympathetic nervous system (SNS), the nasal passages’ arterioles constrict and dry the mucous membrane.
The spray, a nasal decongestant that narrows the nasal passage blood vessels, relieves sinus pressure and congestion, and nasal discomfort due to hay fever, allergies and colds. However, the patients under 6 years of age should not use the spray without prescription. Supervision is required in case the patients belong to the 6-12 age group.

Side effects
The spray has some side effects too. For instance, the spray may cause
  • addiction
  • burning,
  • dizziness,
  • dryness within the nose,
  • headache,
  • increase in nasal discharge,
  • nausea,
  • nervousness,
  • sleep problems,
  • sneezing and
  • stinging.
Sometimes the spray may increase or decrease the heartbeat. In such situations, see the physician at the earliest.

How to use it
  • The spray should not be administered more than twice in 24 hours.
  • Read the prescription and / or instructions on the label of the spray. If the instructions are not clear to you, do consult the physician or the pharmacist.
  • The amount of spray used should neither be more than the quantity prescribed by the physician nor less. If you do not follow the physician’s recommendations for the spray quantity and duration, sinus pressure and other symptoms may exacerbate.
  • Stop using the spray after three days. If symptoms do fade, consult the physician.
  • Liquid / solution of oxymetazoline is sprayed into the patient’s nose.
  • Do not gulp the spray. Just use it for the nose.
  • Wash the spray dispenser tip nicely after every use. The same dispenser should not be used by more than one patient to avoid spread of the infection.
  • If you are allergic to oxymetazoline, inform your physician.
  • Since some medicines may interact with the spray, tell your physician about the medicines you are taking for any other ailment. The expectant and breast feeding ladies should not use the spray without consulting the physician.

Wednesday, December 12, 2012

Chronic sinus congestion and chronic dysbiosis

Chronic sinus congestion and chronic dysbiosis

These chronic conditions are related. Chronic dysbiosis in the sinuses and small intestine may cause chronic sinus congestion. In many cases, antibiotics administered to chronic sinus congestion fail and lead to dysbiosis of the intestine.

What is dysbiosis?
Dysbiosis, a common disorder, means harmful growth of intestinal flora and the consequent imbalance. Dysbiosis affects metabolism and create disturbance in gastrointestinal (GI) tract. It also causes behavioral, neurologic and cognitive problems, asthma, allergies and autoimmune problems.
Forms of dysbiosis
In small intestine, dysbiosis involves fermentation i.e. indigestion of carbohydrates that produces alcohol, gases and sugars. In large intestine, dysbiosis is referred to as putrefactive which means indigestion of animal proteins and fats that produces alcohol, gases and sugars. Both fermentation and putrefactive forms of dysbiosis lead to metabolic toxicity.
Candidiasis, a type of dysbiosis, involves excessive growth of Candida albicans, a type of yeast. The yeast is generally found in the mucous membranes of the sinus cavity, urinary tract, vagina and gastrointestinal region. Small amount of Candia is not harmful. However, when Candida level grows beyond the normal healthy level it produces toxins that cause problems.  Chronic candidiasis causes various ailments, including sinusitis, post nasal drip and skin problems.
Causes of dysbiosis
  • Changes in acid-alkaline ratio (pH) in gastrointestinal (GI) tract
  • Chronic stress
  • Excessive consumption of alcohol, grains and sugar
  • Additives used in food
  • Overdose of antibiotics
  • Use of birth control drugs
  • Herbicides, pesticides, preservatives, solvents and other chemicals
  • Exposure to heavy metal and radiation and chemotherapy
  • Bacteria H. pylori that causes ulcer
  • Use of pain relievers such as corticosteroids and antacids

Treatment of dysbiosis depends on the form and symptoms. The treatment may include removal of toxins and allergens, replacement of acid, bile and enzymes, use of prebiotics and probiotics, mitigation of inflammation and strengthening immune system. A probiotic is a tablet or food containing beneficial bacteria that improves your health. Prebiotics, non-digestible food, encourages growth of harmless micro-organisms. Consult your doctor for the best therapy.

Tuesday, December 11, 2012

Basil for sinus congestion

Basil for sinus congestion

Basil, a culinary herb, is known as Saint Joseph’s Wort in English-speaking regions. One of the favorite herbs of Greeks and Romans, basil is also regularly used in the Asian and Italian food. Botanists call it Ocimum basilicum.

The plant
The annual plant, a native of India, is used to decorate temples in the country. Holy variety of basil grown in India is called Ocimum sanctum.
The herb, susceptible to frost, grows well in sunny locations with some shade. You can sow the seeds in large containers.
Basil attracts butterflies. So if you like butterflies plant it in your garden and enjoy its multifold benefits.

The versatile herb, known for more than forty centuries, is used for cooking, cosmetics and medicines. Spicy and pungent scent of the herb enhances flavor of food. For example, it improves taste of vegetables such as marrows, brinjals and courgettes. You can use its oil, powder, paste and or fresh leaves. Ayurveda and Siddha doctors use it for its medicinal properties.
Leaves and seeds are used for cooking. Basil is used with mint, parsley and celery in cooking. Basil also goes well with tomatoes. The herb is an excellent salad dressing.
Dry it in summer and use the powder to garnish food in winter.
Italians use the herb in famous pesto sauce.
You can burn dry basil to keep mosquitoes at the bay.
The African tribes believe that basil leave paste encourages hair growth.
The herb aids in digestion. It gives relief from nausea. Apply fresh basil leaves to the temples to heal headaches.
To heal infections of the mouth, gargle with the herb. Add basil leaves in boiling water for gargle.
Basil leaves offer relief from the pain in heels due to standing for a long time.
A combination of basil, fennel and rosemary is used for lung disorders like asthma and bronchitis.
Add fresh basil leaves in hot water and inhale the steam / vapors to ease sinus congestion.
The herb has antimicrobial, antibacterial and antiseptic properties.
Basil strengthens immune system and cleans the system and thereby protects you against all kinds of diseases and infections including sinus congestion and infections.
The herb, named after serpent-like animal Basilisk that carried deadly poison, was used as an antidote to poison. It was believed that just a gaze of the animal could kill.


