Monday, April 30, 2012

Encephalitis

The Greek word encephalitis means “in the head”. Encephalitis refers to acute inflammation of the human brain’s parenchyma. Secondary encephalitis, post-infectious encephalitis, is an extension of the infection of other body parts, such as varicella, rubella and measles. The fatal disease is also a rare complication of infection-sinus. Encephalitis related to infection-sinus could be of two types: circumscribed encephalitis and diffuse encephalitis. Circumscribed encephalitis is also called brain abscess.




Causes
Even a small scratch in the dura, the membrane surrounding the brain, may cause encephalitis. Generally, encephalitis and meningitis occur simultaneously.  Encephalitis could be infective (viral) and non-infective. Virus is the most common pathogen responsible for encephalitis. The viruses causing the disease include adenoviruses, Colorado tick virus, cytomegalovirus, enteroviruses, herpes simplex viruses, Japanese encephalitis, St. Louis encephalitis and West Nile virus. The viruses can travel from the nasal cavity to the sinuses to the brain, causing encephalitis.
Some times, non-viral agents can also cause the inflammation. Non-viral factors could be bacterial, fungal and protozoa-related. Some times, vaccinations may also cause encephalitis.

Symptoms
Symptoms vary with the factors responsible for the disorder. A combination of the following symptoms may develop:

Changes in personality of the patient like drowsiness, irritability, disorientation and confusion
Chills
Fever
Headaches, which could be severe
Malaise
Nausea, vomiting
Papilledema
Stiff neck
Vision loss
Weakness of muscles


Treatment
Since brain inflammation causes several clinical, cellular and molecular changes in the patient, immediate treatment of underlying causes, including infection-sinus is necessary. Another reason for quick treatment is deadly nature of the disease.
The treatment includes a thorough neurological examination to assess cranial nerve abnormalities, ataxia, hemiparesis, state of consciousness and movement problems. Examination of the mucous membranes and skin is also performed. The type of medication depends on the form of encephalitis. For instance, herpes encephalitis is treated with acyclovir, an antiviral medication.

Friday, April 27, 2012

Is there a possibility that the sinuses will be cured permanently?

Rhinosinusitis is an inflammation of the paranasal sinuses produced by different etiologies (causes). Rhinosinusitis begin to be an acute disease, that should be cured to avoid the chronification. When a patient suffer from an acute rhinosinusitis (ARS) the treatment should be leaded to cure him. In order to cure the ARS you should eliminate the mucus and the interstitial liquid from sinuses, produced as response to the cause. The most common cause of ARS is a cold produced by a virus. Its treatment is to eliminate the mucus and the interstitial liquid from the sinus, by drainage. Consequently you will clean the sinuses and will reduce and finally eliminate the inflammation.
Another case is the chronic rhinosinusitis (CRS). It is produced by an acute rhinosinusitis that was not cured and chronified. In the CRS there is a permanent  degree of sinus inflammation that increase in the exacerbations of the disease, In this case sinus should also been drained. The drainage of mucus and interstitial liquid is also its treatment to avoid to get worse of the disease. An CRS is a chronic disease that patient will suffer for all their lives. The medical objective ¡s to prevent or cure the exacerbations.
Nasodren is a treatment to drain the mucus and the interstitial liquid. For this reason Nasodren is an adequate, efficacious and safe treatment for rhinosinusitis of different etiologies

Thursday, April 26, 2012

Imaging methods for identifying symptom of sinus infection

Identifying a symptom of sinus infection is the first step in treating it. Different imaging methods are used to diagnose the infection. Some of the images show accurate morphology and location of the ostiomeatal blockage, the main cause of the infection. Correct usage of imaging technology is also necessary for accurate and safe surgery. This article focuses on the main precursors of computed tomography (CT), the most popular imaging method.




Standard roentgenographs or plain films

The plain films have been used since twentieth century to visualize maxillofacial structures. Standard roentgenography is an easy and fast method. Images are taken from four different views viz. submentovertex, lateral, Towne’s and Waters' to evaluate morphology of the region. The combined exposure to radiation of the four views ranges from 40-60 mSv.  The films are still in use. The films offer quite good view of the maxillary sinuses and the lower part of the nasal cavity. The films also display the sphenoid sinus’ view along the mid-sagittal plane and the frontal sinus outline.
However, films are unable to capture a clear view of the posterior and anterior parts of the ethmoid sinus and inferior part of the frontal sinus. Although the films are economical, superpositioning of various facial structures limit their usability.  Plain films do not display required information for an endoscopic surgery.

Polytomography
To get a better radiographic view of delicate bony structures of the paranasal sinus periphery and the ethmoid sinuses, polytomography was developed. Polytomography produces a cross-sectional image.
The exposure to radiation while scanning the sinus along just one plane and using a 5-mm thick image is four times more than that of the plain films taken along the four views. Although imaging along sagittal and coronal planes is possible, phantom artifacts obscure the small bony structures. The artifacts may also indicate a symptom of sinus infection that does not exist. Polytomography can reduce the superpositioning problem of the plain films, but this method requires a lot of time. In fact, now-a-days no one uses polytomography.

