Thursday, August 30, 2012

How to treat sinusitis of ethmoid sinuses

Management of ethmoid sinusitis or ethmoiditis consists of medical therapy and surgery. However, the medical therapy, including an antibiotics course and decongestants, is the first-line treatment. The surgical procedure, called ethmoidectomy, is rarely used. During the procedure, the sinuses are opened to drain into the nose. Ethmoidectomy advised for neoplasm treatment or a biopsy but seldom. Diagnostic transnasal endoscopy helps in identifying purulent or mucopurulent secretion present in the ethmoid sinus region.

Ethmoiditis can be divided into acute and chronic forms. Acute ethmoid sinusitis is common disease in children, but the isolated sinusitis is rare in adults. The disease form and agents (allergy, bacteria or virus) and anatomical defects (polyps) directly influence the treatment


How to treat sinusitis-acute

  • Simple cases of the acute condition are responsive to medical management that reduces edema and inflammation of the mucosa, restores sinus drainage and alleviates the pain.


  • If acute symptoms do not respond to the medical therapy, external ethmoidectomy is preferred.
  • If the symptoms are unresponsive to humidification and antral puncture, the ethmoidectomy is considered.


  • Surgery is also suggested for the sinusitis progressing quickly. However, if patients are unable to tolerate anesthesia, surgery is not performed.
  • The acute ethmoid sinusitis that leads to an abscess formation within the sinus or the surrounding region, including brain or eye (orbit), requires surgery. The abscess deteriorates the vision and leads to protrusion of the eyeball (exophthalmos) and thereby immediate attention is necessary. The abscess shall be drained endoscopically or externally.


How to treat sinusitis-chronic

  • To manage chronic ethmoiditis, the ethmoid air cells may be removed surgically.


  • Ethmoidectomy implies extraction of all diseased tissues using intranasal or external incision approach.
  • If the patients suffering from chronic condition also have polyps, intranasal ethmoidectomy and nasal polypectomy are used to remove both the infected ethmoid tissue and air cells via the intranasal channel. This procedure is also used to drain the sphenoid and frontal sinuses.


  • In external ethmoidectomy, a rare procedure, the sinus is accessed by making a medial orbital incision.
  • Endoscopic sinus surgery is suggested in case of children suffering from chronic ethmoiditis and progressive polyposis.


Visit your doctor and discuss all the treatment options considering your symptoms

Wednesday, August 29, 2012

9 drugs causing swollen sinuses

Although several natural agents may cause sinus diseases, the sinus problems could be a common side effect of a number of drugs developed to treat other diseases. For instance, Tamiflu given for swine flu causes sinusitis. Asthma therapies and even tumor and gum treatment may infect the paranasal sinuses.


      Asthma treatment
Singulair, a prescription drug from Merck & Co., Inc., prevents asthma attacks. However, the drug may cause sinus infection, causing swollen sinuses and severe pain in the sinuses.
The synthetic corticosteroid Alvesco (ciclesonide) may lead to the infection of sinus, nasal congestion, back, leg and joint pain, and other problems. This prescription medicine, also referred to as inhaled corticosteroid (ICS), reduces lung inflammation.
Xopenex® (levalbuterol HCl), an inhalation solution, may lead to rhinitis and sinusitis. Xopenex® treats the airway constriction due to asthma. 
Inflammation of the sinus mucosa (sinusitis) is one of the common side effects of Symbicort. AstraZeneca Global manufactures Symbicort (budesonide and formoterol fumarate dehydrate), an inhalation aerosol for asthma patients. 
Asmanex is an anti-inflammatory treatment for asthma. This inhalation powder containing mometasone furoate may lead to nausea, rhinitis, sinusitis and other problems.
Tumor drug
Afinitor, an oral prescription treatment, is given to the patients suffering from brain tumor (subependymal giant cell astrocytoma (SEGA)) and tuberous sclerosis (TS). This is the first therapy developed for the patients who cannot undergo a surgery for tumor removal. However, the U.S. Food and Drug Administration (FDA) approved treatment has some serious adverse effects, such as breathing problems. Its common side effects include sinus infection, mouth ulcers, seizure and skin problems.
Other medications
Tamiflu, administered to the patients suffering from swine flu, has several side effects, such as sinusitis, fever, muscle ache and earache.
The FDA approved GINTUIT is a cell-based treatment. The FDA approved the treatment in 2012. GINTUIT, a product from Organogenesis, Inc. based in the U.S., is made from bovine collagen and allogeneric human cells. The treatment is used for mucogingival (gum tissues and oral mucosa) problems. GINTUIT may treat your some gum problems, but it can lead to swollen sinuses and nasopharyngitis.
Actemra, a prescription drug, treats active rheumatoid arthritis (RA) by working on cytokine found in the human immune system. Excess amount of cytokine leads to RA. The drug may cause diarrhea, headache and infections of the upper respiratory tract, including sinus infections and common cold.
Be careful while selecting a medicine for any medical condition. Consult the family physician about adverse effects of the medicine in advance.