Monday, December 10, 2012

Topical decongestants

Topical decongestants

Topical decongestants, highly effective vasoconstrictors, offer quick relief from swelling of the mucous membranes and nasal congestion. The most commonly used topical decongestants include xylometazoline, tetrahydrozoline, phenylephrine, naphazoline and epinephrine. These are used to treat symptoms of common cold, rhinitis and sinusitis.  Phenylephrine, used in both systemic and topical decongestants, is one of the common sinus decongestants.
Composition of topical decongestants
Topical decongestants contain sympathomimetic amines and their derivatives, and propylhexedrine. A sympathomimetic drug imitates the central nervous system actions. An amine is a compound containing ammonia. Sympathomimetic amines include epinephrine and phenylephrine. The derivatives of sympathomimetic amines include naphazoline, oxymetazoline and tetrahydrozoline are.

Phenylephrine is a principal component of many nasal drops and sprays.
Naphazoline is used for ophthalmic and nasal solutions. The solutions are available in prescription and over-the-counter (OTC) forms. The ocular solution treats itching and irritation in the eyes. The nasal drops relieve the congestion.
Oxymetazoline, a nasal spray, is sold as OTC. It is also used in ocular drops that reduce redness in the eyes.
 Tetrahydrozoline, a nasal decongestant, is a prescription drug.
How a topical decongestant works
A topical decongestant stimulates alpha-adrenergic receptors present in the nasal blood vessels’ muscle, reducing blood flow to the nose. Pharmacokinetics of the topical decongestant is different than that of systemic. Topical constricts the arterioles by directly acting on the receptors found in the nose muscle. The direct action ensures that only a small quantity of the decongestant is absorbed. Less absorption minimizes the chances of drug interactions. However, it interacts with monoamine oxidase (MAO) inhibitor, causing hypertension and severe headache. If used with a beta blocker, hypertension and bradycardia may occur. When used with methyldopa, the pressor response increases. Reduction in blood supply and capillary permeability resolve swelling of the membranes. Thus, sinus drainage improves, nasal passages become clear and the Eustachian tubes open.
When to use topical decongestants
  • The topical sinus decongestants are used with acute rhino sinusitis treatment for reducing edema and improving drainage of the infected sinus. However, scientific research studies did not show any improvement on use of these decongestants. Thus, their use in acute rhino sinusitis is still controversial.

  • Overuse of topical decongestants causes rebound congestion. So follow the prescription.
  • The sinus decongestants may also provide some relief in the patients suffering from sinus barotraumas.

  • Topical decongestants are also used to control epistaxis.

Thursday, December 6, 2012

3 types of endonasal frontal sinus drainage procedures

3 types of endonasal frontal sinus drainage procedures

There are three types of endonasal frontal sinus drainage techniques: simple frontal sinus drainage (Type I), extended frontal sinus drainage (Type II) and median drainage (Type III).
Simple frontal sinus drainage (Type I)

This technique is indicated when the frontal sinus is opacified or unopacified in the patients suffering from pansinusitis. The patients neither have asthma nor aspirin hypersensitivity. They have not undergone a surgery. In terms of radiology and pathology, the frontal sinus disorder is mild. Other indications include orbital and endocranial complications due to a failed conservative surgery for acute sinusitis, and chronic sinusitis without polyposis.
The Type I operation is combined with endonasal pansinus operation or circumscribed ethmoidectomy.
Extended frontal sinus drainage (Type II)
The type II procedure is used to treat chronic pansinuistis if the large frontal sinus is opacified. If polyposis is not severe but more drainage is required, extended drainage procedure is recommended. The technique is also preferred in case of recurrent barotraumas and frontal sinus examination after circumscribed trauma that affected the ethmoid sinuses’ part located close to the infundibulium.
The type II operation coupled with an endonasal ethmoidectomy can remove small benign tumors like fibrous dysplasia, osteofinromas and osteomas.
Median drainage (Type III)
The technique is used to remove the frontal bone’s anterior beak, frontal intersinus septum and septum top. The removal opens the frontal recesses and facilitates a central drainage pathway. The type III drainage provides the maximum possible endonasal drainage to the nasal cavities from the frontal sinus.
The type III is recommended for pansinusitis that meets the following criteria:
  • The frontal sinus is opacified.
  • Symptoms of underlying diseases like Woakes syndrome, Kartagener syndrome and mucoviscidosis
  • The patients have bronchial asthma and aspirin intolerance.
The operation is also useful if the frontal sinuses are very big, mucosal pathology of the sinus is severe, or all the sinuses feature polyposis. However, it should be avoided if the frontal sinuses are small.
Other indications include intracranial and orbital complications that originate in the frontal sinus mucoceles and the sinuses but without any bone damage. Small benign mid line tumors can also be removed during this type of surgery.
Which is the best procedure?
While selecting the most suitable sinus drainage procedure, keep in mind the following points:
  • Extent and severity of pathology
  • Patient specific anatomy
  • Current outflow from the sinus

Wednesday, December 5, 2012

2 plant oils that enhance sinus infection remedies’ range

2 plant oils that enhance sinus infection remedies’ range

There is a broad spectrum of sinus infection remedies, including plant oils. A number of research studies proved that natural concentrated plant oils kill unfriendly bacteria and ease inflammation of the paranasal sinuses and drain the mucous from both nasal passages and sinuses. This article focuses on two such oils.

Eucalyptus oil

Eucalyptus has astringent, antiviral, antibacterial and antifungal properties. Eucalyptus oil is one of the most commonly used plant oil to clear the sinuses. The oil liquefies the mucous, facilitating drainage of the mucous, healing of the sinus infections and opening up of the sinus channels. The oil kills pathogens and resolves inflammation and strengthens the immune system.

Add the oil in the water used for steam inhalation to clear sinuses and nasal passages. Inhaling eucalyptus vapor is safe and an age old remedy. Many commercially available decongestant rubs also feature eucalyptus oil. However, Eucalyptus is ineffective in case of viral sinusitis.

Since ages eucalyptus has been used to treat sinusitis, sore throat, cough and runny nose due to its decongesting, antioxidant and anti-inflammatory properties. In 2004, Laryngoscope published a study that revealed that eucalyptus eases inflammation of the paranasal sinuses.

Myrtle oil

Myrtle, an evergreen plant found in Mediterranean region, has shiny green leaves that are a storehouse of oil. The plant bears white flowers. The beautiful plant grows well in shade. Myrtle is cherished as symbol of chastity and innocence.

