Tuesday, October 7, 2008

Sinusitis …Acute and chronic nasal Sinusitis & Allergic Rhinitis

What Is Sinusitis?


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Sinusitis is a swelling of the inner lining of the sinuses. The sinuses are the spaces between the bones in the face where air passes and where a fluid called mucus drains into the nose.
In sinusitis, the swelling blocks the openings in the sinuses through which mucus drains into the nose. When mucus cannot drain properly, the pressure of the blocked fluid inside the sinuses can be painful.

Sinusitis is quite common. It feels much like a head cold, with a stuffy or runny nose and a headache. For most people, sinusitis is a temporary condition that goes away with simple treatment. If the symptoms do not clear up easily, medication can help. In rare cases, surgery may bring permanent relief.

What Are The Sinuses?


The sinuses are the spaces between the bones of the face. Air passes in and out of these spaces, and mucus drains through them and out of the nose. The sinuses also reduce the weight of the skull and give our voices a nicer sound.

There are four main pairs of sinus openings, sometimes called sinus cavities, in the face:

Maxillary - in the cheekbones
Ethmoid - between the eye sockets
Frontal - in the forehead and above the eyebrows
Sphenoid - deep in the head at the back of the nose

Each of these pairs of sinus openings has a channel that leads to the nose. These channels are quite narrow and can be easily blocked when the lining of the channels becomes swollen. This lining is called the mucous membrane. This same mucous membrane forms the inner lining of the nose.

How Does The Mucous Membrane Work?

The mucous membrane in the nose and sinuses is our personal air filter. It warms, moistens, and cleans the air. The mucous membrane creates a clear, wet, slightly sticky mucus that gathers any dust, smoke, bacteria, or virus particles that may have been in the air.


Tiny hairs along the membrane called cilia act as miniature oars, moving the mucus along, much like a conveyor belt, through the sinuses and out the nose.

When the mucus containing the unwanted particles reaches the nose and throat, the body prompts us to swallow, spit, sneeze, or cough them out of the body. But when the sinus openings become blocked, cilia can no longer move the mucus through.

The mucous membrane is also one of the body's front-line defense systems. It releases chemicals that help to destroy bacteria and viruses before they can attack.

How Is Sinusitis Different From Rhinitis?

Rhinitis results in a basic runny nose, sometimes accompanied by facial pain and a headache. It is caused by a swelling of the mucous membrane of the nose only, rather than the mucous membrane of the sinuses.

Rhinitis is much more common than sinusitis and is more frequently caused by allergies than by a bacteria or virus. Many people, especially children, experience rhinitis during the winter months as a reaction to the cold air.


Nice To Know:
Most cases of sinusitis are actually a combination of rhinitis and sinusitis, meaning that the mucous membranes of both the nose and sinuses are swollen. This condition is sometimes called rhinosinusitis.

How Common Is Sinusitis?
Almost everyone experiences rhinitis at some point in their lives, and the majority of people will also experience sinusitis.
Sometimes, a simple head cold will turn into sinusitis if the body has difficulty fighting off the bacteria or virus that caused the cold. This is the case when the body aches and fatigue from a cold go away, but the runny nose and postnasal drip symptoms continue and worsen.

Facts about sinusitis
Each year, sinusitis affects millions of peoples around the world.
It is the most frequently reported chronic condition in the United States and the fifth most common reason for taking an antibiotic.
It accounts for more than 13 million doctor visits per year in the United States alone.
Medical costs for the treatment of sinusitis in the United States are estimated at $2 billion per year. This does not include the few cases that require more costly x-rays and surgery.
Modern-day pollution has increased the number of people suffering from allergies. As a result, sinusitis is also on the rise.
Who Gets Sinusitis?
Sinusitis affects all age groups. Any healthy person can develop it, but certain groups are more prone to it than others.

Allergy sufferers are particularly prone to sinusitis, especially during hay fever seasons, or in environments where the air is filled with smoke or fumes. For some people, sinusitis will develop after eating a food to which they are allergic, or after exposure to allergens such as animal fur and dander.

Adults and children who suffer from asthma are more likely to develop sinusitis.
Some people are simply born with openings in the nose that are a bit too narrow and become easily blocked. Sometimes the small openings are the result of a deviated septum. The septum is the partition between the left and right sides of the nose. If this partition is crooked, the openings in the nose will be narrow.


