How To Cure Your Sinus Infection
When I see patients with their first episode of acute sinusitis, if their symptoms are relatively mild, I'll usually prescribe a ten-day course of the antibiotic amoxicillin (250 mg three times a day). If there's not significant improvement in their discomfort within three to five days, I may switch them to Augmentin (500 mg twice a day for ten days), which will cover most resistant organisms. If symptoms are severe at the outset or they've already been treated with a first-line antibiotic like amoxicillin and their symptoms returned, I'll prescribe Augmentin. A five-day course of Zithromax (Z-Pak) or Ketek (Ketek Pak) is also very effective for acute sinusitis, but they're more expensive. I usually reserve these antibiotics, as well as Biaxin, for patients who cannot take amoxicillin or Augmentin because of a penicillin allergy.
As you've seen, sinusitis can be either acute or chronic. That's pretty simple. But what if I told you that chronic sinusitis is actually not one but five or ten or even twenty-five different diseases It complicates matters, but it's true. While modern medicine has a long way to go before we understand chronic sinusitis as well as we do acute sinusitis, it's increasingly clear that chronic sinusitis is a spectrum of diseases. I like to use the term Sinusitis Spectrum to explain why patients with chronic sinusitis respond so differently to treatment. A medication that benefits one person may have little or no effect on another. And the same surgery that permanently cures one person may need to be repeated a few years later on another. Figuring out where you fit on the Sinusitis Spectrum can help you put your own case into perspective. Once you've done that, you can focus on the treatments most likely to benefit you.
Physicians prescribe hundreds of millions of dollars worth of antibiotics each year for people with sinusitis. These bacteria-slaying medications generally are effective. In most cases, antibiotics eliminate the infection-causing bacteria, allowing inflamed nasal mucous membranes to shrink and your sinuses to drain. So let's take a look at the world of antibiotics for sinusitis how they work, the different types that are available, and their benefits and drawbacks.
The biggest problem contributing to resistance is unnecessary use of antibiotics. For example, they're often needlessly prescribed for the common cold, which is caused by a virus, not bacteria. Antibiotics are not effective against viruses. Sinusitis, on the other hand, is caused by bacterial infection, so antibiotics have a legitimate role in its treatment. antibiotics for chronic sinusitis. As a result, there's little economic incentive for drug manufacturers to seek government approval a difficult and expensive proposition, because chronic sinusitis is not one disease but a spectrum of many diseases. Therefore, we don't have scientific data demonstrating one antibiotic's superiority over another for chronic sinusitis, nor do we know the optimal dose or dose duration. A second treatment dilemma relates to the offending bacteria. Recall from Chapter 5 that one of three bacteria causes most cases of acute sinusitis Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella...
I frequently ask this question to patients who have been referred to me with sinusitis, and nearly always their answer is worse. If you're struggling with sinus problems, chances are you would say the same. What's important about this response is it reflects that sinusitis leads to more than just headaches or nasal drainage or blocked breathing passages. It affects your overall quality of life. Regardless of your worst symptom whether it's pain, congestion, a perpetually runny nose, fatigue, or something else you share a common bond with others who have sinusitis reduced quality of life. Basic elements of daily living from getting a good night's sleep to doing your job to enjoying your free time may become difficult or impossible. That's the bad news. Fortunately, there's good news about sinusitis, too enough to fill several chapters in this book, and I hope enough to help you find long-lasting relief. But before you dig in, I'd like to start by raising a few key points. You have...
Like adults, children can develop sinus infections. Most often, kids' infections follow on the heels of a cold, but they can also be triggered by allergies. Although the infection process is the same as in grown-ups, several factors specific to children affect the way we diagnose and treat pediatric sinusitis. First, doctors have a harder time distinguishing between a child's sinusitis and severe cold or allergies. In an infant or a young child, the only symptom of sinusitis that parents may notice is green nasal drainage, a nighttime cough, fever, or increased irritability. Physicians, meanwhile, usually do not have the benefit of a sinus CT scan. This tool is only used for the most persistent cases because we are hesitant to expose the child's developing body to radiation. combining decongestants, antihistamines, and cough suppressants are helpful for both colds and sinusitis. Antibiotics are prescribed when symptoms persist and sinusitis seems probable. Another difference is that...
Unless you have prior experience with sinusitis, you may have trouble distinguishing it from other ailments, such as colds and allergies. People often mistakenly confuse the three because so many of their symptoms are similar. But they are, in fact, different entities with different causes Colds. Whereas sinusitis is caused by bacteria, colds are caused by viruses. These much smaller microorganisms invade the body's cells, where they reproduce and are eventually released into the bloodstream to invade other cells. The body's immune system is usually quite effective at controlling viral infections, so most colds go away within a week. Colds can occur at any time but are most common during winter (the cold season). What can be confusing is that it's not uncommon for a cold to precede a sinus infection. Allergies can be either perennial, meaning they occur year-round, or seasonal. Allergies to dust and pet dander are often perennial. Seasonal allergies tend to be worst during the spring,...