Myrtle oil, concentrated oil that is popular in Europe, has antiseptic, anti-inflammatory and anti-bacterial properties.  

Myrtle, an expectorant, aids in treating sinus infections, bronchitis and colds.

The oil can be used for massage and / or as an air spray.

The oil has cosmetic uses as well. For example, perfumes industry uses it.

1,8 cineole

Both myrtle and eucalyptus feature 1,8 cineole, a compound that stimulates cilia within the sinus cavities, enabling mucous movement and drainage, and aids in opening the blocked sinuses.

Cineole is also called eucalyptol that is main component of the eucalyptus oil. A study stated that cineole may reduce dosage of antibiotics for the sinusitis patients. However, cineole may irritate the stomach membrane, so caution is required while using it. Another research study concluded that cineole reduces discomfort due to non-purulent rhino sinusitis.

How to select plant oils

Look for Bio-Typed oils that are packed in soft get capsules. Bio-Typed oils mean that the product is tested for its effectiveness, purity and safety using advanced technology. There are hundreds of types of eucalyptus, but all eucalyptus trees are not included in the sinus infection remedies.

Tuesday, December 4, 2012

Review of sinus cures

Review of sinus cures released Sinusitis - Pipeline Review, H2 2012 and Sinusitis Global Clinical Trials Review, H1, 2012 reports in 2012.

Sinusitis - Pipeline Review, H2 2012 by Global Markets Direct
The report reviews existing and the latest developments in the global paranasal sinus cures market. The information is collated from various sources, such as third-party documents focusing on the disease, universities and companies’ press releases, investors’ documents, SEC filings of the companies and global databases. 

What does it contain?
  • The report, a comprehensive source of information about sinusitis therapeutics, offers information about an array of sinusitis products that are being developed by universities, research institutes or companies.  The product appraisal covers different development stages ranging from discover to registration.

  • Drug profiles consist of product description and mechanism, and progress in research and development. The report profiled Bacitracin, Levofloxacin vibrENT, Lidocaine + Adrenaline, Pulmozyme, SinuNase and Xolair.
  • The review includes role of major players in advancement of sinus cures. The contribution of Accentia Biopharmaceuticals, Inc., Clarassance, Inc., PARI Pharma GmbH and GlaxoSmithKline plc to sinusitis therapeutics is discussed in the report.
  • The document even covers projects that have been discontinued or are in the late-stage.
Reasons to read it
  • To learn about business deals and new products
  • To understand strategies of the emerging players that are developing highly effective products and gain a competitive edge
  • To develop effective out-licensing and in-licensing strategies
  • Important market and pipeline information will help in selecting the most suitable partner for business expansion by acquiring promising companies and / or merging with related businesses. Get the report.
Sinusitis Global Clinical Trials Review, H1, 2012 by GlobalData
The report offers information and statistics on clinical trials focusing on sinusitis drugs. The document is based on in-house evaluation, secondary and primary research and proprietary databases.
What does it contain?
  • Number of trials conducted in Asia-pacific, Africa, Middle-East, Europe and Americas
  • Status of recruitment for the trial, the sponsors, trial phases
  • A list of suspended, terminated and withdrawn trials
  • Major companies involved in the trials for sinusitis therapeutics
  • Profiles of clinical trials
  • Overview of clinical trials by major players, such as Acclarent, Inc., Bayer AG, Pfizer, Inc., Entellus Medical, Inc. and Sanofi

Reasons to read it
This abridged version of sinusitis related clinical trials being conducted in different parts of the world provides insight into the drug scenario. The latest therapeutics market information will aid in business decisions. Get the report.

Monday, December 3, 2012

Does monotherapy heal swollen sinuses and other symptoms of sinusitis?

Does monotherapy heal swollen sinuses and other symptoms of sinusitis?

Monotherapy means treating a disorder with a single drug. Does monotherapy heal swollen sinuses and any other signs and symptoms of sinusitis? There is no definite answer to this question, as different research studies have arrived at different conclusions. The results of a few such studies are summarized in the article.

Systemic corticosteroid monotherapy for clinically diagnosed acute rhino sinusitis: a randomized controlled trial by Roderick P. Venekamp, et al concluded that the monotherapy did not show any clinically relevant improvement in the patients. During December 2008-April 2011, the placebo-controlled, double-blind, block-randomized trial was conducted in the Netherlands. Read the report.
The efficacy of sinuforte in the starting monotherapy of the patients presenting with acute rhino sinusitis, a randomized open study, by Semenov VF and Banashek-Meshcheriakova TV showed that the 73% patients felt better after monotherapy. The study was conducted on the patients suffering from a moderate level of acute suppurative rhino sinusitis. Get more information.

In the article Efficacy and safety of mometasone furoate nasal spray in the treatment of sinusitis or acute rhino sinusitis, Klossek JM highlighted results of a placebo-controlled, double-blind randomized study on adult patients with uncomplicated acute sinusitis. The study compared mometasone furoate as nasal spray (MFNS) monotherapy and an antibiotic therapy. The study showed that the patients given MFNS monotherapy experienced more improvement in the symptoms than the patients who received an antibiotic therapy. Klossek concluded that MFNS has an important role to play in acute sinusitis treatment. MFNS may be used as monotherapy or with antibiotics. Get more information.
Some studies revealed that Nasodren®, nasal spray by Hartington Pharmaceutical, S.L.U. can be used as monotherapy or in combination with other therapies to treat acute rhino-sinusitis. Read complete results.
The randomized study New perspective in non-invasive treatment to sinusitis was conducted in various centers by Kirukov, et al. The study tested safety and efficacy of sinuforte monotherapy in sinusitis patients. The study showed that the monotherapy is safe and effective for treating exudative sinusitis of moderate to mild severity. Read the study.
The role of Stenotrophomonas maltophilia in refractory chronic rhino sinusitis by Grindler, et al stated that the monotherapy with fluoroquinolones or TMX is effective in the patients of refractory chronic rhino sinusitis (CRS). Stenotrophomonas maltophilia, a gram-negative bacillus that is drug-resistant, may cause refractory CRS. Read the complete report.
A monotherapy or a combination of therapies is a physician’s decision. However, treating swollen sinuses is necessary because it can affect drainage and cause congestion, leading to discomfort.