A broken nose or other nose injury can cause a deviated septum, leaving less space on one side of the sinuses.
Smokers, or those who frequently inhale secondary smoke, are more likely to develop sinusitis.
Children with cystic fibrosis are particularly vulnerable to sinusitis because the disease creates abnormally thick mucus. The cilia then have a difficult time moving the thick mucus out of the body.
People with Kartagener's syndrome get both sinusitis and chronic chest infections. This is an extremely rare condition in which the cilia do not function properly.
People with low resistance to infection, a condition called immunodeficiency, are prone to sinusitis. In rare cases, a child can be born with immunodeficiency, but it is more likely caused by malnutrition or medications that impair the immune system. HIV (human immunodeficiency virus) and AIDS are diseases that cause immunodeficiency.
What Causes Sinusitis?
There are two different types of sinusitis, and each has different causes:

· Acute sinusitis
· Chronic sinusitis
Acute Sinusitis
Acute sinusitis means that the symptoms of the condition are temporary, usually lasting no more than 30 days. However, the symptoms of acute sinusitis are more severe and painful than the

symptoms of chronic sinusitis.
The most common causes of acute sinusitis are:
Virus. Viral infections can paralyze or even destroy the cilia so that they are unable to move mucus out of the nose.

Bacteria. If the sinus openings become blocked and the infected mucus cannot move out of the body or drain down the throat, it creates is an ideal environment for bacteria to grow. The bacteria in turn creates an acid environment in the sinuses, which further paralyzes the cilia. This causes the mucous membrane to swell more. The sinus openings become even more blocked.

Fungus. Fungus is a plant or mold, often microscopic, that can be ingested with food or inhaled in the air. Once in the body, it can affect the immune system and aggravate the sinuses.

Nose blowing. Bacterial infections can be caused by pressure from blowing the nose too much.
Scuba diving. Scuba diving while suffering from a cold can create too much pressure in the sinuses and leave room for bacteria to grow.

Foreign objects. Young children sometimes try to put objects in their nostrils, and this can introduce bacteria into the sinuses.
Medications. The side effect of certain medications may affect the functioning of the mucous membrane.

Diseased teeth. On rare occasions, the maxillary sinus in the cheekbone becomes infected by the root of a diseased upper tooth.


Need To Know:
Acute sinusitis is typically the result of a cold that lingers on too long and becomes an infection. It is important to treat acute sinusitis early to prevent the infection from spreading.

Chronic Sinusitis
Chronic sinusitis means that the symptoms of sinusitis occur frequently or for long periods of time. The symptoms are usually more annoying than painful. However, those with chronic sinusitis are more likely to have recurring attacks of acute sinusitis, which can be quite painful.
Chronic sinusitis is often a combination of swelling caused by allergies or fungus, or by bacteria or a virus.

Anything that interferes with the normal functioning of the mucous membrane can bring on symptoms. When mucus cannot drain properly, bacteria has a perfect environment in which to grow.

Chronic sinusitis is most often caused by:

Allergies. Allergies can be caused by almost anything. However, the most common allergens are airborne particles, foods, animals, feathers, and fabrics. If the culprit is a food, fabric, or animal, simply avoiding the allergen will stop symptoms. If the allergen is a chemical or substance in the air, such as dust or ragweed, treatment such as regular allergy shots for a period of time can provide relief.

Asthma. Adults and children suffering from asthma are more prone to sinusitis.

Temperature and humidity. When temperature and humidity are extreme, or when these air conditions change quickly, the sinuses can become irritated.


Narrow sinuses. Some people simply have narrow sinus openings or a deviated septum, so that when there is swelling, it is even more difficult for air to pass through.

Defective mucous membrane. Some people have poorly functioning mucous membranes, sometimes permanently damaged by a past infection.

Dehydration. Not drinking enough liquids will cause dehydration. Without enough fluid in the body, the mucus will thicken, making it difficult for the cilia to move it through the sinuses.