Ultrasonography
The method is based on the ultrasound wave principle: The principle suggest that the waves reflect at the borders of two different media having different acoustic properties. For example, in case of the sinus containing fluid, the sinus’ posterior wall reflects an echo. In case of a normally healthy sinus, the anterior wall of the sinus reflects the sound.
Brightness (B-mode) and amplitude (A-mode) ultrasonography is useful in visualizing paranasal sinuses.  Utlrasonography is mainly used for “accessible” parts of the sinus. The imaging method gives limited access to the maxillary sinus. The ultrasonograhic images of the other sinuses are not useful.

Wednesday, April 25, 2012

Untreated sinus symptom may cause otitis media

The word “otitis” means ear inflammation. “Media” means middle. Otitis media is thus middle ear’s infection and / or inflammation owing to blocked Eustachian tube. Generally, H. influenzae, M. catarrhalis and S. pneumoniae cause otitis media. The disease could be acute, chronic and otitis media with effusion.




Acute otitis media (AOM)

AOM means acute inflammation or infection of the middle ear.  The tympanic membrane (TM) may bulge in the patients suffering from AOM. Other symptoms include middle ear effusion (MEE) that may contain pathogens. Both virus and bacteria can cause AOM. Major pathogens causing AOM are Streptococcus pyogenes, M. catarrhalis, H. influenzae and S. penumoniae.
Otorrhea, air-fluid level, decrease in mobility of the TM and bulging of TM indicates MEE. Otorrhea means muco-purulent secretion from the ear. Otalgia (earache) and apparent redness of TM is ascribed to the inflammation of TM. Bacteria and viruses trigger earache in the patients.  Sore throat, restlessness in night and fever may also be associated with AOM.
Otitis media with effusion (OME)
OME, also called secretory otitis media, refers to minor inflammation of the middle ear. MEE is non-purulent and generally free of pathogens. OME can be secondary to AOM, but it may develop as an independent condition. Nasopharyngities, sinusitis and allergy can cause edema of the mucosa. As a result, the Eustachian tube may get blocked, causing OME. Chronic sinus symptom or allergic rhinitis-induced edema may trigger chronic secretory otitis media. In case of recurrent chronic and acute OME, radiographic images of the paranasal sinuses will help in confirming / ruling out an association between OME and sinusitis.
AOM vs. OME
Fluid in the middle ear and hearing loss are associated with both OME and AOM. Irritability, fever and earache are present in AOM but absent in OME. Pus coming from the ear, “runny ear”, may occur in some AOM cases. However, OME patients do not have runny ear.
Chronic otitis media (COM)
COM could be active, inactive and inactive with frequent reactivation of primary condition. Otorrhea is a common symptom of chronic active otitis media. The chronic inactive otitis media may lead to retraction pocket, perforation and ossicular resorption.
Otitis media and sinusitis are related to each other. Exposure to secondary smoke and time spent in day-care may cause both sinus symptom(s) and otitis media. Inflammation means presence of fluid in the middle ear without any infection. Infection means bacteria- or virus-induced inflammation. That is why otitis media needs an antibiotic therapy.

Tuesday, April 24, 2012

Post nasal drip (PND)

Untreated sinusitis becomes a chronic condition, in which the mucous may drain from the infected sinuses into the rear part of the throat, postnasal drip. The bacteria residing in the rear damage the mucous, releasing sulfur gases. If antihistamines are administered to treat the drip, the mouth becomes dry causing more malodor.


Eating whole wheat and the products made from the wheat may cause sinus inflammation in some people, as a result, the mucus production increases substantially. The consequent postnasal drip impairs gastric function and leads bowel related problems. As a result, production of the mucus further increases, leading to excessive drip.
Excessive cold food causes condensation and excessive water accumulation, causing the drip. Decrease the amount of cold food, the drip would disappear.
The PND-induced cough may be confused with cough related asthma. So, consult your physician before starting the treatment.
Studies also have found out that the drip may be related to chronic chest disorders.
Nasopharyngeal carcinoma patients may complain about postnasal drip with blood.
Subcutaneous lymphoid nodules, which mean the posterior pharynx resembles to cobblestones, may form because of the drip.
The following simple remedies may dry up the postnasal drip:
  • Sniffing mixture of apple cider vinegar and lukewarm water may help in drying the drip.

  • Mix baking soda and salt into warm water. Squirt / sniff the liquid into the nostril and blow the nose.
  • Some times nasal drip is accompanied by sore throat. Honey with hot water may reduce the sore throat pain.

  • Drinking lemon with warm water may give you relief from the postnasal drip.
The extra mucus generally drips near or on the vocal fold and causes irritation, discomfort and desire to clean throat. Repetitive coughing may injure the vocal structures.
Sometimes aggressive surfing sessions may cause the nasal drip. This is normal. Do not worry about this. The drip occurs because while surfing you loose balance and fall. At that time, water collects in the sinuses.  This nasal drip is also called nose drip, postsession nasal drip, faucet nose, nasodrain or saltwater drip.
Cosmetic rhinoplasty may also cause temporary nasal drip within 48-hours of the surgery. If Pituitary gland drains into the sinus glands, nasal drip may occur.

Monday, April 23, 2012

Sinusitis etiology

Sinus physiology depends on three factors: quality and quantity of secretions, mucociliary transport and ostiomeatal unit’s (OMU) patency. If these functions are normal, sinuses function properly. However, many times, a number of agents affect these functions, causing symptoms-sinus infections. The study of these causes is called etiology. These causes are divided into two groups: local and environmental. Environmental factors include exhaust fumes, cigarette smoke and other air pollutants, and swimming.