Friday, November 30, 2012

Natural events: a cause of severe sinus infection symptoms

Natural events: a cause of severe sinus infection symptoms

Numerous factors may trigger symptoms of sinus infection. Even some of the natural events like dust storms, hurricanes, wildfires “storm” your sinuses and aggravate the condition and cause severe sinus infection symptoms. For instance, recently Sandy hurricane and a wildfire in Wetmore in the United States of America worsened symptoms of the infection. It is sad that natural catastrophes are devastating but every time they remind us about invincibility of the Nature. The same message captured in one of the cartoons on a local television program. The cartoon read there is no “super power” that can compete with and outsmart the Mother Nature.

Storms and sinusitis
Storms commonly reduce barometric pressure.  The low pressure swells the nasal passages, causing sinus headaches. The low pressure also affects blood supply to the sinuses and nasal passages.  The swollen sinus membrane blocks the blood supply to the nasal passage. Thus, the blood goes to the mucus and the number of white blood cells falls, making you more prone to sinus infection. Alternatively, it exacerbates the existing infections. 
Sandy hurricane, dubbed as “super storm”, caused havoc on the US’s eastern coast in October 2012.  Medical practitioners observed that the hurricane also exacerbated the sinus infection symptoms due to sudden fall in barometric pressure.  Sudden fall in the pressure creates imbalance between the pressure within the paranasal sinuses and the atmosphere. To regain the pressure equilibrium, the sinuses expand. The air traps into the swelling of the sinus membrane, blocking the passages. The pressure increases within the sinuses, triggering pain and headaches.
Dust storms also pose various health risks, including allergic reactions. In some areas, dust storms are common. The local governments give warnings and advice public how to avoid related health risks. Follow the guidelines.
High winds and wildfires
Natural and man-made forest fires or wildfires are a source of deadly smoke. The smoke causes breathing difficulties and affects the sinuses. Some people like children, older people and patients are more susceptible to the smoke than others. It irritates the sinuses and causes headaches.  Forest fires and wildfires also pollute air quality. The breathing in poor quality air causes severe sinus infection symptoms, especially in the patients already suffering from the infection.
For example, a wildfire damaged parts of Wetmore in October 2012. In Wetmore, high winds brought power lines closer and thereby sparking began. The sparking caused the fire. Physicians suggested that people, especially sinusitis patients, should stay indoors to avoid the smoke and protect the sinuses.
We cannot stop catastrophes but we can avoid and minimize consequent health risks with timely treatment and precautions. Therefore, if sinus infection strikes you during such events, do visit the doctor for an apt advice.

Thursday, November 29, 2012

Great Mullein, a natural sinus relief

Great Mullein, a natural sinus relief

Are you looking for natural sinus relief?
Mullein (Verbascum thapsus) from Scrophulariaceae family of plants,  a natural sinus relief, is commonly known as Aaron’s, beggar’s blanket, candlewick, cuddy’s lungs, feltwort, golden rod, Jacob’s staff, our lady’s flannel, wild ice and velvet dock. The herb has been used for different purposes since antiquity. For instance, dyes and torches were made with it.  This velvet plant was used for managing respiratory problems during the Civil War. Although it is a native Asian, European and North African, the herb is grown in America and Australia as well because of immigrants. The European immigrants, for example, introduced mullein in America, where it is known as a weed instead of a wildflower.

The plant
The word “mullein” is derived from Latin word “mollis” which means “soft.”  The plant covered with soft hairs bears yellow flowers that are 2-cm wide. The woolly leaves are green and white in color. It grows in well-lit areas.
The herb rich in vitamins B3, C and A, calcium and iron has taproot system. Its potassium content is also quite significant.
Health benefits
The herb with astringent, anti-spasmodic, demulcent and anti-inflammatory properties acts as an expectorant (i.e. loosens phlegm) and helps in draining out mucus.
Mullein reduces swelling in the joints and glands.
Mullein is used for a number of respiratory diseases, including sinus congestion, hacking and whooping coughs, swollen glands, bronchitis, hay fever and asthma. The herb is also used to treat ear infections in children.
The oil is used for swellings, skin ailments and bruises. The herb is also improves sleep and cures stubborn warts. The oil made from the flowers help in reducing ear inflammation and pain.
Mullein tablets and extracts reduce bowel inflammation and bleeding.
The flowers and leaves drain out extra mucus from the respiratory tract and soothes the membranes.
The herb reduces pain and inflammation in the digestive tract, bronchial tubes, throat and nasal region.
Greeks used the herb to treat eye infections, tonsillitis, sore throats, insect stings and coughs.
Scientific studies concluded that mucilage and saponins found in the herb reduce and soothe inflammation. It can be used as pain reliever and to treat sleep disorder.
How to use the herb
Its leaves and flowers are used for medicines.
Mullein is used as infusion, gargle, oil, powder, suppository, syrup and tincture. Suppository, a drug delivery system, is used for vagina, rectum and urethra. Mullein oil can be bought from natural food stores.
You can add mullein in steam before inhaling it.
A tea of mullein, fenugreek seeds, marshmallow root and rose hips may help in easing sinus congestion.
For the right dosage of the herb, contact your physician.

Wednesday, November 28, 2012

9 patients who are benefited by inhaling steam

9 patients who are benefited by inhaling steam

Inhaling steam means to draw vapours or air into the lungs through the nose or mouth. The moist heat loosens congestion in the lungs, liquefying secretions. The steam also acts as an antiseptic in the respiratory passage. The patients of the following diseases will be benefited by inhaling steam:

The air passages (bronchi) and bronchial tubes (bronchioles) transport air between the lungs and windpipe. Bronchitis means inflammation and irritation of the membrane of the passages. A number of factors, such as allergies, bacteria, smoking and viruses trigger symptoms of the disease. The ailment could be acute or chronic. Steam inhalation moistens and soothes the irritation during acute condition.

Bronchiectasis is distortion and dilatation of the bronchi that may be due to recurrent infections or inflammation of the air passages and tubes. The damage to the lungs is irreversible. The symptoms of the disease include smelly breath, chronic cough, foul sputum, fatigue and paleness. The inhalation helps in clearing phlegm.

