Sinusitis

[zanbashi05]

Some are suffering from sinusitis. they called it " monster ".

 

Any E.N.T. mtc Doctors could help explain on this field ?

 

-Sign and symptoms

-Treatment

[otitismedia]

from E-medicine

Sinusitis is the inflammation/infection of 1 or more paranasal sinuses and occurs with obstruction of the normal drainage mechanism. It is traditionally subdivided into acute (symptoms lasting <3 wk), subacute (symptoms lasting 3 wk to 3 mo), and chronic (symptoms lasting > 3 mo).

 

History

 

* Presentation of sinusitis is often nonspecific.

* Patients may present with a persistent cold.

* Most complaints are related to the involved sinus.

* Common complaints are nasal congestion, purulent drainage, and facial pain with headache.

* Pain is often exacerbated by leaning forward or any head movement.

* Patients may complain of retro-orbital pain if the ethmoid sinus is involved.

* Some patients complain of dental pain or alteration in smell.

* In pediatric patients, most URIs last 5-7 days.

o By 10 days, the URI almost always improves.

o Most rhinoviral infections improve within 7-10 days so the complaint of persistent or worsening symptoms may indicate a developing bacterial sinusitis.

o Pediatric patients may complain of a daytime cough and persistent nasal discharge.

o Complaints of facial pain and headache are rare in children.

 

Physical

 

* Purulent secretions in the middle meatus (highly predictive of maxillary sinusitis) may be seen using a nasal speculum and a directed light.

* Fever is seen in fewer than 2% of individuals with sinusitis.

* Facial tenderness to palpation is present.

* Complete opacification of sinus on transillumination is present.

* Partial opacification is a nonspecific finding, and it is not as reliable.

 

Causes

 

Acute sinusitis is usually bacterial in origin. A URI or severe allergic rhinitis leading to obstruction of the ostia and stasis of drainage often precedes it.

 

* Haemophilus influenzae and Streptococcus pneumoniae are the organisms most commonly found in adults. In chronic sinusitis, the infecting organisms are variable, and a higher incidence of anaerobic organisms is seen (eg, Bacteroides, Peptostreptococcus, and Fusobacterium species).

* In children, similar organisms are seen, with the addition of Moraxella catarrhalis. In older children and young adults, Staphylococcus aureus is an occasional finding.

* In systemically impaired hosts, Candida, Aspergillus, and Phycomycetes may be the cause. Risk factors include the following: diabetes mellitus, cancer, hepatic disease, renal failure, burns, extreme malnutrition, and immunosuppressive diseases.

 

Workup

Imaging Studies

 

* Sinus radiography: False-negative results occur in 40% of cases; mucosal thickening or air fluid levels may be seen.

* A-mode ultrasonography has very little advantage over plain radiography.

* Computerized tomography (CT): This very expensive imaging study is used extensively by otolaryngology (ENT) specialists and in the evaluation of chronic sinusitis. In some institutions, CT scanning is preferred as the initial study of choice. It is extremely sensitive, although it may tend to overdiagnose the disease. CT scans cannot distinguish between viral and bacterial infections.

* Magnetic resonance imaging (MRI) can be used to demonstrate intracranial spread but is not as good as CT scanning in aiding in the diagnosis of acute sinusitis.

* Radiographs or CT scanning is not mandatory in the diagnosis. Uncomplicated sinusitis is often diagnosed clinically, with studies reserved for complicated cases or patients who are nonresponsive to the usual therapies.

 

Medication

 

Nasal decongestants

Antibiotics

 

Follow-up

Further Inpatient Care

 

* Any patient showing evidence of extension of infection into the CNS should be admitted and evaluated by an ENT physician.

 

Further Outpatient Care

 

* Prescribe antibiotic of choice and nasal decongestant. If an over-the-counter nasal spray (eg, Afrin) is used, warn the patient to use it no longer than 3 days to avoid any rebound phenomenon.

* Instruct patients to drink a lot of fluids. Use of a humidifier or vaporizer helps in keeping secretions moist and loose.

* Warm compresses to the face provide relief of pain. Pain medication may be prescribed, nonnarcotic or narcotic, at the discretion of the emergency physician.

* Instruct patients to return to the ED or see their personal physician if high fever, visual symptoms, vomiting, lethargy, or any symptom indicating possible extension beyond the sinus cavities develops.

 

Complications

 

* Chronic sinusitis

* Osteomyelitis

* Orbital cellulitis

* Intracranial extension resulting in septic cavernous thrombosis

 

Prognosis

 

* The prognosis is generally good with appropriate treatment.

[zanbashi05]

how about a saline solution like muconase? Is it not good to be used for 3 weeks?

from E-medicine

Sinusitis is the inflammation/infection of 1 or more paranasal sinuses and occurs with obstruction of the normal drainage mechanism. It is traditionally subdivided into acute (symptoms lasting <3 wk), subacute (symptoms lasting 3 wk to 3 mo), and chronic (symptoms lasting > 3 mo).

 

History

 

* Presentation of sinusitis is often nonspecific.

* Patients may present with a persistent cold.

* Most complaints are related to the involved sinus.

* Common complaints are nasal congestion, purulent drainage, and facial pain with headache.

* Pain is often exacerbated by leaning forward or any head movement.

* Patients may complain of retro-orbital pain if the ethmoid sinus is involved.

* Some patients complain of dental pain or alteration in smell.

* In pediatric patients, most URIs last 5-7 days.

o By 10 days, the URI almost always improves.

o Most rhinoviral infections improve within 7-10 days so the complaint of persistent or worsening symptoms may indicate a developing bacterial sinusitis.

o Pediatric patients may complain of a daytime cough and persistent nasal discharge.

o Complaints of facial pain and headache are rare in children.