There are a number of local factors causing symptoms-sinus infections. Craniofacial anomalies, such as velopharyngeal insufficiency, cleft palate and choanal atresia, may lead to sinusitis.  Nasal obstruction due to rhinitis medicamentosa, tumors, adenoid infection, foreign bodies, polyps and rhinitis cause sinusitis. Ethmoid bulla prominence, atelectatic maxillary sinus, paradoxic middle turbinate, Haller’s cells, concha bullosa and septal deviation are common examples of anatomic aberrations triggering sinusitis. Ciliary dyskinesias, surgery, dental infection and barotrauma may also lead to sinusitis.
The anatomical aberrations reduce the size of bony channels, enhancing the risk of developing the sinus infection. For instance, concha bullosa, a common cause of recurrent sinusitis, compresses the uncinate process, obstructing the infundibulum and middle meatus. As a result, symptoms-sinus infections develop. If convex side of the bent middle turbinate touches the lateral nasal wall, uncinate process compresses and the OMU gets obstructed. Haller’s cells, also called infra-orbital cells, obstruct the maxillary ostium and infundibulum. The ethmoidal cell prominence may impair the drainage of the sinuses.
Mucociliary transport process clears the sinuses and enables proper movement of secretions from sinuses to nose to nasopharynx. Neither bacterial infections nor fall in inspiratory air humidity reduces the transport directed to the ostia of the sinus. However, obstructions, especially that of ostia, initiate a cycle of malfunctioning of sinuses, say secretions are retained within the sinuses, leading to chronic sinusitis.
Cilia, hair like structures on the cell surface of the respiratory tract, are responsible for removing dirt and mucus. Appropriate movement of the mucus lining within the sinuses prevents from infection development. The mucus lining and cilia shall work as a unit for correct movement. Ineffective cilia transportation and movement cause the diseases like dyskinesia, which means uncontrollable symptoms like compulsive or repetitive movements.
Primary ciliary dyskinesia (PCD) means disorders related to the cilia structure.  For example, Kartagener’s syndrome is a type of PCD. The syndrome encompasses the triad of sinusitis, bronchiectasis and situs inversus. The structure defects related to cilia include absence / less amount of the adenotriphosphate required for the cilia movement, cilia of abnormal length, lack of radial spokes and distorted basal apparatus.

Friday, April 20, 2012

Is there any side effects with Nasodren?

Is there any side effects with Nasodren?

Nasodren is a natural product. Its active ingredient are saponins, a cyclamen extract that gives a fast relief from rhinosinusitis symptoms, like nasal blockage, obstruction, congestion or nasal discharge. Saponins can’t pass trough to the mucosa membrane and therefore do not reach bloodstream and consequently they do not produce systemic side effects.



Nasodren acts activating the physiological defense mechanisms of the upper airways (increased mucus secretion, greater ciliary cleansing activity and increased arterial blood flow) that are impaired during rhinosinusitis. Nasodren stimulates the trigeminal nerve endings of the nasal mucosa that leads to a seromucus discharge, reduction of the inflammation of the mucosa and opening of the ostiums and therefore cleaning sinuses and nasal cavity
This specific mechanism of action may produce some itching, sneezing, and a brief sensation of mild to moderate burning sensation in the nasopharynx and more rarely, a brief lacrimation and flushing of the face. These are manifestations of the positive response to the product. All these effects usually diminish during the course of treatment.

There are studies showing that when administered locally, Nasodren do no alter neither produce morphological changes in the mucosa of the nasal cavity or sinuses

Nasodren, locally administered, is safe for the nasal mucosa.

Do no use Nasodren in case of allergy to Primulaceae, the family of plants to which Cyclamen europaeum (Nasodren active ingredient) belongs to.
Please read the leaflet to see how to use Nasodren.

Thursday, April 19, 2012

Tips to reduce sinus pain

Tips to reduce sinus pain

The sinus walls are sensitive to pain. Irritation of the walls and / or pressure change within the sinus causes pain. Blowing the nose, coughing and sneezing change the pressure within the sinus, causing pain. The research studies concluded that the mucosa lining the ostia of the sinuses is the most sensitive to pain. Swollen membrane of the ostia prevents air from entering into the sinus, causing pain. However, the mucosal cavity within the paranasal sinuses is not pain-sensitive.




After sinus surgery, pain may also occur. However, the surgeon will prescribe medication for resolving the pain. If medication does not help, consult the doctor at the earliest. In some cases, lying-down causes pain, because the body position affects the drainage ability of the sinus. Bending changes the pressure, causing the pain. Position-dependent pain can thus be resolved by changing the position. Generally, sinus pain is secondary to the congestion of the turbinates and / or nasal mucosa. Pain intensity is the highest over the affected sinus.
Since teeth roots are located close to the paranasal sinuses, it is not easy to distinguish between pains of odontalgic and sinus origin. A careful examination and some extra tests are required. For instance, a bilateral pain would be due to problems of the frontal sinus, especially, when upright sitting posture improves the pain. The unilateral pain that relieves in recumbent position is likely due to maxillary sinus disorders. If physical examination does not help in distinguishing between dental and sinus pain, radiography will help in finding sinus condition and thereby the cause of pain.
The maxillary sinusitis may cause pain in maxillary teeth, gums and cheek. This sinus pain can be reduced by lying supine, lying down with face up. The temporal, supraorbital or periorbital pain will improve with keeping head upright.
Frontal pain associated with frontal sinusitis improves by keeping head upright. If patient lies down in supine position, the pain worsens in case of acute frontal sinusitis.
The pain behind the nose, pain in inner canthal region and temporal, retro-orbital and periorbital pain due to ethmoid sinusitis also reduce by keeping head upright.
Sphenoid sinusitis causes temporal, frontal, occipital and retro-orbital pain and pain in vertex. Keep head upright to resolve this sinus pain
Facial massage may relive sinus pain.
Treat swelling of the nose lining.