Although it's likely that many genetic links to sinusitis will be found in the future, for now these are the two we know the most about. to abnormal secretions in various organs of the body, including the lungs, pancreas, liver, and reproductive tract. In the respiratory system, this dysfunction produces very thick mucus, which can block the lungs and sinuses, triggering pneumonia and sinusitis. More than 90 percent of patients with CF have chronic sinusitis large nasal polyps are also common. Many need sinus surgery to clear the polyps, which often regrow, requiring repeated surgery. Although in the past most people with CF did not survive into adulthood, treatments have become so effective in recent years that many CF patients are now living well into middle age. In addition, some children and adults are now being diagnosed with a milder form of CF that is caused by a partial defect in the DNA gene it's less likely to affect longevity, but secretions can still be thick, causing...
When you get a sinus infection, one of two things happens you get better or you don't. If your symptoms are gone within a month, or even two or three, you had acute sinusitis. But if the pain, congestion, drainage, or other symptoms last longer than three months, you have chronic sinusitis. This time frame, not the cause or symptoms, is the main thing that distinguishes acute sinusitis from chronic sinusitis. The mechanics of the infection and the way you feel when you're sick are essentially the same for both. Aside from the duration, about the only significant difference is that people with acute sinusitis are more likely to run a fever. In practical terms, however, there is a real difference. People who have acute sinusitis tend not to think of themselves as having a serious problem. They have an episode of sinusitis, which slows them down for a few days or weeks, but then it goes away, and they get on with their lives. People with chronic sinusitis, on the other hand, are engaged...
Women's bodies tend to retain fluid during pregnancy, and among the tissues that become swollen are the mucous membranes lining the nose and sinuses. Similar to a cold or allergies, this swelling can block the sinus ostia and trigger an infection. As a result, it's not uncommon for women with sinusitis to have more flare-ups than usual during pregnancy. If you are pregnant and have a persistent sinus infection, check with your obstetrician before taking any medication. Obstetricians often will OK use of medications that have been used for decades and have a safe pregnancy profile, such as the deconges-tant pseudoephedrine and the antibiotic amoxicillin. On the plus side, once a pregnant woman with sinusitis symptoms gives birth, the fluid retention recedes and the sinusitis usually subsides.
When a person has three common sinusitis symptoms congestion, postnasal drip, and headache it seems logical to conclude that he or she has sinusitis. But sometimes what seems logical is still wrong. How can this be In some cases, a person has more than one health ailment, so a constellation of symptoms that are actually unrelated seem connected, and what seems like sinusitis isn't really sinusitis at all. Let's take a look at some of the most common examples where patients and doctors may mistake other diseases for sinusitis.
People with sinusitis who don't get better with conventional therapy often try alternative treatments, such as acupuncture, herbs, vitamins, homeopathy, and more. If you're contemplating entering the world of alternative therapies, you're probably wondering, Do they work This is a tricky question to answer. Unfortunately, few rigorous studies have examined whether alternative therapies actually benefit people with sinusitis (or other chronic diseases, for that matter). Alternative therapies are not strictly regulated by the federal government, so practitioners and manufacturers have little incentive to conduct costly studies proving their techniques and products are safe and effective. Without research, we're left with anecdotal evidence, which makes it hard for me as a physician to give a ringing endorsement of any particular alternative therapy.
Vacuum sinusitis is a peculiar ailment in which a person seems to develop sinusitis symptoms without having an infection. We're not even 100 percent sure it exists, but we do know people sometimes have symptoms of sinusitis, particularly facial pain, which temporarily get better when they take sinus medications Because vacuum sinusitis is not well understood, ENT doctors are generally reluctant to operate on patients who have normal CT scans. Instead, we usually try steroids and decongestants. In addition, we look for another diagnosis that may be causing sinusitis-like symptoms, such as migraines, neuritis, or neuralgia, as discussed in Chapter 20.
For simplicity's sake, the Sinusitis Spectrum breaks down into three general categories (see Figure 6.1). On one end of the spec- 155 FIGURE 6.1 The Sinusitis Spectrum Everyone with sinusitis can be found somewhere along the Sinusitis Spectrum, based on the cause and severity of his or her disease. The spectrum is divided into three main groups Locals, Intermediates, and Systemics with each group responding to the various treatments for sinusitis in different ways. trum are people whose sinusitis stems from physical abnormalities within their nasal cavity or sinuses. People in this group have a site-specific, localized problem, so let's call them Locals. On the opposite end of the spectrum are those whose sinusitis can be traced to a more general disorder affecting other areas of their bodies, not just their nose and sinuses. You might think of your body as a large system, so we'll call them Systemics.