Common cold
Common cold, a self-limiting ailment, is a viral infection of the upper respiratory tract, throat, nose and sinuses. Steam inhalation relieves the mucus membrane’s inflammation and eases congestion, helping you in clearing the nose.

Cough, a natural reflex, clears the airways and protects the lungs. Cough removes irritants like mucus and smoke. But cough could be bad also. Excessive and abnormal cough leads to light-headedness, exhaustion and chest pain. Steam softens thick and stubborn mucus, giving relief from cough.

Lung abscess
A lung abscess, a rare disease, refers to the cavity in the lungs containing pus. Tuberculosis, pneumonia and other severe infections, fungal infections and tumour in the lung may create the abscess. The steam reduces the lung congestion.

Infections and inflammation of the paranasal sinuses (sinusitis) causes stuffiness and congestion, blocking the nose and sinuses. Inhale steam to resolve inflammation of the mucus membrane and ease the congestion.

Sore throat
Sore throat, a self-limiting disorder, means pain in throat due to a throat infection(s). The symptoms include general malaise, headache, fever, cough and hoarse voice. The steam resolves soreness and irritation in the throat.

Tracheotomy means opening the trachea surgically. The operation creates an airway between the trachea and anterior neck. After tracheotomy procedure, moist and warm air gives comfort.

Whooping cough
Contagious whooping cough or pertussis means violent uncontrollable coughing, making breathing difficult. This bacterial infection lasts for 42 days. The steam moistens the throat and resolves irritation. The inhalation with thyme, lavender, peppermint, rose and eucalyptus may help in easing the cough.

Tuesday, November 27, 2012

Acute sinusitis

Acute sinusitis

Acute sinusitis, an infection of the paranasal sinuses, is also called acute rhino-sinusitis. Generally a common cold triggers acute sinusitis. Even a complication of the infection in the upper respiratory tract or allergy may cause acute conditions. The infection impacts mucus drainage in the sinuses, causing face pressure. Acute condition could be due to a fungal, bacterial or viral infection. People with weak immune system and having other ailments like HIV infection are more prone to sinus infections.

  • Unilateral face pressure, which increases on bending forward
  • Face pressure is concentrated around the eyes, forehead or cheeks.
  • Frontal headache or pain in the upper molar teeth
  • Cough worsens during sleep.
  • Tenderness in the infected sinus
  • Purulent post-nasal drip
  • Cold persists for more than 14 days.
  • Face swelling
  • Poor sense of smell
  • Difficulty in breathing through the nose due to nasal congestion
First line treatment
Amoxicillin is the first line treatment for all age groups. However, it is not prescribed if strains are highly resistant to beta-lactam. Close monitoring is required in children and infants. If they do not respond to the antibiotic, change the medicine.
Second line treatment
While deciding second line of treatment, consider antibiotic usage pattern in the last half year and amoxicillin response. The treatment may include trimethoprim sulfamethoxazole, cefuroxime, cephalosporins and amoxicillin/clavulanate.
Topical and oral decongestants are also administered in the patients except children. Saline nasal sprays clean up the nose, relieving congestion. If fungus or virus caused the infection, antibiotics will not help. Acute (fungal) sinusitis is rare condition because our bodies are naturally resistant to fungi. The fungi-based condition requires antifungal drugs. Treatment for allergies is required if allergies triggered the symptoms of acute sinusitis.
Research studies and treatment
Corticosteroids are generally administered to resolve acute sinusitis. However, a recent research study concluded that oral corticosteroids do not show any clinically relevant improvement. The findings of the double-blind, randomized controlled trial were published in the Canadian Medical Association Journal (CMAJ).
Decongestants, antihistamines and nasal irrigation for acute sinusitis in children by Shaikh N, Wald ER and Pi M concluded that considering absence of any evidence, extensive research is still required to assess the efficacy of these therapies. The authors reviewed more than 500 existing studies to find suitability of the therapies. Read the report.
In the study, A randomized, placebo-controlled trial of antimicrobial treatment for children with clinically diagnosed acute sinusitis, Garbutt, et al concluded that neither amoxicillin-clavulanate nor amoxicillin offered clinically relevant benefits to the young patients suffering from acute sinusitis. Get more information about the study.

Monday, November 26, 2012

Allergic fungal sinusitis

Allergic fungal sinusitis

Allergic fungal sinusitis (AFS), a type of noninvasive fungal sinusitis, is an inflammation of the paranasal sinus mucosa due to allergy to fungi. The inflammation may remodel and erode bone although it is indolent. AFS generally occurs in more than one sinus simultaneously.

In AFS, fungi occupying the atopic immunocompetent patient’s sinuses work like an allergen and trigger cellular immune and humoral responses. As a result, inflammation occurs and blocks the sinuses, and disturbs the secretion balance, encouraging proliferation of the fungi.
AFS is often confused with allergic rhinitis. A carefully examination is therefore required to avoid complications and consequent increase in discomfort and treatment cost.
Main fungal causes of sinusitis
Earlier Aspergillus species of the fungus was considered as the main cause of the sinusitis. However, now-a-days the medical community believes that dematiaceous fungi, aerosolized environmental fungi, are the principal agents that trigger AFS. Dematiaceous is a group of Alternaria, Biploaris and Curvularia fungi species, which are referred to as ABC-D. Other dematiaceous fungi include Exserohilum and Caldosporium species. In some patients, aspergillus is still one of the causes of sinusitis.

AFS Diagnosis
There is no standard diagnostic criterion to detect AFS. However, some of the diagnostic features follow:
  • Immunocompetency
  • Degeneration of the epithelial cells
  • Viscous brown nasal discharge
  • Fungal elements found in culture or stains
  • The patient is hypersensitive to fungal antigens.
  • Fungi have not invaded the bone, blood vessels and submucosa.
  • Mucosal invasion absent in the tissues collected from the mucosa
  • Proven presence of fungal specific immunoglobulin E (IgE)
  • A histological examination reveals that mucin featuring eosinophils is attached to the inflamed mucosal tissue. The mucin featuring eosinophils is known as allergic mucin.
  • Allergic mucin is tenuous and thick.
  • Sinus secretions feature fungal hyphae, Charcot Leyden crystals and eosinophils. The number of eosinophils is extremely large.
  • No air-fluid levels in the computed tomography (CT) findings
  • Affected sinus is completely opacified in CT.