Tuesday, August 28, 2012

5 sinusitis medicines recalled in 2011

5 sinusitis medicines recalled in 2011

Recall in the U.S.
The U.S. Food and Drug Administration and the pharmaceuticals issued recalls of the following medicines used for sinusitis in 2011:
American Regent, Inc. recalled lot number: 1395 of “Epinephrine Injection, USP, 1:1000, 1 ml. Amputes, NDC #0517-1071-25” in April 2012. Voluntary recall ascribed to presence of small particles in the injection and discoloration. Only the lot number: 1395, expiring in July 2012, recalled. The injection, a haemostatic agent, is also prescribed for mucosa congestion associated with acute sinusitis, rhinitis and hay fever.

Pentrexyl Forte Natural
Phoneix Import & Distribution LLC voluntarily recalled Pentrexyl Forte Natural in May 2011 due to misleading packaging. The packaging of the dietary supplement, therefore, confuses it with antibiotics. The drug without antibiotics may delay the recovery process in case of severe disorders. The recall applies to the lot number: 102050 and the lots distributed from November 1, 2010 to May 1, 2011. The red and white capsules, packed in green and white boxes available in retail stores located in Texas, expire in April 2014. The drug treats uncomplicated sinusitis.

Recall in China, Hong Kong, Taiwan
Augmentin, amoxicillin and clavulanate potassium
The State Food and Drug Administration (S.F.D.A.) ordered GlaxoSmithKline Plc. (G.S.K.) for recalling amoxicillin and clavulanate potassium, and Augmentin, the sinusitis medicine, from the Chinese market because the drugs contain Di-isodecyl phthalate (DIDP), an additive used to enhance flexibility of plastics. DIDP is unsafe for humans. Augmentin is administered to the patients having bacterial infections, including sinusitis.

Recall in Canada
Mylan Amlodipine and Mylan-Minocycline
Mylan Pharmaceuticals issued a voluntary recall of  Mylan Amlodipine 5mg tablets (bottles of 100) and Mylan-Minocycline 50mg capsules (bottles of 100 from lot number: 1037180) in March 2011 due to an error in labeling these drugs used for different disease treatments. Mylan Amlodipine is given to treat chest pain (angina) and high blood pressure, whereas Mylan-Minocycline treats sinusitis, bronchitis and urinary tract infections. The interchange of labels poses serious risk to the chest pain patients using the sinusitis medicine instead of angina medicine, and vice versa.
Bi Yan Pian
Wing Quon Enterprises Ltd recalled Bi Yan Pian (NPN: 80023876) in September 2011 due to high content of mercury in the acute and chronic sinusitis medicine made from the herb. The mercury is 10 times more than the upper limit fixed by Health Canada. The mercury can cause numbness, diarrhea, muscle cramps, pain in abdomen, nausea and vomiting.