Wednesday, April 18, 2012

Types of bacterial sinusitis

Types of bacterial sinusitis

To distinguish between viral and bacterial sinusitis, two symptoms shall be taken into account: purulent nasal discharge for three (3) days accompanied by high fever, and no improvement in the infection for at least ten (10) days. Since many symptoms are common in bacterial sinusitis and common cold, the symptoms’ duration is used for differential diagnosis. Based on the duration, bacterial sinusitis is divided into five different categories: acute, recurrent acute, subacute, chronic and acute exacerbation of chronic.



Acute

The bacteria found in the nasopharynx cause acute bacterial sinusitis. The most common bacteria include Moraxella catarrhalis, H. influenzae and Streptococcus penumoniae. The infection lasts from ten (10) days to four (4) weeks in case of acute bacterial sinusitis. The patient may have severe and non-severe symptoms. Nasal congestion, headache and facial pain could be severe and non-severe. Other severe symptoms include periorbital edema and colored, opaque and thick rhinorrhea. 
The non-severe symptoms consist of rhinorrhea of any type, cough and irritability. High fever indicates severe condition, whereas absence of fever or low fever represents non-severe case of sinusitis.
Recurrent acute
In case of recurrent acute sinusitis, four or more incidences of the acute infection may occur every year. Each incidence may linger for a week to ten days. Between the incidences of acute bacterial sinusitis, there are absolutely no symptoms of the disease. The patient quickly responds to an antibiotic treatment. The physician may suggest sinonasal cultures to select an appropriate antibiotic. Endoscopic sinus surgery may also be required to treat the recurrent symptoms. The pathogens causing an acute condition may trigger recurrent acute bacterial sinusitis.
Subacute
Subacute sinusitis is a transient stage between acute and chronic bacterial infections. The infection may exist for 4-12 weeks. Moraxella catarrhalis, H. influenzae and S. penumoniae commonly cause acute and subacute bacterial sinusitis. Cough due to subacute sinusitis is treated with antibiotics and antihistamine-decongestants.
Chronic
The infection lasting more than twelve (12) weeks is defined as chronic bacterial sinusitis. In case of subacute and chronic conditions, fever is uncommon, but sore throat and nasal congestion are common. Chronic bacterial sinusitis rarely occurs in children.
All bacteria causing acute symptoms may lead to chronic condition. Respiratory anaerobes, Streptococcus aureus, Pseudomonas aeruginosa and H. influenzae play a major role. However, role of other bacterial pathogens causing acute condition decreases.
Acute exacerbation of chronic
This condition refers to sudden deterioration of the chronic infection. A new set of symptoms may also develop. Common bacteria responsible for acute community acquired sinusitis may cause acute exacerbation of chronic disorder.

Tuesday, April 17, 2012

5 sinusitis evaluation scales

5 sinusitis evaluation scales

Several different scales are used to evaluate chronic signs of a sinus infection in the patients who have been administered medication and undergone a sinus surgery. The primary objective of the scales is to measure quality of life (QOL) of the patients. Some scales focus on subjective and general assessment whereas others on a specific disease.




Chronic Sinusitis Survey (CSS)

The duration-based CSS analyzes signs of a sinus infection for eight (8) weeks and reviews consequent need for medication. The disease-specific survey incorporates clinical changes. The survey has been used to conduct research focused on how sinus surgery affects QOL of the patients suffering from chronic rhinosinusitis. However, it generates limited psychometric data. The limited output may not consider all the signs.

The CSS features six items that are divided into two categories: symptom and medication.

Rhinosinusitis Outcome Measure (RSOM-31) and Sinonasal Outcome Test (SNOT20)
The disease-specific RSOM-31 consisted of thirty-one (31) questions, including some general health related questions, for complete evaluation of sinusitis related symptoms. RSOM-31 has been revised as SNOT20 comprising just twenty (20) items. Thus, evaluation can be completed easily and quickly. SNOT-20, a single scale measure, is being tested for its value and sensitivity.
Rhinosinusitis Disability Index (RSDI)
The index analyzes self-perceived outcome of chronic signs of a sinus infection. The reliable index is in the first-person format. The disease-specific index tries to find relationship between the signs and daily life limitations. The tool consists of thirty (30) items that are divided into three subscales: functional, physical and emotional.
Chronic Sinusitis TyPE (Technology of Patient Experience) Specific Questionnaire
This is a comprehensive instrument for subjective evaluation of the patients with chronic rhinosinusitis. The tool consists of three (3) forms covering initial patient review, medical history and evaluation after the treatment. The instrument is available for public. The TyPE and CSS are simple methods and offer information about treatment efficacy.
Medical Outcomes Study Short Form-36 (SF-36)
The form not only evaluates general health status of the patient in response to a therapy, but also analyzes requirements for future surgical and medical processes. However, this method does not focus on a specific disease. SF-36, a health survey, features thirty-six (36) questions divided into eight (8) general health sections, including social functioning, vitality and bodily pain. An abridged version of SF containing twelve (12) questions is called SF-12 that has two (2) components: mental health and physical health. Both the forms are used extensively, because they are the benchmark in the field.