Poor air quality. Pollution, fumes, dust, smoke or crowded living conditions - anything that reduces the quality of the air - can affect the function of the sinuses and mucous membrane.
Weak immune system. When the immune system is not strong, the mucous membrane and cilia cannot do their job to resist infection. Immune deficiency can be caused by poor diet, medication side effects, or diseases such as HIV and AIDS.

Hormones. In a few cases, hormonal imbalances can lead to sinusitis.
Stress. Research shows that the mucous membrane and sinuses can react to stress. One such condition is known as vasomotor rhinitis, in which stress, rather than an infection or allergy, causes excessive swelling and mucus production.

Polyps. In rare cases, polyps are the cause of sinusitis. Polyps are benign (noncancerous) water-filled swellings about the size of grapes that develop in the sinuses. They most frequently occur in people who have asthma. Polyps generally need to be surgically removed.

Tumors. One of the most rare causes of sinusitis are tumors, which need to be surgically removed from the sinuses.


Polyps inside the nose

What Are The Symptoms Of Sinusitis?
Symptoms of sinusitis vary from person to person. While one person may have all of the symptoms, someone else may have only one or two of them.
Acute sinusitis is usually painful, while chronic sinusitis is generally more uncomfortable than painful.

The most common symptoms are:
Stuffy or runny nose
Clear, thin discharge from the nose (as in chronic sinusitis), or thick yellow or green discharge from the nose, sometimes tinged with blood (as in acute sinusitis)
Sneezing and/or coughing
Pain over the bridge of the nose
Headache that is worse in the morning, when bending forward, or when riding an elevator
Postnasal drip from the nose into the throat
Frequent throat clearing
Itchy eyes and nose
Reduced sense of smell and/or taste
Bad breath
Fever and chills
Pain in the roof of the mouth or teeth
Face and eye pain


If there is facial or eye pain, the condition is acute, and it is easy to tell which sinus openings are blocked. If blowing the nose does not bring forth enough mucus, a gentle massaging of the areas of facial pain can sometimes help reduce blockage.

Less common symptoms, which may or may not be accompanied by a stuffy nose, are:
Earache, feeling of fullness in the ear, swelling and tenderness behind the ear, and/or ear popping due to mucus in the eustachian tube of the ear
Sore throat and hoarse voice caused by infected postnasal drip
Swelling of the eye area due to a spread of infection from the sinuses to the eye
Severe headache with vomiting, a very rare symptom, which indicates the possibility of meningitis, caused by a spread of the infection into the brain.



Need To Know:
The symptoms of sinusitis are very similar to those of the common cold. Especially with children, the symptoms may mimic a cold, and only a doctor's examination can determine the true cause. If the symptoms do not subside within 10 days, or if there is any fever, a doctor should be consulted.

Are Sinusitis And Chest Congestion Related?
Just as with a head cold that moves into the chest, sinusitis and chest congestion often occur together. This is because the respiratory system of the chest and sinuses are connected to one another. Chest congestion and sinusitis also have similar causes.
Just as infections of the sinuses can become severe if not treated early, an infection of the chest can lead to pneumonia without early medical attention.
Therefore, people with conditions causing chest congestion, such as asthma or bronchitis, are especially prone to rhinitis and sinusitis. Often, treating sinusitis also improves the symptoms of asthma, bronchitis, and chest infections.



All are good for chest congestion

How Is Sinusitis Diagnosed?
A doctor will usually diagnose sinusitis based on the symptoms you report and the ones that he or she observes upon examination. Unfortunately, x-rays and magnetic resonance imaging (MRI) do not give an accurate picture of the sinuses. However, some doctors find an x-ray of the head called a CT scan to be useful.

The first thing the doctor will do is ask about your symptoms, such as headaches, facial or mouth pain, mucus drainage that is yellow or green, swelling around the eyes, and fever.
Sometimes, the doctor will simply massage or tap the areas of the face to determine which sinus openings are tender to the touch.
Some doctors use tests to determine breathing capacity and smelling ability to make an accurate diagnosis.

If the symptoms of sinusitis do not subside with treatment by a family doctor, a more thorough examination by a specialist in nasal disorders, called an otolaryngologist, may be necessary.
A specialist may choose to use an endoscope, which is a thin, lighted instrument inserted into the nostrils so that any blockages in the sinuses can be seen.