Monday, August 27, 2012

2 new sinus cures

Recently, two advanced sinus cures have been unveiled: Propel implant and Microbiome analysis for CRS treatment. So, sinusitis patients have more choices.
Propel mometasone furoate implant
The U.S. Food and Drug Administration (FDA) gave Premarket Approval (PMA) for Propel mometasone furoate to Intersect ENT, Inc. in August 2011. The self-absorbing implant is used for sinusitis treatment. The implant enables controlled localized delivery of drug in patients suffering from chronic sinusitis. The implant, inserted after endoscopic sinus surgery, delivers the steroid directly into the sinus tissue. The temporary implant opens the sinus and slowly releases a corticosteroid into the sinus membrane.
Propel is developed for the patients of 18 years or older and who have undergone an ethmoid sinus surgery. The implant stabilizes the middle turbinate, separates tissues of the mucosa and minimizes edema after the surgery. The flexible implant adjusts itself to the space created during the operation. The synthetic material implant can neither be reused nor reprocessed. The human body absorbs the implant within 4 to 6 weeks after the installation. Active ingredient of the implant is mometasone furoate, a steroid that reduces inflammation.
The implant should not be used for
  • the patients having confirmed or suspected mometasone furoate intolerance and
  • the patients who are hypersensitive to caprolactone, glycolide or lactide copolymers.
Microbiome analysis may reveal factors responsible for CRS
The composition of human microbiome (microbe communities) plays an important role in several diseases, including obesity and asthma. Based on this fact, a hypothesis was developed. The hypothesis states that the nasal microbiome is associated with chronic rhinosinusitis (CRS). A team of the scientists from the University of California (UC) San Fransico (U.S.) and Fudan University (Shanghai, China) conducted experiments on animals and analyzed the microbiomes in 2012. The study involved ten (10) healthy people and ten (10) people suffering from CRS.
The study showed that
  • The nasal microbiome of the CRS patients was depleted. The bacteria diversity in the microbiome was substantially lower. The patients’ microbiome was rich in Corynebacterium spp., whereas healthy bacteria were less. Corynebacterium may lead to sinusitis symptoms.
  • The microbiome replete with lactic acid protects against the infections.
  • The composition of microbiome thus may reveal cause of CRS and indicate suitable sinus cures.

Friday, August 24, 2012

Pelargonium sidoides-based natural remedies for sinusitis

Natural remedies for sinusitis change with a change in longitudes and latitudes. For instance, indigenous South African tribes use Pelargonium sidoides, whereas Americans use Elder. Pelargonium sidoides and / or drugs derived from the herb are also used in some parts of Europe. Today we will focus on the herb, which is also called kalwerbossie, rabassam, South African geranium and umckaloabo. The perennial plant with heart-shaped velvety leaves and mild aroma bears deep red-purple flowers during summer and spring.

The South Africans have been using the herb roots for various ailments of respiratory tract since ages. The herb relieves the symptoms by strengthening the immune system. A number of investigations also purported that the herb has anti-adhesive, antiviral and antibacterial properties. The results of some studies and trials conducted to evaluate the herb-based natural remedies for sinusitis follow:
Herbert Kolodziej in the article “Antimicorbial, Antiviral and Immunomodulatory Activity Studies of Pelargonium sidoides (EPs® 7630) in the Context of Health Promotion” published in Pharmaceuticals 2011 claimed that the herb has antibacterial properties of moderate level. Moreover, its antiviral capabilities may inhibit respiratory virus replication. Browse the complete article.
Donald Brown in his botanical profile of the herb “Pelargonium sidoides Extract (EPs 7630): Alternative Treatment of Acute Upper Respiratory Tract Infections” reviewed different studies conducted to assess the herb extract’s effect on both adults and children. The author stated that the extracts were effective and safe for the treatment of acute upper respiratory tract (URT) disorders. EPs 7630 reduced severity and length of sinusitis and other acute URT diseases. Read the full profile.

In 2009, Rhinology, the Journal of the International Rhinologic Society, published the results of the double-blind, randomized, placebo-controlled trial to appraise the safety and efficacy of the herbal medicine for treating acute rhino sinusitis (ARS) mainly caused by bacteria. The report authors, Andreas Schapowal, Claus Bachert, Meinhard Kieser and Petra Funk, concluded that the medicine, referred to as EPs 7630, had superior efficacy to placebo. The well-tolerated medicine was safe. Anecdotal and observational statistics hinted that the herb facilitated sinusitis treatment. Read the full study.
The Cochrane Collaboration’s Cochrane Summaries published “Pelargonium sidoides (Umchaloabo) for treating acute respiratory tract infections” written by Antes G, Günther J, Kern WV, Rücker G, Motschall E and Timmer A in 2009. The authors reviewed the herb-based drug, sold in both liquid and tablet forms, positively for sinusitis treatment and some other respiratory infections. You can read the full article here.
A word of caution, do consult a doctor before using the herb and / or herbal medicines, as both have some serious adverse effects.

Thursday, August 23, 2012

Causes of sinusitis: problems in OMC

There are a number of causes of sinusitis. One of the anatomical causes is the ostiomeatal complex (OMC), which is referred to as “the key to the sinuses.” The term ostiomeatal unit was coined by Naumann. The words “ostio” and “meatus” mean “passage.” The unit, located on the lateral nasal wall, consists of the maxillary sinus’ ostium, frontal recess (frontonasal duct), infundibulum, middle turbinate, middle and anterior ethmoidal cells, bulla ethmoidalis, hiatus semilunaris and uncinate process.