Monday, April 16, 2012

Side effects of sinus infection

Side effects of sinus infection

If sinus inflammation and infection spread via the upper aero-digestive tract mucosa, pharyngitis, laryngitis or tonsillitis may develop. The tract consists of the larynx, pharynx, oral cavity, nasal cavity, ear and paranasal sinuses.
Movement of mucopus, the mucus containing pus, to pharynx from the infected sinuses via the nasal airway is referred to as pharyngitis.  The most common symptom of pharyngitis is sore throat due to inflammation, which could be secondary to various upper respiratory infections, such as rhinitis. Sore throat is generally accompanied by cough, malaise, headache and rhinorrhea.




Both infectious and non-infectious factors may cause the sore throat. The non-infectious causes include postnasal drip, which is associated with sinusitis, exposure to smog or cigarette smoke, malignant disorders and low humidity. Viruses causing common cold are the most common agent triggering pharyngitis. For instance, rhinovirus is the predominate cause of pharyngitis. Allergy, infection or trauma can also trigger pharyngitis. Pharyngitis is quite often found in association with otitis and rhinitis.
Bacteria may also cause pharyngitis. Group A beta-haemolytic streptococcus (GABHS) is one of the main bacterial causes of pharyngitis. If GABHS-induced infection is not treated in time, complications, such as acute glomerulonephritis, peritonsillar abscess and acute rheumatic fever, may occur.

Other symptoms include inflammation of the pharynx’ mucous membranes and

infection or inflammation of the posterior oropharynx, soft palate, uvula and tonsils. Chronic sinusitis may cause lateral lymphoid bands’ hypertrophy, which means overgrowth or enlargement owing to expansion of the cells. The hypertrophy may be unilateral and affect the sinus.

Subepithelial lymphoid tissues cause granular pharyngitis, in which nodules are easily visible. Chronic sinusitis also causes granular pharyngitis or tonsillitis. Chronic pharyngitis includes chronic rhinitis, chronic nasopharyngitis and chronic pharyngitis. Acute pharyngitis encompasses sore throat without abscess, chronic pharyngitis due to viruses and streptococcal pharyngitis, and acute laryngopharyngitis.
Pharyngitis, an infectious disease, is more common in crowded places. The disease is more common in older children than younger children and infants. Most of the pharyngitis cases in adults are viral.
Laryngitis, one of the side effects of sinus infection, means irritation of vocal cords. Especially, recurrent or chronic laryngitis may be secondary to the infection and polyps.
Sinusitis may cause tonsillitis, inflammation of tonsils, and vice versa. Tonsils, lymphatic tissues, are prone to infections. Thus, timely treatment is necessary to avoid all side effects of sinus infection.

Friday, April 13, 2012

Is Nasodren effective?

Is Nasodren effective?


Nasodren is a product indicated for the treatment of acute and chronic rhinosinusitis, postoperative care after sinonasal surgery, and otitis media with effusion. 

Its active ingredient are saponins, a cyclamen extract that gives a fast relief from rhinosinusitis symptoms, like nasal blockage, obstruction, congestion or nasal discharge.





Nasodren is different because it has a unique and physiologic mechanism of action that produces a reflex secretion to clean and drain the nose and sinuses from accumulated mucus.

Nasodren acts activating the physiological defense mechanisms of the upper airways (increased mucus secretion, greater ciliary cleansing activity and increased arterial blood flow) that are impaired during rhinosinusitis. Nasodren stimulates the trigeminal nerve endings of the nasal mucosa, which leads to a seromucus discharge, reduction of the inflammation of the mucosa and opening of the ostiums (the passages that communicate the sinuses to the nasal cavity), and therefore cleaning sinuses and nasal cavity.

Nasodren is a very safe product since it is not absorbed and therefore do not reach bloodstream and consequently does not produce systemic side effects (i.e. does not reach the liver, the kidneys or any other organ) unlike, for instance, antibiotics or steroids.

Nasodren can be used in monotherapy or in combination with other products used for the treatment of rhinosinusitis  (antibiotics, steroids, decongestants, etc.).

In case you decide to use Nasodren, please, read the Product Information Leaflet.

Thursday, April 12, 2012

Antrostomy heals sinus infections’ symptoms

Antrostomy heals sinus infections’ symptoms


When surgery is the only option to treat sinus infections’ symptoms, the surgeon can choose from different types of surgeries, such as antrostomy, sphenoidotomy, intranasal or external ethmoidectomy and frontal trephination. However, the antrostomy may cause complications. Injury to nasloacrimal duct may occur. Sphenopalatine artery may bleed.





Surgeons generally fail to envisage the maxillary ostium during maxillary antrostomy. For right positioning of the antrostomy, this visualization is very important.