Signs and symptoms of AFS
  • Rhinorrhea
  • Sinus pressure
  • Headache
  • Symptoms of chronic sinusitis, allergic rhinitis and nasal airway obstruction, such as postnasal drainage, purulent nasal discharge and nasal congestion
  • Chronic sinusitis patient might have undergone a surgery(s).
  • Extreme symptoms include nasal obstruction and nosebleed.
  • The patients may already suffer from allergic disorders or asthma.
  • Other symptoms include visual disturbances, proptosis and periorbital swelling.

Do not ignore any of the causes of sinusitis to avoid complications.

Friday, November 23, 2012

Differences and similarities between tension and sinus headaches

Differences and similarities between tension and sinus headaches

What is a tension headache?
Tension headache, also called muscle contraction headache, is a combination of three different headaches: muscular, vascular and neurogenic headaches. This band-like headache may be accompanied by pressure in the shoulders, neck, head, temples and forehead.
Tension headache related discomfort increases with the progress in day, but it rarely affects daily activity. Tension headache is more common in women than men.
A number of factors triggers tension headache, such as psychological, sleep deficiency, tension in the pericranial and cervical muscles and excessive use of over-the-counter (OTC) analgesics.
If the patients’ CD4 count exceeds 100 and the patient complaints about a headache, the headache may be a sinus headache, tension headache or migraine.  The CD4 count refers to the amount of T-helper lymphocytes in each cubic millimeter blood.  The count assesses the level of immunity.

The cause of sinus headache is different than that of a tension headache. Tension headache is a primary headache. The primary headache means a headache that is not due to an organic disorder.
Sinus headache is a secondary headache. The secondary headache occurs because of a well-defined disorder. For instance, a sinus infection is a major cause of sinus headache. Another cause of sinus headache is sinus inflammation.
Tension headache is dull. The associated pain is bilateral spreading between the occiput and forehead and forms a band. The pain intensity varies from mild to moderate. The pain lasts half-an-hour to many days if the headache is severe. Tension headache is common.
The pain in sinus headache is persistent and dull, whereas it resembles tightness in tension headache.
Tension headache is confused with sinus headache because the pain in both headaches can be located in the forehead. Especially, frontal sinus headache will involve the forehead.
Sinus congestion and pressure in the forehead and eyes accompanies sinus headache.
In children, sinus headaches generally experienced at a fix time in the day. Tension headaches are continuous. They may sometimes come and go, but they generally never vanish. Analgesics are administered to treat tension headache. However, analgesics may reduce the sinus headache, but complete treatment of the underlying disorder can only ensure full relief.
Neither sinus nor tension headache induces nausea and sensitivity to light, the two important symptoms of migraine headache.
The patients having either sinus or tension headache can generally continue their daily social and work activities without problem.

Thursday, November 22, 2012

Acute bacterial rhinosinusitis treatment

ABRS treatment guidelines by SAHP

In 2004, Sinus and Allergy Health Partnership (SAHP) revised treatment guidelines for acute bacterial rhinosinusitis (ABRS) to ensure that medical practitioners can easily differentiate between bacterial and viral sinusitis. Separate guidelines were issued for adults and children. This article focuses on adult guidelines.
To make selection of the empiric antibiotic therapy for adult patients with mild to moderate level symptoms of acute bacterial rhinosinusitissimple, the patients are divided into two groups based on severity of symptoms and previous therapy.
Group1 includes patients with mild symptoms who were not administered antibiotics within last 28-42 days.
Group 2 consists of adult patients with moderate symptoms irrespective of previous antibiotic treatment, and the patients with mild symptoms who were administered antibiotics within last 28-42 days.


 Guidelines for Group 1
SAHP recommends amoxicillin / clavulanate, amoxicillin, cefpooxime proxetil, cefuroxime axetil, cefdinir, β-lactam allergic# TMP/SMX (trimethoprim / sulfamethoxazole), doxycycline, azithromycin, clarithromycin, erythromycin and telithromycin for the Group 1 patients. Calculated bacteriologic and clinical efficacies of amoxicillin / clavulanate is the highest at 97-99% and 90-91% respectively. The corresponding efficacies of telithromycin are 73% and 77%. The guidelines also suggest alternatives in case the therapy does not show desired results or worsens the symptoms during 72 hours. For instance, if amoxicillin or doxycycline therapy fails, switch to gatifloxacin, levofloxacin and moxifloxacin. If cefuroxime axetil does not improve the symptoms, switch to ceftriaxone.
Combination therapy is recommended in case cefdinir fails. Rifampin plus clindamycin can be administered if azithromycin, clarithromycin and erythromycin therapy worsens the symptoms or does not improve the symptoms.
Guidelines for Group 2
The Group 2 patients have four options: gatifloxacin / levofloxacin / moxifloxacin, amoxicillin / clavulanate, ceftriaxone and β-lactam allergic# gatifloxacin, levofloxacin, moxifloxacin, clindamycin and rifampin. Both calculated bacteriologic and clinical efficacies of the therapies are above 91%. Bacteriologic efficacies are very high (99 to 100%). In case the therapies worsen the symptoms or do not improve the symptoms within 72 hours, reevaluation is recommended.
A word of caution for the patients suffering from acute bacterial rhinosinusitis, this article provides facts for information only. Before starting a therapy, you must contact your physician.
SAHP, an outreach program for primary care physicians and patients, is a collective effort of the American Rhinologic Society (ARS), American Academy of Otolaryngic Allergy (AAOA) and American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS). The non-profit partnership was set up in 2000, when the guidelines were unveiled for the first time.

Wednesday, November 21, 2012

Diagnosing sinusitis in children

Diagnosing sinusitis in children

Sinusitis in children requires a different approach for the diagnosis and treatment due to various reasons. For instance, the number of children whose computed tomography (CT) scans are abnormal is very high, thus the scan should not be used to decide whether surgery of the sinus is required or not. Mainly abnormality in the scan is due to self-limiting common bacterial and viral infections or inflammatory changes that occur after the infection and do not relate to a specific group of symptoms.
Dr. Michael D. Poole suggested considering the number of the following common sinus “syndromes” to classify the pediatric chronic sinusitis patients. The syndromes include:
  1. “ relatively normal rhinosinustis with an excessively concerned family
  2. frequently recurrent rhinosinusitis (day-care syndrome)
  3. purulent rhinosinusitis unresponsive to empirically selected oral antimicrobials
  4. rhinosinusitis associated with posterior nasal obstruction (adenoid enlargement)
  5. sinusitis with reflux and
  6. significant component of IgE-mediated rhinitis/sinusitis.”