Within the complex, the slim channels connect the paranasal sinuses to the nasal cavities. The ethmoid, frontal and maxillary sinuses drain into the complex. If the mucosa of the complex swells, both the cavities and sinuses will be obstructed. The blocked complex interferes with mucus drainage, creating a suitable environment for the growth of bacteria and consequent inflammation. The infection or blockage of any part of the complex can thus lead to sinusitis. For instance,
  • Anatomic anomalies within the middle nasal meatus region, located in the complex, may disrupt ventilation and mucocillary clearance of the sinuses. The pathways facilitating mucocillary clearance for the ethmoid, frontal and maxillary sinuses open into the complex.

  • Structural problems in the anterior ethmoid sinus may block the complex, and thereby adversely affect the maxillary or frontal sinuses.
  • Structural problems, including tumor, foreign bodies, polyps, deviation of the septa, concha bullosum, unusually big uncinate process, abnormally large extramural ethmoid cells may also obstruct the complex.

  • Edema of the mucosa due to allergy, infection, exposure to chemicals, air pollutants and cigarette smoke reduces distance between the mucosa because the OMC is a narrow area, and thus it impairs mucociliary function.
  • The uncinate process’ deviation may impair sinus drainage.

A thorough examination of the OMC will help in finding the causes of sinusitis. Computed tomography (CT) of the sinonasal tract in coronal plane shows the complex clearly and the mucosa inflammation. If the OMC is blocked, it needs to be opened. In case of mechanical factors responsible for the obstruction, functional endoscopic sinus surgery (FESS) is required to open the complex. If pathology in the complex is unclear, the surgeon may prefer rigid endoscope to flexible one because the former unfolds a good view of the area.

Wednesday, August 22, 2012


Antibiotics sulfamethoxazole and trimethoprim (SMX-TMP / TMP-SMX) are active ingredients of Bactrim, Bactrim IV, Bactrim double strength (DS), Bactrim PED (for children), Septra, Septra DS, SMZ-TMP DS and Sulfatrim Pediatric. Even generic tablets of the antibiotics are sold in the market. Since Bactrim is used as the first or second-line antibiotic for sinusitis, the drug may be referred to as Bactrim-sinusitis. Other indications for SMX-TMP include traveler’s diarrhea, bronchitis, middle ear infection and urinary tract infection.


SMX-TMP is also referred to as co-trimoxizole. Sulfamethoxazole is tasteless odorless white compound. Trimethoprim is bitter odorless white-yellow color compound. Sulfamethoxazole and trimethoprim are active against aerobic gram-positive microorganisms, such as Streptococcus pneumoniae, and aerobic gram-negative microorganisms, including Haemophilus influenzae. Sulfamethoxazole and trimethoprim work together to block the processes used by bacteria to produce folic acid. The bacteria cannot survive without sufficient amount of the acid. By inhibiting metabolism of folic acid, SMX-TMP protects against bacteria.
The patients suffering from anemia because of low folic acid, severe kidney or liver disorders and porphyria should not take SMX-TMP. If you are allergic to compounds of the sulfa antibiotic group, such as SMX and TMP, do not take the medicine. Keep yourself hydrated if you are taking SMX-TMP to reduce chances of kidney stone.

United Research Laboratories (URL) / Mutual Pharmaceutical Company offers NDA (New Drug Application) Bactrim products approved by the U.S. Food and Drug Administration. The Bactrim™ DS and Bactrim™ tablets are rated as AB. AR Scientific, Inc., a marketing agent of URL, markets Bactrim™, a line of prescription medicines. However, Hoffmann-La Roche, Inc. owns trademarks Bactrim and Bactrim DS. 
Bactrim reduces growth of drug-resistant bacteria. The synthetic antibacterial formulation thus prevents and / or treats bacteria-caused infections. Moreover, several research studies appraising use of antibiotics in sinusitis treatment showed that Bactrim-sinusitis relives the symptoms of mild sinusitis. Bactrim is cheaper than amoxicillin. If you are allergic to penicillin, the physician may prescribe Bactrim. The rare side effects of Bactrim include Stevens-Johnson syndrome and skin problems.  
Inactive ingredients of Bactrim are pregelatinized starch, magnesium stearate, sodium starch glycolate, sodium benzoate and Docusate sodium. Absorption of orally administered Bactrim is quick. Both the main compounds are excreted through the kidneys. Take the drug with fluids: water, milk… The common side effects of the medicine include breathing problems, stomach upset, vomiting and headache. If side effects appear, contact your physician immediately.

