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:



Bronchitis
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
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
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.



Sinusitis
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
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.


Symptoms
  • 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
Treatment
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


Definition
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.


Differences
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.
Similarities
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
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.

Wednesday, November 7, 2012

Natural sinus remedies: a review of horseradish

Natural sinus remedies: a review of horseradish

There is no dearth of natural sinus remedies. However, horseradish, an integral part of folk medicine, is an age-old remedy.


The plant
Botanists call it Armoracia rusticana. The herb with rubefacient, expectorant, diuretic, carminative and antioxidant properties naturally grows along streams, in damp meadows and cool forests. However, it can be grown in home garden.
The plant bears small flowers of white color.
The radish is rich in potassium, magnesium, calcium, iron and vitamins C and A.
The 30-cm long and 12-mm thick root is pungent, spicy and hot.
The perennial is believed to be a native of Russia or Europe. However, the herb is now-a-days found in New Zealand, South and North America, Asia, parts of Africa and Europe.
Although the herb is part of folk medicine, in some parts of North America, it is considered as a troublesome weed.
Uses
Vinegar made from horseradish root is used for chronic sinus congestion.
The radish eases sinus pressure and stimulates mucus drainage.
The herb reduces inflammation of frontal sinuses.
The herb is used in different ways in different parts of the world. Japanese, for instance, uses powdered radish as condiment. Fresh grated roots can also be used. If you are allergic to horseradish, do not use it.
Commercial products without chemical additives are also available. Sinus Free, Planetary formula number 77, is used for opening blocked sinuses. The formula contains thyme, eyebright, yarrow and the root of horseradish. The formula aids secretion of mucus. The flavonoids found in the formula stabilize mast cells, controlling the histamines’ release.
Harvest Moon Natural Foods sell Sinus Plumber Horseradish and Pepper Nasal Spray.

The U.S. Food and Drug Administration (FDA) approved Armoracia lapathifolia Gilib (horseradish) as flavor enhancer, spice and seasoning. The herb is rated as Generally Recognized as Safe (GRAS).

Suitability for sinusitis

Some studies have been conducted to test its suitability for sinusitis. The studies have found out that it may be used with other herbs for sinusitis therapy due to its antibiotic properties. The antibiotic allyl isothiocyanate is released while grating the root. However, more scientific research and data is required to elaborate on its role in healing sinusitis.
The herb, one of natural sinus remedies administered to treat the congestion, has some side effects. The documented side effects include allergic reactions, diarrhea, sinus irritation, vomiting and stomach related symptoms. So check with your physician before administering it. The herb may worsen stomach ulcers and lead to abortion.
A German study conducted during 2004-05 concluded that a herbal drug containing horseradish and nasturtium might be as effective as a traditional antibiotic therapy for acute sinusitis, urinary tract infections and bronchitis. You can read the full study here.

Tuesday, November 6, 2012

treatment guidelines

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
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.

Monday, November 5, 2012

How to grade sinus disease

How to grade sinus disease

The following general and disease-specific methods are used to grade chronic rhinosinusitis:

Child Health Questionnaire

Child health questionnaire (C.H.Q.), a general quality of life measurement test, has two versions: CHQ-87CF, child form and CHQ-50PF, parent form. CHQ-87CF, a form filled by children (the patient), contains 87 items, whereas CHQ-50PF, available in sixty languages, features 50 items to be answered by the parent. The test offers psychosocial and physical health scores.

Glasgow Benefit Inventory

Glasgow Benefit Inventory (G.B.I.), a retrospective assessment method, evaluates results of otorhinolaryngologic surgeries. The 18-item questionnaire includes questions on changes in health after the procedure. The 5-point Likert Scale-based answer options include extremely negative, negative, no change, positive and extremely positive. Using these 18 items one comprehensive scale featuring physical functioning, social support and general health subscales is developed. The G.B.I. scores vary from +100 to -100. Positive scores indicate betterment in quality of life, whereas negative score means deterioration and zero means no change.

Nasal Symptom Questionnaire

The questionnaire, based on Lund’s non-validated tool, was designed to assess nasal impairments. The 12-item instrument uses 4-point Likert Scale. The problems are rated on the 0 to 3 scale. “0” means no problem. If the score is three, the patient has severe sinus disease.