How Is Sinusitis Treated?

Treatment options for sinusitis include:


Antibiotics typically clear up an infection within two weeks. However, in the case of chronic sinusitis, antibiotics may need to be taken for up to 28 days.
Antihistamines sometimes used to block allergic reactions and dry excess mucus. However, antihistamines should be used with cautionas they can cause severe drying of the mucous membrane.

Decongestant nasal sprays are used short-term to reduce mucous membrane swelling. However, long-term use of these sprays can cause other problems. Steroid nasal sprays also reduce swelling and are especially useful for the treatment of sinusitis caused by a fungus.
Saline nasal sprays or rinses, which consist of a salt solution, can be made at home or bought without a prescription. Saline cleans the nose and adds moisture that thins mucus.

Cromolyn sodium, under the brand name of Nasalcrom, is a nasal spray that can be used for the short-term relief of symptoms. Different from antihistamines, decongestants, and steroids, it is best used only when symptoms are at their worst, as it can cause side effects.
Allergy shots on a regular basis for a period of time can be helpful when sinusitis is caused by certain allergens.

Surgery can bring permanent relief when sinusitis symptoms do not respond to medications over time or are the result of a nasal obstruction such as polyps.


The Problem With Antihistamines

Antihistamines should not be taken for more than a few days, as the main side effect is severe dryness of the mucous membrane. This dryness prevents the drainage necessary for healing.
There are some new antihistamines called histamine type 1 blockers, which claim to cause less drying of the mucous membrane.
The Problem With Nasal Sprays
Decongestant nasal sprays should not be used for more than three days without instructions from a doctor. Long-term use of these sprays can cause a "rebound" condition that makes nasal congestion worse, as the swollen membrane becomes dependent upon the spray. Therefore, decongestant nasal sprays are actually addictive.

After three days of use, wait at least a week before using a decongestant again. People who consistently use these sprays risk high blood pressure, as well as damage to the mucous membrane and the heart.
Low-dose steroid nasal sprays, on the other hand, have been found to be safe for a period of time, depending on the type of steroid prescribed.

Self Treatment

As long as the symptoms go away within a few days, a doctor's care for sinusitis is not necessary. However, if there are high fever or chills, difficulty with vision, thick yellow or green mucus discharge, or a temporary loss of consciousness, a doctor should be consulted immediately.
Those who suffer from chronic sinusitis or frequent attacks of acute sinusitis often treat themselves with nonprescription medications and nasal sprays during a short duration of symptoms. However, chronic sinusitis that occurs frequently can cause permanent damage to the sinuses and should be diagnosed and treated by a doctor.
Treating Yourself
You can care for yourself at the onset of a cold, allergy attack, or sinusitis symptoms by doing the following:


SINOCLEAR HERBAL NASAL DROPS

Drink more water.
Keep the nostrils moist with saline nasal sprays, a humidifier, or by breathing steam from a basin of hot water. A saline rinse can be made at home by mixing one cup of warm water with 1/4 teaspoon of non-iodized salt and 1/4 teaspoon of baking soda. A bulb syringe like those used to clear the nose and throat of babies can be used to rinse the sinuses with the saline solution.


Discontinue eating dairy products, such as milk and cheese, until symptoms subside, since dairy products contribute to mucus production in the body.
Avoid substances that dehydrate the body, such as spicy foods, alcoholic beverages, tea, and coffee.
Avoid excessive forceful nose-blowing.
Avoid swimming or diving, which can put undue pressure on the sinuses.
Avoid air travel, or use a decongestant nasal spray if a flight is unavoidable.
Consult a doctor immediately if a fever or thick yellow or green mucus is present.

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Prevention
To prevent attacks of sinusitis:


Adopt a healthy lifestyle that includes exercise and a balanced diet.
Keep air filtration systems in your home or workplace clean.
Use nose plugs when swimming or diving in a pool, to keep chlorine from irritating the sinuses.
Drink plenty of fluids to maintain adequate moisture in the body.
Use a humidifier if air is dry, especially during winter months when artificial heat intensifies the dryness of the air.
Avoid allergens whenever possible.
Use coffee, tea, alcohol, and dairy products in moderation.
Do not smoke, and avoid secondhand smoke.
Avoid stress as much as possible.
Take vitamin supplements to maintain a healthy immune system.
There is some evidence that garlic tablets (available at a pharmacy or health food store) can help strengthen the immune system.