Septra is a registered trademark of GlaxoSmithKline, Inc. (GSK). Both Septra and Septra DS are indicated for bacteria caused infections. Septra is available in oral suspensions and tablet forms.

Tuesday, August 21, 2012

Factors responsible for swollen sinuses

The paranasal sinuses swell, i.e. becoming larger and unusually rounded. However, what does cause this expansion?

There are a number of factors responsible for swollen sinuses. Such as,
  1. Uneven pressure distribution

The sinuses feature mucous membranes that continue into the nasal passage. Since the sinuses reside within the bones, they are inflexible. The healthy sinuses maintain pressure equalization, an even distribution of the pressure. However, the nasal membranes swell in the wake of respiratory disorders, blocking the slim air channels opening into the sinuses and affecting the pressure distribution. If the pressure outside the sinuses is more than that within the sinuses, the sinus mucosa may swell and release fluids, compressing and reducing the air volume.
  1. Infections, microorganisms & irritation

Both bacterial and viral infections may cause swelling of the sinuses. The respiratory infections stimulate growth of microorganisms that may venture into the sinuses and cause swelling of the mucous membranes.  The bacteria, fungi and / or virus occupying the sinuses illegally irritate the mucosa, causing swelling of the sinuses.
  1. Injuries

The cheek and nose trauma can fracture the maxillary and ethmoid sinuses. Some times sinus infection may break the membranes, causing bleeding. The injuries to the membranes of the paranasal sinuses also lead to swollen sinuses.
  1. Allergies

In some people, allergies lead to swelling of the sinus openings (ostia). Airborne or environmental allergens and mold may initiate swelling of the sinuses. Alcohol may exacerbate the swelling.
  1. Diseases other than sinusitis

Sinus swelling is one of the main symptoms of sinusitis. However, many other diseases also increase the size of the sinuses and change the shape. Here is a short list of the disease:
Autoimmune disorders
Cocaine abuse
Dental problems
Eustachian tube dysfunction
Fracture of the nasal bone
Juvenile nasal angiofibroma (JNA) (a benign growth of the upper throat or the rear part of the nose)
Rhinophyma (bulbous ruddy nose)…

  1. Activities

Some activities, such as scuba diving, swell the sinus due to increase in pressure underwater. If you swim in contaminated pool, the water may enter your sinuses, causing sinus infection and swelling.
  1. Anatomical defects

Anatomical problems such as tumors, nasal polyps and / or deviated septum may block the sinus cavities, causing swelling.

Monday, August 20, 2012

Sinusitis and earache

Can sinusitis cause earache? Yes!
Sinusitis and earache are associated.  The pain in ear due to sinusitis is called referred pain (or the pain of nonotogenic origin). So take good care of your sinuses. The sinus infection may cause earache in many ways, such as

  • Diseased structures around ear may lead to pain in the ear. The paranasal sinuses are not very far from the ear. The Eustachian tubes, located near the nasopharynx, connect ears to the rear of the nose. The tubes maintain pressure balance between the nose and the ears, and the ears and constantly changing outside atmosphere.

  • The infected fluids draining off from the sinuses may lead to ear infection and thereby cause earache.
  • Some nerves supply to both the sinuses and ear structures, so the sinus infections can travel to the ear and vice versa.

  • In fact, sinusitis is a major cause of otitis media, the infection and pain involving the middle ear. The otitis infection, one of the most common causes of earache, could be viral or bacterial.
  • Sinus infections may cause tinnitus, ringing or noise in the ears. The infections even lead to loss of hearing.

  • Chronic sinusitis may lead to ear pain.
  • Otalgia means pain in ear. Primary otalgia is the pain originating within the ear whereas the pain originating outside the ear is called referred otalgia. Sinogenic referred pain due to allergy and sinusitis can lead to referred otalgia. This pain is accompanied by tenderness over maxillary sinus and nasal congestion.  To find the source of the referred otalgia, a physician examines all the nerves supplying to the ear, as irritation of the nerves and their branches may lead to earache. Thorough examination of the throat, nose, ear, eye and head is also necessary to treat the otalgia.

Treat both otitis media and sinusitis, and earache will resolve on its own. Analgesics, antimicrobials (amoxicillin, cefpodoxime…) and topical agents are used for the treatment of otitis media. In case of frequent occurrence of the ear infection, tympanostomy tubes are inserted into the eardrum to drain the fluids.
Change in diet may also help in healing the otitis media. For instance, do not consume soy, dairy items, eggs, citrus and other allergenic foods. Herbal eardrops and ear oils reduce fluid accumulation, pain and infection. Monkshood, Indian tobacco and St. John’s wort oils are generally used for the infection treatment. Cleavers, coneflower, eyebright, elderberry and marigold herbs facilitate the healing process. However, do consult your physician before starting treatment.