The antrostomy is suggested for chronic sinus infections’ symptoms that do not heal with traditional antibiotic therapy. Although intranasal antrostomy can be performed via inferior and middle meati, now-a-days the middle meatal antrostomy is preferred.
Intranasal antrostomy, a surgical procedure, creates a channel linking the maxillary sinus and nose via inferior / middle meatus. The channel facilitates drainage and telescopic visualization of the sinus. The antrostomy helps in conducting biopsy of the affected tissues and removing thickened mucosa. General anesthesia is given to the patient prior to the procedure. A wide array of antibiotics is prescribed for up to ten days.
Inferior meatal antrostomy (IMA)
Inferior meatal antrostomy creates an opening in the inferior meatus’ nasoantral wall. Intranasal IMA may be used to treat severe acute rhinosinusitis in children and chronic purulent maxillary sinusitis, but it produces complications. For instance, IMA may damage the nasolacrimal duct. Bleeding may continue even after the operation is complete.
Some medical practitioners still prefer the IMA procedure, while others do not. State-of-the-at techniques shall be used for IMA procedure. For instance, Buiter and Lund suggest that 1*1.5 cm window will ensure that the opening for ventilation and drainage lasts forever. However, the IMA is not done if osteitis is present and in case of polypoidal hypertrophy. 
Middle meatal antrostomy (MMA)
MMA creates a nasoantral opening to facilitate the antral cavity irrigation. MMA has been performed since late nineteenth century.  During maxillary MMA, the natural ostium of the sinus is cleaned and opened up to restore drainage. In some cases, surgeons also remove polyps, whereas in others surgeons do not remove the polyps. It is surgeon’s discretion. However, antrochoanal polyps must be removed. The antrochoanal polyp begins in the sinus wall and then enters into the nose via the sinus opening. MMA may also cause complications, such as orbit penetrations and sphenopalatine vessel trauma.
IMA vs. MMA
Controversies surround both the approaches. However, IMA’s popularity has declined with increase in endoscopic surgeries because performing an IMA with an endoscope is difficult. IMA is less physiological than MMA. If IMA is performed in a professional manner in right time, its results are very good. Post-surgical complications related to IMA are less than that of MMA.

Wednesday, April 11, 2012

Sphenoidotomy

Sphenoidotomy


Sphenoidotomy is performed to open up the sphenoid sinus and resolve symptoms of sinus infection. Since the sphenoid sinus is hemmed with several important structures, including carotid artery that supplies blood to the brain, optic nerve, brain and cavernous sinus, there are full chances of injuries to any of these structures during the surgery.

For instance, laterally, the sphenoid sinus is surrounded by the carotid artery and optic nerves. The ethmoid sinus makes anterior border of the sphenoid sinus. The pituitary gland and the brain are located superiorly to the sphenoid sinus. Sphenoidotomy is therefore a challenging operation requiring extraordinary surgical skills. If the infection is not treated in time, it may spread to the artery and brain.





Different approaches, such as transseptal, transnasal, transantral and transethmoidal, can be adopted for sphenoidotomy depending on symptoms of sinus infection. In transethmoidal approach, the procedure is performed through the anterior wall’s ethmoid portion. Transethmoid sphenoidotomy is performed to treat chronic sphenoid disorder accompanied by ethmoid diseases. The procedure is simultaneously executed with an external ethmoidectomy. The transethmoid sphenoidotomy may cause an injury to nasolacrimal duct, CSF rhinorrhea and / or orbital trauma.
The transnasal sphenoidotomy is done through the anterior wall’s nasal part. The transnasal sphenoidotomy approach is used for isolated sphenoid sinus disorders. The sphenoidotomy performed through the sphenoethmoidal recess or transnasally is safe and relatively easy. The transseptal approach is rarely used. Popularity of the intranasal sphenoidotomy grew with launch of endoscopic instruments and techniques.
The procedure helps in treating thickening of the mucosa and / or opening up the blocked natural ostium. If mucosal disorder is severe, there is a cyst or polyps are obstructing the sinus function, the cyst / polyps shall also be removed and medication shall be administered to treat other symptoms of sinus infection. To treat inflammation of the sphenoid sinus, drainage canals can be widened.
However, sphenoidotomy may cause some complications, such as bleeding from the posterior nasal artery, a branch of the sphenopalatine artery. Damage to the optic nerve is also possible. Cerebrospinal fluid leak may develop. An injury to the carotid artery is another major risk. Sphenoidotomy may fail due to two main reasons: the surgeon did not enter the sphenoid sinus unintentionally or intentionally, and the surgeon used secondary scarring for closing the sinus after entering it.

Tuesday, April 10, 2012

Sinus puncture: a traditional method to obtain sinus culture

Sinus puncture: a traditional method to obtain sinus culture

To decide an appropriate antimicrobial therapy for sinuses’ infection, a thorough understanding of the sinus microbiology is the prerequisite. Different methods, including sinus puncture, are used to analyze the microbiology. Sinus puncture, the traditional method to collect sinus aspirates, is used when the patient does not respond to the medicine, the patient’s condition deteriorates or the immune system of the patient is compromised / weak. The puncture will reveal bacteria causing the sinuses’ infection.