General Nasal Patient Inventory

General Nasal Patient Inventory (G.N.P.I.), a disease-specific approach introduced in 2003, contains 45 items that reduced its specificity. The inventory is rarely used due to its length.

Sinonasal-5 Quality of Life Survey

Sinonasal-5 Quality of Life Survey (SN-5) is used for children suffering from chronic rhinosinusitis. The quality of life assessment method is aimed at the parents of the child patient. The survey evaluates emotional impairment, allergic symptoms, restriction of activities, nasal obstruction and paranasal sinus infection. Take the test and find whether the young patient has mild or severe sinus disease

Sino-Nasal Assessment Questionnaire 11

Sino-Nasal Assessment Questionnaire 11 (SNAQ-11), validated in 2000, contains all important chronic rhinosinusitis symptoms, including nasal congestion, blocked nose and facial pressure / pain.

Rhinosinusitis Quality of Life Survey

Rhinosinusitis Quality of Life Survey (RhinoQOL) is an improvement over the chronic sinusitis survey (CSS). The 17-item survey does not cover changes in smell sense that is a main symptom of the disease. The survey focuses on time span instead of symptom severity. The instrument is hardly used to assess the disease.

You have so many options to record and monitor the sinus symptoms, so why not carefully observe the symptoms before they develop into severe sinus disease.

Friday, November 2, 2012

Experience with cyclamen in sinonasal diseases

Experience with cyclamen in sinonasal diseases

Acute rhinosinusitis is an extremely common disease seen both in primary care centres and in otorhinolaryngology offices.
In general, it is estimated that up to 30% of the visits to the GP are related in one way or another with this disease, indicating both its clinical significance and its socioeconomic impact. Normally, for the treatment of acute sinusitis cases, classic treatment resources are used, such as decongestants or antibiotics. However, in many of these cases, the treatment prescribed is insufficient and the hoped-for results are not achieved, which entails, among other serious consequences, increased health costs and a significant increase in the risk of complications.


Acute sinusitis
  • Common disease affecting more than 30% of the patients seen in primary care
  • Nasal decongestant drops
  • Antibiotics
  • Acetylcysteine
  • Costs for the national health system
The situation with chronic sinusitis is no less serious, as it accounts for almost 15% of the visits made to the GP. Some of the most commonly used resources for the treatment of this disease are decongestants, topical or systemic corticoids, analgesics, antibiotics, acetylcysteine and endonasal surgery. However, as happens with acute sinusitis, the hoped-for benefits are not always obtained and the failure rate is too high.
Chronic sinusitis
  • Common disease affecting more than 15% of the patients seen in primary care
  • Nasal decongestant drops
  • Topical steroids
  • Systemic steroids
  • Antibiotics
  • Acetylcysteine
  • Endonasal surgery/recurrence rate
  • Costs for the national health system


Clinical experience 
With this situation, Dr. Hoppe wished to highlight the benefits that could be obtained from including cyclamen extract in the therapeutic armamentarium, whether for the treatment of acute or chronic rhinosinusitis, or to improve postoperative care in patients undergoing endoscopic surgery for chronic rhinosinusitis.
In particular, he discussed his experience with the use of this preparation in dozens of patients with acute sinusitis, “substantial improvements were reported in all cases.” Administration of this product stimulates the mucous membranes at the lower end of the nasal cavity, triggering an intense reflex secretion with almost immediate dehydration of the mucosa, accompanied by shrinkage of the mucous membrane and opening of the inflamed osteomeatal complex. This secretion causes an intense physiological drainage of the paranasal sinuses in patients with acute rhinosinusitis.
The experience in chronic rhinosinusitis has also been very positive, with substantial improvements in the patients who have received the cyclamen extract spray.
It has been shown that this natural compound, when used in postoperative care after endoscopic nasal surgery, promotes elimination of eschars and mucous membrane debris and facilitates mucus circulation and expulsion. Thus, it is viewed as an alternative resource in these situations. As the speaker informed, “until recently, the standard postoperative care in our centre after endonasal surgery was basically rinsing with saline solution three times a day, removing the scabs daily (for 6 days) and administering topical corticoids after day 14 (for 3 months).”
On the basis of his experience, Dr. Hoppe concluded that “cyclamen extract should be viewed as an interesting and innovative medicine for the treatment of acute and chronic rhinosinusitis, and it also has an interesting potential role in postoperative care after endoscopic nasal surgery.”