Thursday, August 16, 2012

Sinusitis and otitis are related

Sinusitis and otitis are related medical conditions because the paranasal sinuses and ears are located close to each other in the skull. Ear or facial pain is a typical symptom of sinus infection. If the sinusitis patient bends forward, ear pain or sinus pressure may increase. Sinusitis is a disease of the sinuses, whereas otitis means an infection or inflammation of the ear. The ear is divided into three parts outer, middle and inner. The corresponding infections are medically referred to as otitis externa, otitis media and otitis interna.

 Otitis externa
The otitis externa, also called swimmer’s ear or external otitis, affects the external auditory (otitis externa) canal and outer ear. The principal pathogens causing the infection include corynebacteria, Propionibacterium acnes, Staphylococcus epidermidis and Staphylococcus aureus. Indeed, Staphylococcus aureus also infects the paranasal sinuses. 
The otitis extern triggers pain in the ear. Some times loss of hearing and fever accompany the pain. The disease generally occurs in humid and warm conditions. Water immersion is one of the causes of the otitis externa. 

Otitis media

Otitis media is an infection of the middle ear, extending between the eardrum and the slim channel leading to the nasal cavity. The sinuses and the middle ear have many common structural features. Both are open spaces. Both have mucous membranes. Both have slim channels that open into the nose.
Otitis media is the most common cause of earache. Other symptoms of otitis media include

  • inflammation of the mucous membrane that lines the middle ear,
  • fluid in the ear,
  • discharge from abscess or boil,
  • itching,
  • mild temporary loss of hearing and
  • irritation.
Sinusitis is a major cause of otitis media. Haemophilus influenza, Moraxella catarrhalis and Pneumococcus cause both otitis media and acute sinusitis. Otitis media is common among children. Untreated otitis media may lead to language and speech disorders, and loss of hearing.

Otitis interna
Otitis interna, also referred to as labyrinthitis, involves the inner ear. Inflammation of the inner ear may cause vertigo. Otitis interna causes excruciating pain, which is burning, tearing or throbbing. The pain increases due to motion, loud noise and chewing.
A complete examination of the paranasal sinuses in case of ear problems and vice versa is required to confirm or deny that the sinusitis and otitis are related. The treatment shall be decided accordingly.

Wednesday, August 15, 2012

Principal components of sinus decongestants

Sinus decongestants mainly contain the following ingredients:


The most commonly used ingredient of the sinus decongestants is pseudoephedrine, an oral medication. For instance, pseudoephedrine is the principal component of several popular sinus decongestant brands, including Drixoral, Nasofed, Trimeton, Contac and Sudafed. Although pseudoephedrine does not need prescription but it is misused so you will find it behind the pharmacy counter. The drug is stronger than phenylephrine.


 The drug shrinks the mucous membranes of the nose (vasoconstriction), promoting sinus drainage and improving airflow. Pseudoephedrine reduces nasal mucus, relieving nasal congestion associated with sinusitis and allergic rhinitis temporarily. The drug is quickly absorbed and acts within 4-6 hours / 8-12 hours depending on the formulation. The liver metabolizes the drug. 
The drug may adversely affect pregnant patients and the patients suffering from diabetes, coronary artery disorder, sever hypertension, thyrotoxicosis and some other diseases.  The drug has some grave side effects, including nervousness, palpitation and tachycardia. Consult the physician before administering the medicine.


The drug, a strong alpha-adrenergic stimulant, reduces nasal, nasopharyngeal and sinus congestion. Phenylephrine is sold in three different formulations: drop, oral and spray. Rhinall, Neo-Synephrine and Sudafed PE brand tablets contain phenylephrine. Since the drug absorption is poor when administered orally, the drug is given topically or parenterally. The drug stimulates alpha-1 vascular receptors and plays the role of a vasopressor, causing vasoconstriction.
The drug should be avoided if the nasal membranes are abraded, as its systemic absorption may affect urinary, cardiac and central nervous systems. Overuse of the drug may lead to rebound congestion. The drug may also cause reflex bradycardia, excitability, restlessness and headaches.