While obtaining sinus aspirates, normal flora and saprophytic organisms shall not contaminate the specimens. Even a slightest presence of normal flora in the sinus aspirates can mislead the physician because numerous indigenous anaerobic and aerobic bacteria reside in the nasopharyngeal mucous membranes.  The puncture is the best method to obtain such contamination free aspirates. The cultures based on contamination free aspirates can be studied and analyzed properly.
Two different approaches are adopted to puncture the maxillary sinus, which is easily accessible as compared to the other paranasal sinuses. The maxillary sinus can be punctured via the inferior meatus or the canine fossa. Before puncturing, the region lying below the inferior nasal turbinate and the nasal vestibule should be sterilized because S. aureus and other causative bacteria occur in large number in the nasal vestibule.
Despite all precautions, nasal flora may contaminate the specimens. So, the culture results can be misinterpreted. To avoid this, the acute infection has been redefined quantitatively. If the density of the bacterial species is high, the infection is acute. Bacterial density of 104 colony-forming units per millimeter helps in differentiating between contamination and bacterial colonization.
When quantitative analysis is not possible, a Gram stain of the specimens helps in semi-quantitative analysis.  Bacterial presence in the Gram stain aids in estimating the bacterial density. If a positive culture with high density of bacteria has several white blood cells, the infection may be bacterial. However, a Gram stain cannot distinguish between eosinophils and neutrophils.
The Scandinavian scientists have been using sinus puncture since mid 1950s. Now-a-days, even the US scientists also use the method. Sinus puncture is preferred for patients having severe sinuses’ infection. Sinus puncture is also common for research works. Sinus puncture is a safe method if performed by a professional and experienced doctor. It is less painful.  However, the invasive method may not be possible in primary care centers.

Thursday, April 5, 2012

Sinus puncture: a traditional method to obtain sinus culture

Sinus puncture: a traditional method to obtain sinus culture

To decide an appropriate antimicrobial therapy for sinuses’ infection, a thorough understanding of the sinus microbiology is the prerequisite. Different methods, including sinus puncture, are used to analyze the microbiology. Sinus puncture, the traditional method to collect sinus aspirates, is used when the patient does not respond to the medicine, the patient’s condition deteriorates or the immune system of the patient is compromised / weak. The puncture will reveal bacteria causing the sinuses’ infection.



While obtaining sinus aspirates, normal flora and saprophytic organisms shall not contaminate the specimens. Even a slightest presence of normal flora in the sinus aspirates can mislead the physician because numerous indigenous anaerobic and aerobic bacteria reside in the nasopharyngeal mucous membranes.  The puncture is the best method to obtain such contamination free aspirates. The cultures based on contamination free aspirates can be studied and analyzed properly.
Two different approaches are adopted to puncture the maxillary sinus, which is easily accessible as compared to the other paranasal sinuses. The maxillary sinus can be punctured via the inferior meatus or the canine fossa. Before puncturing, the region lying below the inferior nasal turbinate and the nasal vestibule should be sterilized because S. aureus and other causative bacteria occur in large number in the nasal vestibule.
Despite all precautions, nasal flora may contaminate the specimens. So, the culture results can be misinterpreted. To avoid this, the acute infection has been redefined quantitatively. If the density of the bacterial species is high, the infection is acute. Bacterial density of 104 colony-forming units per millimeter helps in differentiating between contamination and bacterial colonization.
When quantitative analysis is not possible, a Gram stain of the specimens helps in semi-quantitative analysis.  Bacterial presence in the Gram stain aids in estimating the bacterial density. If a positive culture with high density of bacteria has several white blood cells, the infection may be bacterial. However, a Gram stain cannot distinguish between eosinophils and neutrophils.
The Scandinavian scientists have been using sinus puncture since mid 1950s. Now-a-days, even the US scientists also use the method. Sinus puncture is preferred for patients having severe sinuses’ infection. Sinus puncture is also common for research works. Sinus puncture is a safe method if performed by a professional and experienced doctor. It is less painful.  However, the invasive method may not be possible in primary care centers.

Wednesday, April 4, 2012

Headache producing ASS

Headache producing ASS

The sphenoid sinuses, home to ASS, are located on the sides of the sphenoid bone that divides the sinus into two unequal cavities. ASS is not a normal donkey! ASS is acute sphenoid sinusitis. Toddlers never get ASS because they do not have cavities where it can hide and create turbulence. The sphenoid sinus fully develops by the eighth year only. In adults, ASS may occur owing to blocked ostium. Inflammation or structural problems may plug the ostium, causing headaches-sinus.



ASS always triggers headaches. Based on location, these headaches-sinus can be of three types: temporal, occipital and frontal. The patients may also experience a combination of these. The headaches-sinus are curable provided the infection is detected in time and treated properly.
The symptoms include dull pain in the orbit and around it, blur vision or loss of vision and / or unilateral visual impairment. ASS causes deep, persistent pain over the head or behind the nose or eyes. This pain may increase with bending forward. The pain may reach to the mastoid region. In posterior rhinoscopy, postnasal discharge may be spotted.  Pus may be identified on the posterior wall or roof of nasopharynx. Alternatively, pus may secrete over posterior part of the middle turbinate.
On an X-ray, sphenoid sinus may appear opaque. A physician may be able to see the fluid level on the X-ray. To get a clear picture of the fluid level, an x-ray of the sphenoid sinus is taken in lateral view. Radiographic scans like MRI and CT also aid in diagnosis.
Diagnosing ASS is difficult because the sphenoid sinus is located posteriorly. The diagnosis is delayed until complications appear. The infection may spread to nearby structures and cause hypopituitarism, meningitis, subdural abscess, orbital cellulites and ocular palsies. A neurological emergency, ASS may produce severe headaches. If meningeal and cavernous sinus are infected, patient may die. Neoplasms or mucoceles of the sphenoid sinus may resemble to ASS, so physicians must differentiate between the two conditions.
Staphylococcus aureus “produces” ASS. However, ASS rarely occurs in isolation. It is generally accompanied by pansinusitis, which means it develops with other types of sinusitis. For instance, ASS accompanies infection of one of the ethmoid sinuses.
If ASS does not respond to an antimicrobial treatment, transnasal puncture of the sphenoid sinus is required to drain the sinus. During severe cases, the infection is likely to spread into the optic canal, orbital apex and optic nerve and cause acute loss of vision and retrobulbar optic neuritis.