Although in many parts of the world plain films and ultrasounds are used to diagnose pediatric sinusitis, but these are ineffective methods for various reasons. For example, the films and ultrasound capture images of the maxillary sinus but several studies have observed that one-fourth children’s ethmoid sinuses are affected, so they have ethmoid disease.
The nasal cavity cultures are not used frequently for children because the patients do not comply with doctor’s guidelines and obtaining culture specimen free of contamination is difficult.
Since several factors, including age, immature immune system and defective ciliary function, are related to chronic sinusitis, defining the pathophysiology is problematic. The sinusitis cases are high in young children, especially they suffer from maxillary sinusitis. The immune system of children is immature, thus they are more prone to viral infections of upper respiratory tract and related acute sinusitis. The viral infections result in mucosal edema. The edema blocks the ostium, increasing chances of bacterial infection developing within the sinuses. The viral infection adversely affects the ciliary function that causes bacterial infection within the sinuses.
Many studies state that allergies and sinusitis in children are related. However, this has not been credibly demonstrated. So many professionals do not agree with it.
Gastroesophageal reflux disease (GERD) is not found in children as per the available information. Thus, chronic sinusitis in children cannot be related to GERD. GERD and related sinusitis is rare. However, scientific data is required to throw light on how GERD is related to chronic sinusitis.
Diagnosing sinusitis in children is a challenge because of overlapping symptoms of common cold, nasoadenoidal symptoms and other related diseases, and sinusitis. These interpretational issues make pediatric sinusitis management difficult. Conservative approach consists of no intervention to minimal intervention.  The conservative approach believes that chronic sinusitis in children resolves spontaneously. Other experts advocate surgery at early stage. However, surgical treatment is mired in various controversies. Scientific research work is required to compare surgical and medical treatments and create standardized guidelines.

Tuesday, November 20, 2012

A review of sinusitis medicine, surgery

A review of sinusitis medicine, surgery

Pediatric sinusitis can be treated with sinusitis medicine and / or sinusitis surgery. However, finding the best approach is difficult. There is need for a detail investigation of the symptoms and available treatment options. For instance, in case of chronic rhinosinusitis in children, although several physicians recommend antimicrobial therapy for 21-42 days, but data on optimum therapy period is unavailable.  
Young patients with chronic bacterial rhinosinusitis generally have several stubborn pathogens, thereby, an empirical therapy based on a single agent does not produce the desired results.
Adenoidectomy is generally performed on stubborn sinusitis in children. The operation minimizes pathogens or removes the nasal obstruction. However, some doctors feel it is not necessary because it is not effective.

Some studies found out that pediatric endoscopic sinus surgery (PESS) improves the condition of the patients with sinusitis that complicates asthma. However, there are doctors who successfully manage sinusitis without PESS. PESS is a well-tolerated and quite safe operation, but its scope is limited as in many cases of young patients, the symptoms have reappeared after the surgery. There is lack of scientific data and studies to prove that PESS is a better solution than non-surgical treatment options. The PESS may lead to complications like direct impact on facial growth.


 Controversies and lack of authentic scientific data and research work makes the chronic pediatric sinusitis treatment difficult. Resistance to Streptococcus penumoniae and other bacteria is increasing. This resistance also causes problems in choosing sinusitis medicine. The increase in resistance may lead to increase in number of surgeries for sinusitis. Resistance to Streptococcus penumoniae is a cause of increasing concern because this is the most common pathogen responsible for acute sinusitis.
Although endoscopic sinus surgery is the main treatment in case of chronic sinusitis, use of the surgery is controversial.  The Consensus Panel that met at Brussels, Belgium in September 1996 divided the indications suitable for the surgery in two categories: Absolute and Possible.
Absolute indications:

  1. “ complete nasal airway obstruction in cystic fibrosis due to massive polyposis or closure of the nose by medialization of the lateral nasal wall;
  2. antrochoanal polyp,
  3. intracranial complications,
  4. mucoceles and mucopyoceles,
  5. orbital abscess,
  6. traumatic injury to the optic canal,
  7. dacryocystorhinitis due to sinusitis and resistant to medical treatment,
  8. fungal sinusitis,
  9. some meningoencephaloceles, and
  10. some neoplasms.”
However, the panel states that children with chronic sinusitis rarely require endoscopic surgery. Even sphenoethmoidectomy is not recommended in case of children. The sphenoethmoidectomy is recommended only in two cases: allergic sinusitis and symptomatic polyps related to cystic fibrosis.

Monday, November 19, 2012

Status of sinusitis

Status of sinusitis

Chronic sinusitis symptoms in children are ascribed to a number of factors including oversized adenoid pads, anatomic defects and a broad array of respiratory pathogens. However, with advancements in medical science the symptoms, the factors and the treatment are viewed in different light. Difference of opinion occurs in medical community about different aspects of the disease.
The adenoid pad, a lymphoid tissue located in the nasal region, produces antibodies required to protect the body against infections. The pads expand in all human beings but when the size becomes too big, the pads obstruct the nasal airway and Eustachian tube. Then the problem begins and sinusitis-like conditions may develop, requiring removal of the pad. 