Do not smoke, and avoid secondhand smoke

Is Surgery Ever Required?
Surgery can bring relief when all other courses of treatment have failed to improve breathing. It is especially effective when polyps are present or when a deviated septum prevents adequate passage of air through the nose.

A doctor will not recommend surgery unless symptoms have been chronic or frequent over a period of time, and either have not responded to medication or are especially severe.

Sinus surgery can correct:
Swelling and blockages caused by chronic sinusitis
Swelling and blockages caused by repeated attacks of acute sinusitis
Deviated septum
Polyps
Tumors

Endoscopic Sinus Surgery
While there are several different types of sinus surgery that may be recommended, endoscopic sinus surgery is rapidly becoming the surgery of choice for more and more doctors.
Endoscopic sinus surgery utilizes a thin, lighted instrument called an endoscope.



Much like a telescope with a wide-angle camera lens, the endoscope is inserted in the nostrils, and the doctor looks inside the sinuses through an eyepiece.
The endoscope beams a light into different parts of the nose and sinuses, allowing the doctor to see what is causing blockages.
Surgical instruments can then be used next to the endoscope to remove the blockages and improve breathing.

Unlike most traditional surgeries, endoscopic sinus surgery does not involve cutting through the skin, as it is performed entirely through the nostrils. Therefore, most people can go home the same day. Additionally, it leaves no visible scars and causes less pain and discomfort.
Depending upon the extent of the surgery, a local anesthetic or general anesthetic may be used.

Sinus Washouts

A sinus washout is a minor operation in which one of the maxillary sinuses, the pair closest to the cheekbones, is punctured with a small needle passed through the nose. The excess mucus is then washed out of the sinus. When the sinuses are clear, and any infection or pus has been washed out, the swelling will go down. The mucous membrane and cilia are then able to return to normal functioning.

Sinus washouts are rarely painful and are usually performed under a local anesthetic, which means the person is awake but cannot feel any pain in the area of the operation. However, the procedure can be uncomfortable, as the needle can create a crunching feeling, and the washing of the mucus can feel quite strange.
A general anesthetic, which puts the person completely to sleep, is preferred with children. Some adults may also feel more comfortable under general anesthesia.


Can Sinusitis Become Serious?

While it is quite uncommon, sinusitis can become serious, especially in children. If left untreated, an infection that has spread to the eye can cause blindness. Spread of the infection into the brain can result in serious diseases such as meningitis.
Fortunately, with the modern antibiotic treatments available, such spread of infection is very rare.

Putting It All Together
Here is a summary of the important facts and information related to sinusitis:
Sinusitis is a common condition, usually easily treated, in which swelling blocks the opening of the sinuses through which mucus drains into the nose.
When mucus drainage is blocked, the result can be a feeling of pressure and pain, often accompanied by other symptoms such as fever and postnasal drip.
Sinusitis affects all age groups, but smokers and people with allergies or asthma are most likely to develop it.
Often starting as a cold, acute sinusitis typically lasts no more than 30 days and can be quite painful. Chronic sinusitis, on the other hand, can last much longer, but is usually more annoying than painful.
Sinusitis symptoms often mimic cold symptoms. If there is a fever, yellow or green nasal discharge, or if cold symptoms do not subside within 10 days, an infection is most likely present, and a doctor should be consulted immediately.
A doctor will diagnose sinusitis by taking a detailed medical history, discussing symptoms, and tapping or massaging sinus areas of the face. The doctor also may order breathing capacity tests or use an endoscope to see inside the sinuses.
Treatments for sinusitis include antibiotics, antihistamines, decongestant nasal sprays, steroid nasal sprays, saline nasal sprays or douches, cromolyn sodium nasal spray, allergy shots, and surgery.

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A doctor will not recommend surgery unless symptoms have been chronic or frequent over a period of time without responding to medication, or are especially severe.
Decongestant nasal sprays and antihistamines should be taken for no more than a few days.
Steps should be taken to prevent recurrences of sinusitis so that it does not become chronic, which can cause damage to nasal tissue.

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