Tuesday, April 3, 2012

Acute frontal sinusitis (AFS)

Acute frontal sinusitis (AFS)

AFS is acute sinusitis with symptoms concentrated in the forehead area. The symptoms are limited to the frontal bone, temple and brow region. Acute frontal sinusitis may cause frontal headache due to a change in pressure within the frontal sinus. Blockage of the frontonasal opening and infundibulum creates negative pressure or vacuum, causing the headache. During this headache-sinus, patient may feel tenderness in the supraorbital ridge, orbital floor and / or frontal sinus region. The tenderness is particularly experienced in the areas in which frontal sinus is the thinnest. Acute frontal sinusitis headache starts over the sinus and spreads to the rear of the eyes or the vertex.




Sometimes, although rhinorrhea, nasal congestion and other symptoms are absent, acute headache-sinus occurs. AFS is common in young and adolescent male population. Acute frontal sinusitis accompanies acute ethmoid and maxillary sinusitis. However, information about bacteriology of AFS is very limited, as access to the frontal sinus is difficult. As a result, collecting and studying the sinus cultures are difficult.
The patients having frontal headaches should consult an otolaryngologist, who will identify whether sinus or nasal pathology is causing the headache. Generally, severe frontal headache for short duration accompanies acute frontal sinusitis. This headache is related to nasal symptoms. Chronic frontal sinusitis patients also complain about a headache, which is represented by constant dull pressure. However, this headache usually does not have nasal symptoms.
Acute frontal sinusitis can be of two types: complicated and uncomplicated. The uncomplicated AFS cures itself in response to improvement in immunity. The viral infection of the upper respiratory tract may lead to uncomplicated AFS. If symptoms persist for about ten days, it may be a bacterial infection.  Moraxella catarrhalis, Streptococcus penumoniae and Hemophilus influenza trigger uncomplicated AFS. The uncomplicated AFS requires an antibiotic therapy for 10-14 days to control infection, eliminate obstructions and restore the sinus.
The complicated AFS may have dangerous consequences. Severe sinusitis symptoms persisting over a prolonged period represent complicated AFS. The complicated AFS requires CT scan with IV Contrast and an aggressive medication strategy.  The treatment comprises a serial neurological check up, intravenous hydration and intravenous antibiotic therapy. Surgery may also be required.  Only some patients may experience severe headache-sinus.  If patients also have intracranial abscesses, surgical drainage of the frontal sinus is necessary. The drainage can be done using external ethmoidectomy, endoscopic frontal sinusotomy and / or trephination.

Monday, April 2, 2012

How does a decongestant work?

How does a decongestant work?

A decongestant narrows the nasal passage blood vessels, prevents secretions from going back into the throat and improves airflow. The decongestant contains antihistamines that heal nasal passage swelling, resolves sinus headaches and reduces allergies. There are two types of decongestants: topical and systemic.



Systemic decongestant
A systemic decongestant stimulates autonomic nervous system’s sympathetic division and thereby treats swelling of the vascular network of the respiratory tract. The decongestant also activates alpha-adrenergic receptors present in the blood vessels and decreases blood supply to the nose, reducing edema of the nasal mucosa. The decongestant contracts urinary sphincters and gastrointestinal (GI) tract, reduces insulation secretion and dilates pupils. The indirect action of the decongestants releases norepinephrine, causing peripheral vasoconstriction.
When systemic decongestants are administered orally, the GI tract absorbs them instantly. The decongestants easily enter into different fluids and tissues, such as breast milk, placenta and cerebrospinal fluid. The liver metabolizes the decongestants slowly and partly. The unchanged decongestants are excreted in urine within one day of the administration. The most commonly used systemic decongestants include pseudoephedrine and ephedrine.
The systemic decongestants may interact with other medicines. For instance, a systemic decongestant administered with a sympathomimetic, such as tyramine, epinephrine and dopamine, may stimulate central nervous system (CNS).  The combination of a systemic decongestant and monoamine oxidase (MAO) inhibitor may produce fatal hypertension.  The decongestants shall be administered carefully, especially to patients suffering from heart disorders, glaucoma, diabetes and hypertension, as it may worsen these conditions.
Topical decongestant
A topical decongestant, a vasoconstrictor, gives instant relief from mucous membrane swelling if sprayed to the nasal mucosa and nasal congestion. Popularly used topical decongestants include xylometazoline, tetrahyrozoline, phenylephrine, naphazoline and epinephrine. The decongestants activate alpha-adrenergic receptors occupying the nose’s vascular muscle and decrease blood supply to the nose. As a result, arterioles constrict. The reduction in the blood flow and capillary permeability brings down swelling. The Eustachian tubes open up, the nasal passage becomes clear and the sinuses drain easily, improving respiration. This vasoconstriction facilitates absorption of only small amount of the medicine. Thus, the topical decongestants rarely interact with other medications.
If a MAO inhibitor and topical decongestant are administered simultaneously, hypertension and severe headache may occur. Excessive use of the decongestants causes rebound nasal congestion. The rebound will resolve after a few days, if you stop using the decongestant. The topical decongestant may also cause sharp pain in the nasal mucosa and burning sensation temporarily.