 Especially, abnormal growth and subsequent oversized adenoid pads may trigger sinusitis symptoms in children. Removal of these pads ensures healthy nasal cavity. A number of research studies concluded that adenoidectomy resolves the symptoms and signs to some extend. More work is however required to analyze efficacy of the surgery.
Anatomic defects (abnormalities) leading to pediatric sinusitis is shrouded in controversies. Firstly, some medical professionals opine that differences in anatomy should not be referred to as abnormality; the differences should be considered as a variation in anatomy. It is an interesting issue requiring further investigation because if the variations neither cause nor increase sinusitis signs and symptoms, and systemic factors cause sinusitis, ­ it can be managed with medicines. Alternatively, only conservative operations may be sufficient in case of systemic sinusitis.
Sinusitis in children, particularly in infants, was generally not considered as a separate entity prior to the 1980s. In fact, sinus symptoms were equated with cold or allergy signs. Antihistamines and / or decongestants were administered to resolve the symptoms. Now-a-days sinusitis in children is very common and considered as an individual entity by clinicians.
In the beginning of the 1990s when endoscopic sinus surgery was introduced, the surgery was performed on scores of pediatric patients with sinusitis. However, later on, the surgery was not advocated and the number of surgeries fell. Today, endoscopic sinus surgery is generally recommended for the children having more than one sinus infections or chronic sinusitis symptoms.
Viral rhinosinusitis has been ignored in the past for two reasons: lack of an effective treatment method and the uncomplicated disease resolved spontaneously. Today viral rhinosinustits is considered as a separate entity and treated accordingly.

Friday, November 16, 2012

Symptoms of maxillary sinus cancer

Symptoms of maxillary sinus cancer

Maxillary sinus cancer, a severe sinus disease, is medically referred to as maxillary sinus carcinoma (M.S.C.). This rare disease generally requires a surgical procedure. However, it is more common than other paranasal sinus cancers.

Symptoms of M.S.C.
  • An unusual mass in the maxillary sinus may prevent dentures’ placement.
  • The mass may extend from low-grade adenocarcinoma that erodes walls of the sinus.
  • The cancer patient may have sinusitis symptoms and nasal stuffiness.
  • Imaging of the sinus may show opacity due to the tumor.
  • The patient may become aware of swollen cheeks.
  • Epistaxis
  • Nasal discharge
  • Nasal obstruction
  • The symptoms of M.S.C. also resemble those of chronic sinusitis, causing confusion and delaying diagnosis.

Staging systems
There are several staging systems, including T-system and 6-stage, to define various levels of the cancer.
T-system of staging M.S.C.
The system, defined by Greene, Page, Fleming, et al, divides the severe sinus disease into five stages: T1-T4b.
In T1 stage, the tumor does not cross the maxillary sinus mucosa. There is no bone destruction and erosion.
T2 stage means that the tumor erodes and destroys bone. The tumor spreads to the middle nasal meatus or hard palate. However, it does not affect pterygoid plates and maxillary sinus’ posterior wall.
During T3 stage, the tumor extends to the ethmoid sinuses, pterygoid plates, orbit’s medial wall or floor, subcutaneous tissues or maxillary sinus’ posterior wall bone.
T4a stage means the tumor invades the frontal or sphenoid sinuses, cribriform plate, infratemportal fossa, pterygoid plates, cheek skin or anterior orbital area.
The tumor enters into nasopharynx clivus, cranial nerves except maxillary branch of trigeminal nerve (V-2), middle cranial fossa, brain, dura or orbital apex during T4b stage.
6-stage staging system for maxillary sinus cancer
Bruce, Jarrell and Anthony mentioned a 6-stage staging system for the severe sinus disease in their book NMS Surgery.

Stage TX means the cancer cannot be identified.
Stage T0 implies that primary cancer related evidences are not found.
Stage T1 means the tumor is limited to the inferior antrum. There is no erosion of the bone.
Stage T2 limits the tumor to the superior antrum. There is no erosion of bone of the medial or inferior walls.
During Stage T3, the tumor invades the pterygoid muscles, anterior ethmoids, orbit or cheek skin.
Stage T4 means huge tumor has already invaded the skull base, pterygoid plates, nasopharynx, sphenoid, posterior ethmoids or cribriform plate.

Radical or subtotal maxillectomy is used to treat cancers of the stages T1 and T2.  Radiotherapy is recommended for stages T3 and T4.

Thursday, November 15, 2012

Does the polyps’ surgery cure sinusitis?

Does the polyps’ surgery cure sinusitis?

Yes. Large nasal polyps obstruct the sinus drainage system, leading to mucus accumulation that may cause sinus inflammation and infection. If medication does not treat nasal polyps, surgery is required. The surgery will clear up the blockage, relieving sinusitis symptoms. For instance, chronic sinusitis with antrochoanal polyp (ACP) is always treated with endoscopic sinus surgery, as medication does not cure the polyp.  However, the polyps may recur, thus continuous medical therapy is required. The polyps’ surgery cures sinusitistemporarily.

What is antrochoanal polyp?
An antrochoanal polyp, a benign trifoliate structure, originates within the maxillary sinus. The unilateral and solitary polyp grows from the mucous glands that are blocked or ripped apart. Generally, the polyp expands and reaches into the nose via accessory ostium, and occupies the nasopharynx and nasal cavity. In fact, main growth of the sinonasal inflammatory polyp occurs in the nasal cavity. Extension into the nasopharynx may be considered as tumor.
The polyp is usually linked with bilateral maxillary sinusitis. Nasal infection and allergy may also cause the polyp. Poorly developed osteum of the maxillary sinus encourages growth of an antrochoanal polyp.
In 1906, Professor Gustav Killian described the polyp for the first time. A Killian antrochoanal polyp has two well-defined parts: endosinusal and nasochoanal. The endosinusal component mainly comprises a big cyst filled with fluid of yellow color. The fleshy nasochoanal component may enter into the nasopharynx.
Studies concluded that men are more likely to get the polyp than women. Young adults and teenagers are more prone to the polyp. The patients with antrochoanal polyp may be allergic. A big antrochoanal polyp may affect the voice besides causing headache, nasal discharge and nasal obstruction. The gray polyp is insensitive to touch.  The polyp may cause problems in breathing as well. The maxillary sinus with the polyp appears opaque on the plain-film radiograph. Dysphagia and sleep apnea are secondary symptoms of antrochoanal polyps.
Many antrochoanal polyps feature long stalks and are bigger than other inflammatory polyps. Both number of mucus glands and eosinophils is lower in antrochoanal polyps than other nasal polyps. Stromal cells are scattered within these polyps. These non-neoplastic cells are more fibrous than those found in other inflammatory polyps.
However, do not loose hope as the polyps’ surgery cures sinusitis. Caldwell-Luc operation and polypectomy techniques are used for the surgery. Entire base of the polyp should be removed during the surgery, as incomplete removal of antrochoanal polyp increases chances of recurrence.