 

Physical

 

* Purulent secretions in the middle meatus (highly predictive of maxillary sinusitis) may be seen using a nasal speculum and a directed light.

* Fever is seen in fewer than 2% of individuals with sinusitis.

* Facial tenderness to palpation is present.

* Complete opacification of sinus on transillumination is present.

* Partial opacification is a nonspecific finding, and it is not as reliable.

 

Causes

 

Acute sinusitis is usually bacterial in origin. A URI or severe allergic rhinitis leading to obstruction of the ostia and stasis of drainage often precedes it.

 

* Haemophilus influenzae and Streptococcus pneumoniae are the organisms most commonly found in adults. In chronic sinusitis, the infecting organisms are variable, and a higher incidence of anaerobic organisms is seen (eg, Bacteroides, Peptostreptococcus, and Fusobacterium species).

* In children, similar organisms are seen, with the addition of Moraxella catarrhalis. In older children and young adults, Staphylococcus aureus is an occasional finding.

* In systemically impaired hosts, Candida, Aspergillus, and Phycomycetes may be the cause. Risk factors include the following: diabetes mellitus, cancer, hepatic disease, renal failure, burns, extreme malnutrition, and immunosuppressive diseases.

 

Workup

Imaging Studies

 

* Sinus radiography: False-negative results occur in 40% of cases; mucosal thickening or air fluid levels may be seen.

* A-mode ultrasonography has very little advantage over plain radiography.

* Computerized tomography (CT): This very expensive imaging study is used extensively by otolaryngology (ENT) specialists and in the evaluation of chronic sinusitis. In some institutions, CT scanning is preferred as the initial study of choice. It is extremely sensitive, although it may tend to overdiagnose the disease. CT scans cannot distinguish between viral and bacterial infections.

* Magnetic resonance imaging (MRI) can be used to demonstrate intracranial spread but is not as good as CT scanning in aiding in the diagnosis of acute sinusitis.

* Radiographs or CT scanning is not mandatory in the diagnosis. Uncomplicated sinusitis is often diagnosed clinically, with studies reserved for complicated cases or patients who are nonresponsive to the usual therapies.

 

Medication

 

Nasal decongestants

Antibiotics

 

Follow-up

Further Inpatient Care

 

* Any patient showing evidence of extension of infection into the CNS should be admitted and evaluated by an ENT physician.

 

Further Outpatient Care

 

* Prescribe antibiotic of choice and nasal decongestant. If an over-the-counter nasal spray (eg, Afrin) is used, warn the patient to use it no longer than 3 days to avoid any rebound phenomenon.

* Instruct patients to drink a lot of fluids. Use of a humidifier or vaporizer helps in keeping secretions moist and loose.

* Warm compresses to the face provide relief of pain. Pain medication may be prescribed, nonnarcotic or narcotic, at the discretion of the emergency physician.

* Instruct patients to return to the ED or see their personal physician if high fever, visual symptoms, vomiting, lethargy, or any symptom indicating possible extension beyond the sinus cavities develops.

 

Complications

 

* Chronic sinusitis

* Osteomyelitis

* Orbital cellulitis

* Intracranial extension resulting in septic cavernous thrombosis

 

Prognosis

 

* The prognosis is generally good with appropriate treatment.

[otitismedia]

how about a saline solution like muconase? Is it not good to be used for 3 weeks?

 

saline solution either home made or any commercial brand will do , can be use for as long as you want. i prefer home made solution much cheaper for daily nasal washing. just don't forget to take your medicine and/or nasal spray. BTW, topical nasal decongestant will cause rebound congestion when used for more than a week.

[eloyski777]

saline solution either home made or any commercial brand will do , can be use for as long as you want. i prefer home made solution much cheaper for daily nasal washing. just don't forget to take your medicine and/or nasal spray. BTW, topical nasal decongestant will cause rebound congestion when used for more than a week.

 

Doc, what is rebound congestion? I am just curious because I believe my wife has a similar case to what you discussed in here. Another question Doc, why is it my wife is always having sinusitis every time she is exposed in cold places or cold weather? Thanks in advance Doc.

[renzyrenz]

i always had sinusitis even if with medication it still comes back because i think its a family sickness runs in the genes? haha

[mhim101]

up ko lng po

 

was diagnosed with acute sinisitis

 

8 months ago

 

till now i lost my sense of smell and taste (anosmia)

 

was treated with saline solution and mometasone(nasonex) nasal spray steroids

 

still no effect

 

any suggestions? tia

[maduro]

herbal medicine for sinuses meron na nakatry? im using sinex from us para lang makahinga sa sinus

[maduro]

sino na nakatry ng dahon ng bayabas daw

[capt KK]

Nasal irrigation, where to buy the saline and pot?

[randybluort]

Nasal irrigation, where to buy the saline and pot?

Why not just buy a nasal spray?

up ko lng po

 

was diagnosed with acute sinisitis

 

8 months ago

 

till now i lost my sense of smell and taste (anosmia)

 

was treated with saline solution and mometasone(nasonex) nasal spray steroids

 

still no effect

 

any suggestions? tia

Maybe it's due to a bacterial infection? Please see your doctor again. Sinusitis is usually treated also with antibiotics.

[shinyshiny2]

up ko lng po

 

was diagnosed with acute sinisitis

 

8 months ago

 

till now i lost my sense of smell and taste (anosmia)

 

was treated with saline solution and mometasone(nasonex) nasal spray steroids

 

still no effect

 

any suggestions? tia

 

 

If you still have the symptoms, that sounds like nasal polyposis or atleast something is clearly blocking your nasal passages. Prolonged intake of steroids has numerous side effects and may even worsen your condition. Have an EENT/Head neck surgeon scope your nose/sinuses and throat.