Phenylpropanolamine (PPA)

The drug, a non-amphetamine stimulant,is another preferred component of the decongestants. Propagest, Empro and Acutrim decongestant brands contain the drug. PPA absorption is quick and complete. The drug acts like a vasoconstrictor to clear the congestion.  The function and structure of PPA resemble that of ephedrine. All three drugs are excreted in urine.
However, the U.S. Food and Drug Administration (FDA) advises that PPA is unsafe as over-the-counter (OTC) medicine because it increases chances of haemorrhagic stroke in women. Thus, it is a prescription drug in the country. So consult your doctor before taking the medicine. In some countries, like India, the drug is banned. On the other hand, in some parts of Europe, it is still available.

Tuesday, August 14, 2012

Saline solution and sinusitis treatment

Saline solution and sinusitis treatment are related because the solution cleans up debris and unwanted mucus occupying the sinuses and nose, reducing inflammation and helping in restoring the drainage. The sinus irrigation with the solution is especially effective in chronic and sub-acute sinusitis cases. The solution is easily available or can be prepared at home. The saline is simple to use and has barely any side effects. You can choose from three different saline solutions to irrigate the nose and sinuses.

Hypertonic, hypotonic or isotonic saline solution and sinusitis treatment
The word “hyper” means “more than normal” or “above / over.” Technically, the osmotic pressure of the hypertonic solution is higher than that within the cells of the region being irrigated. The hypertonic saline solution contains a high amount of salt. The amount of salt is higher than the amount of the salt in human body. However, the pH of both the patient’s body and the solution should match to avoid sharp temporary pain in the nose.
The high amount of salt in the hypertonic solution helps in draining the fluid from the swollen membranes, so that the membranes shrink to the normal size. As a result, the airflow in the nose becomes normal and the channels connecting to the nose open. The high salt content may also improve functioning of the cell. The hypertonic saline, a solvent, removes the debris, including crusts of the mucus from the nose.
The solution is used for hay fever or allergic rhinitis and recurrent sinusitis. The solution helps in reducing the nasal membrane swelling, restoring the sinus drainage and enabling easy breathing. Irrigate the nose with buffered hypertonic saline prior to using a nasal steroid to enhance its effectiveness. Initially, the buffered hypertonic saline may cause a burning sensation in several patients. However, they adapt slowly.
The word “hypo” means “less than normal” or “below / under”. Technically, the osmotic pressure of the hypotonic solution is lower than that within the cells of the area being washed. Hypotonic saline contains lower amount of salt than that in human body. Generally, hypotonic solution is avoided.
The word “iso” means “equal.” Technically, the osmotic pressure of the isotonic solution is equal to that within the cells of the region being irrigated. The salt amount in the isotonic saline is equal to that in human body. The solution, also referred to as normal saline, can be used daily, as the body accepts it easily. The chances of inflammation due to isotonic are least.  Isotonic saline rarely injures the mucosa cilia. A few studies found out that isotonic saline facilitate mucociliary clearance in patients having acute sinusitis.

Friday, August 3, 2012

Anticoagulant and Nasodren

Cavernous sinus thrombosis (CST) represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. The prompt recognition and management of this problem is critical. 
Cavernous sinus thrombosis may result from any infection of the tissue drained by the cavernous sinus. This includes the midface, orbit and sinonasal cavity. The mortality rate remains high at 30%, and significant morbidity includes residual cranial nerve palsies and blindness. 
Treatment for cavernous sinus thrombosis includes high-dose intravenous antibiotics directed at the most common causative organisms, coupled with surgical drainage of the primary source of infection.

 The role of anticoagulation is contentious because its efficacy is undetermined and it may cause or exacerbate concurrent intracranial haemorrhage in patients with septic CST. Moreover, prospective trials of anticoagulation may never be performed due to the rarity of this condition. Nevertheless, retrospective reviews of published reports indicate that     haemorrhage caused by anticoagulation is rare, and that early adjunctive anticoagulation is beneficial in these patients if commenced after excluding the      haemorrhagic sequelae of CST radiologically. 
After application of NASODREN®, a slight issuing of red blood cells in the nose was observed in some patients. Therefore, treatment with anticoagulants (e.g. coumarin derivatives, acetylsalicylic acid) should be suspended, taking account of the rate of elimination of the particular anticoagulant.

