Sinusitis
There are 3 pairs of common sinus cavities, the frontal sinuses
above the eye sockets, the ethmoid sinuses between the nasal cavity and the eye
sockets, and the maxillary sinuses underneath the eye sockets, but above the upper
row of teeth. There is a fourth location of a sinus cavity, located in the midline
right underneath the pituitary gland, which is called the sphenoid sinus. These
hidden cavities in the facial bone are lined with a mucous membrane and are connected
to the inside of the nose through very tiny ducts. These can get plugged
with a cold, which can lead to a "vacuum headache". Subsequent bacterial
superinfection can lead to an acute sinusitis. Often the pathogen is a bacterium
such as Haemophilus influenzae or Staphylococcus aureus, but viruses can also
cause an identical clinical picture. As the sinus ducts are plugged and a vacuum
develops inside the sinus cavities, there is an accumulation of inflammatory serum,
which is the ideal breeding ground for bacteria to multiply in. Symptoms There
may be a dull pain around the eyes, there may be a pussy discharge from the nose
and a fever. Depending on which sinuses are affected, there can be swelling over
the area. For instance, with maxillary sinusitis there might be swelling
and tenderness in the area below the side of the nose underneath the eye socket.
At the same time there might be a tooth ache in the upper teeth as the nerve roots
can be directly irritated from inflammation in the bottom part of the sinus cavity
where the nerves run by. With a frontal sinusitis there is often a frontal headache.
With ethmoid sinusitis there is a splitting headache in he front and pain between
and behind the eyes. A sphenoid sinusitis gives the patient a more dull headache
either in the back or in the front. Diagnostic tests In
an acute sinusitis the doctor may make the diagnosis clinically and treat with
a course of antibiotics. In chronic sinusitis, which has the identical symptoms
as acute sinusitis, diagnostic tests may be necessary to locate the sinusitis
and look for other underlying causes. A CT scan can give a lot of detail, shows
the extend of the sinusitis, possible underlying polypoid or cancerous lesions
etc. that may have predisposed the patient to get sinusitis. Treatment Steam
inhalation frequently and for 10 minutes at a time will bring the swelling of
the nasal lining down facilitating the opening up of the sinus ducts and promoting
drainage. Topical vasoconstrictive nasal sprays such as phenylephrine (brand
names: Dionephrine, Mydfrin, Neo-Synephrine) or xylometazoline nasal spray (brand
names: Otrivin, Decongest) will also assist in drainage of sinus cavity secretions.
However, these nasal solutions should not be taken more than 7 days in a row as
they lose effectiveness. In acute sinusitis penicillin V or erythromycin is given
for 10 to 12 days. In chronic sinusitis amoxicillin or tetracycline is given a
prolonged course of 4 to 6 weeks. Nasal discharge is cultured to detect the pathogen,
which guides the choice of antibiotic. If a chronic sinusitis does not respond
to the above mentioned measures, then a referral to an ENT specialist is needed,
as a surgical drainage procedure using endoscopic intranasal surgery may be required
to ventilate the sinuses again. In immune deficient patients, such as AIDS patients
or patients with poor control of diabetes or recipients of transplanted organs
on immune suppressants, chronic sinusitis may develop with more rare fungal infections. Pain
Control: For pain control there is an FDA approved non-drug method
available, IceWave patches from
Lifewave . This is mentioned in the book "Breakthrough" by Suzanne
Somers (Ref. 14) where newer insights of antiaging medicine are also reviewed.
Although the patches are placed over acupuncture points, there are no needles
involved. Nanotechnology, a newer technology, was used in the manufacturing of
these patches and infrared (heat) waves from body heat are utilized to stimulate
an acupuncture point, which modifies pain perception and reduces pain to half
or less. Medically this would be considered an excellent pain reliever. For more
info on the patches see the IceWave patches from Lifewave link above (click "products").
In the US a 5 pack of the IceWave spray is available that can be directly sprayed
onto the skin in the area where the pain is located. Mucormycosis
is one such fungal infection, which leads to black dead tissue from which the
fungus can be isolated. It would need treatment with intravenous amphotericin
B, an antifungal agent, and improvement of the diabetic control, if this is the
underlying metabolic condition. Aspergillosis
is to be suspected in a person with cancer who is on chemotherapy
or otherwise immunocompromised when there is polypoid tissue in the nose and the
sinuses. There are several species such ass Aspergillus flavus, A. fumigatus and
A.niger. The specialist needs to do a biopsy and culture of this material and
once confirmed as aspergillosis, wide surgical drainage and cleaning out of the
papillomatous material has to be done in combination with intravenous amphotericin
B (brand name: Fungizone), which eradicates this fungus. If the seriousness of
this condition is not appreciated, this disease can be fatal as it will spread
systemically (Ref. 4, p.689). Candidiasis
is common in AIDS patients and patients with immune suppressing therapy
or diseases. It is very versatile and causes white thrush on the mucous membranes
of the mouth or genitals (glans of penis, inside vagina), or moist skin areas
between the fingers, or in moist skin folds particularly in obese people. With
regard to the sinuses the accumulation of mycel in the sinus ducts can lead to
blockage of the natural drainage of the sinuses, which leads to the candidiasis
infection. Treatment: Similar to aspergillosis the specialist needs to
biopsy and culture the mycel material. When diagnosed, drainage procedures have
to be done to reopen the sinuses wide. This is combined with anti Candida albicans
therapy such as fluconazole (brand name: Diflucan) orally. For serious systemic
infection Amphotericin B (brand name: Fungizone) is given intravenously (Ref.
1, p. 83). |
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