Thursday, August 2, 2012

Chronic sinus infection: an overview

The sinus infection persisting over twelve (12) weeks is referred to as chronic sinus infection(chronic sinusitis). The symptoms of the infection may appear and disappear, ensuring intermittent relief. Some times, severity of the symptoms may also increase. The infection drains the patients completely. A Harvard University study showed that the symptoms might affect the quality of life of the patient more badly than that of the patient with congestive heart failure.
Many studies have confirmed that concurrent nasal airway inflammation always accompanies chronic sinusitis. The chronic infection follows rhinitis’ symptoms. Therefore, it is also called chronic rhino sinusitis (CRS). Injudicious use of antihistamines and antibiotics to treat sinus infections related to allergies also lead to development of chronic sinusitis symptoms.
Exacerbations of acute bacterial sinus infection may cause the chronic disorder. Other living organisms contributing to the infection are respiratory anaerobes and Staphylococci, such as Staphylococci aureus.

The signs and symptoms of the infection include:
  • Thick greenish yellow discharge in the throat’s rear part or from the nose
  • Nasal congestion or blockage leading to breathing problem
  • Swelling, pain and tenderness around forehead, cheeks, eyes or nose
  • Problem with sense of taste and smell
  • Pain in the ears, teeth, upper jaw
  • Cough worsening at night
  • Bad breath
  • Weariness
  • Nausea and / or sore throat
  • The inflammation secondary to chronic sinus infection causes toxicity.
  • In children, chronic sinus infection may cause headaches.
  • Chronic sinusitis may also alter the mucosa dramatically.

Herbs / natural remedies for chronic sinus infection
A number of herbs are used to treat the symptoms besides allopathic medicines. For instance, Sinupret herbal mixture, consisting of gentian root, European vervain, cowslip, common sorrel and European elder flowers, may relieve the symptoms. The mixture thins the mucus, enabling sinus drainage. The herbs also strengthen immune system so that the body can resist factors causing the infection. However, Sinupret has some side effects, such as gastric problems and rash on the skin. Consult the physician before using the mixture available in tablet form.
Extracts of olive leaf has antibacterial and antiviral properties that heal the sinus infection. Feverfew derived from Tanacetum parthenium plant may give relief from headache and fever associated with chronic sinusitis. Devil’s claw, known for pain relieving properties, may reduce the headache. Rutin reduces sinus inflammation, but has some adverse effects, like skin irritation and stomach problems.

Wednesday, August 1, 2012

10 OR set-up tips for endoscopic sinus surgery

10 OR set-up tips for endoscopic sinus surgery

While setting up the operating room (OR) for an endoscopic procedure to treat sinusitis symptoms, consider the following tips to create conducive atmosphere:

  1. Raise the operating table at an angle so that the patient’s body can be positioned at approximately 20-degree angle. The table arrangement should allow flexing the patient’s head at the neck.
  2. Enough space shall be provided under the table so that the surgeon can place his/her legs under the table and sit closer to the patient.
  3. An easily adjustable seat is required to maximize the comfort level for the surgeon and minimize the neck problems and weariness.
  4. Sitting arrangement for the anesthetist is made at the table’s foot to avoid “space” war with the surgeon’s team that includes surgical assistants and nurses. It will reduce congestion at the OR table.
  5. Find out the surgeon’s preferences for posture during the surgical procedure. Does the surgeon like to stand or sit while operating? Some surgeons prefer to sit and operate. So, they require an additional secure table placed next to the OR table. They will place their elbow on the additional table to hold the camera and endoscope firmly and in correct position. While other surgeons prefer to stand in front of the video stand while operating.
  6. Some sinusitis symptoms require delicate surgical procedures that cannot be performed without a team of two surgeons. During such procedures, one surgeon holds the camera and other one operates freely. A sitting arrangement is required near the head of the OR table for the surgeon who will hold the camera and endoscope steadily. The video screen is placed in such as manner so that both the surgeons can see the screen easily.
  7. Position the video screen in such a manner so that the surgeon (s) can even maintain comfortable posture while watching the screen. Use a big screen with high resolution. For high quality image, install an equally good light source. The surgeon can thus see details of the surgery site clearly and easily. Most of the instruments shall be placed on the video stack for the convenience and reducing the instrument wear and tear.
  8. Many instruments used in the surgery require cables that may disturb the surgeon. Clip the cables to the drapes to ensure that cable weight neither obstructs nor pulls the surgeon back or down. Use light cables and think carefully before arranging them.
  9. A beamsplitter used for the surgery may cause fatigue and posture problems for the surgeon in future. Even the best quality beamsplitters minimize the reflected light and therefore produce poor quality images.
  10. Keep enough space for ancillary staff that facilitate the surgery to heal the sinusitis symptoms.