Decades from now, I expect that most patients with chronic sinusitis will be able to undergo a simple blood test and genetic TABLE 6.1 Symptoms and Treatments Across the Sinusitis Spectrum analysis to determine the precise type of sinusitis they have. Then we'll be able to use gene therapy to replace a missing enzyme or add a strand of deleted DNA, eliminating the inflammatory process that serves as the root cause of most cases of sinusitis. But for now, we know very little about the underlying causes of chronic sinusitis. We tend to lump all sinusitis patients together and treat them with the same regimens, even though they have many different diseases. Until we understand the answers to fundamental questions about the underlying causes of sinusitis, the best thing you can do to control your symptoms is develop a treatment plan based on where you fit on the Sinusitis Spectrum. Some of these treatments can be self-administered. Others need to be done in cooperation with your doctor.
Steroids are also the most effective tool we have for reducing nasal polyps, short of surgery. Polyps' size tends to vary depending on the individual's place on the Sinusitis Spectrum (see Figure 10.1). Most Locals don't have polyps, but if they do, the polyps tend to be small and located in or near the ostiomeatal complex (OMC). Intermediates often have larger polyps, which arise from 91 Figure 10.1 The Sinusitis Spectrum Polyps The location and size of nasal polyps correspond to where a person fits in on the Sinusitis Spectrum. The location and size of nasal polyps correspond to where a person fits in on the Sinusitis Spectrum. Most of this chapter focuses on nasal steroid sprays, because they are widely used by people with sinusitis. At the end, I'll address pills (oral steroids), which are used much less frequently due to their side effects.
From a physician's perspective, selecting the best antibiotic for a given case of sinusitis can be a guessing game. Why is this so First, there's an appalling lack of information on the effectiveness of different antibiotics for the treatment of chronic sinusitis. You may be surprised to learn that the U.S. Food and Drug Administration (FDA) has yet to approve even one antibiotic for the treatment of chronic sinusitis. Many antibiotics are approved to treat acute sinusitis, and doctors simply prescribe these same
A typical course of antibiotics for sinusitis lasts from ten to fourteen days. For more severe infections, the course can be extended to three to six weeks. However, in some circumstances, patients may benefit from antibiotic regimens that are either shorter or longer than the typical course. On the short end are the newer, powerful antibiotics such as Zithromax and Ketek that come in three- and five-day packages. Such short-dosing regimens are effective for people with acute sinusitis as well as those with chronic sinusitis who experience acute flare-ups. However, they may be less effective for individuals with severe infections. At the other extreme is a low-dose, long-term strategy, which may be appropriate for patients who continue to develop sinus infections even after repeated courses of antibiotics for conven-104, tional durations. Such regimens involve half the normal daily
Although food allergies that trigger sinusitis are relatively rare, they do occur often enough that I'm always on the lookout for them in people whose symptoms cannot be explained by more common causes. The tip-off that such an allergy may be present is when postnasal drip is the primary symptom. If you are particularly bothered by such drainage or constant collection of phlegm in the back of the throat, especially upon awakening you may well have a food allergy and not even be aware of it.
Vitamin C and zinc are the two supplements most often claimed to prevent infections. Research in this area has focused on colds whether these products have any beneficial effect on sinusitis in terms of either warding off infections or shortening their duration is not known.
For some people, an operation to open and drain blocked sinuses can have a dramatic effect. But how do you know if you're a good candidate for surgery Because sinusitis is not a life-threatening condition, deciding whether to have surgery is not black and white but, rather, shades of gray. Let's look at some of the issues that arise as you and your doctor make this important decision.
Around the same time that nasal endoscopes and sinus CT scans were introduced, an Austrian ENT doctor named Walter Messerklinger proposed a novel idea regarding the cause of sinusitis and its surgical treatment. According to Messerklinger, frontal and maxillary sinus infections were actually secondary obstructions. The primary cause of sinus obstruction lay in the OMC region of the ethmoid sinuses. Open up the ethmoids, he said, and the maxillary and frontal sinuses (which drain through the ethmoids) will resume normal function. There was no need to create artificial passageways or to scrape the interior sinus lining.
If you're in the midst of a sinus infection, your doctor may prescribe an antibiotic to clear the infection before surgery. Patients are usually advised to stop taking aspirin and aspirin-containing products one to two weeks prior to surgery aspirin 134, thins the blood and increases the risk of bleeding during surgery.
Some researchers believe fungi's role in sinusitis goes beyond the three types I've described. In fact, they think fungi cause almost all cases of chronic sinusitis. This novel viewpoint made headlines in 1999, when researchers at the Mayo Clinic published a study showing fungi are present in mucus samples from nearly all patients with sinusitis. Until then, other researchers had mostly focused on tissue samples and pus (which contains bacteria) to diagnose sinusitis, but not mucus (which contains fungus). The Minnesota researchers theorized that fungi trigger an influx of eosinophils in certain patients prone to sinus infections. These eosinophils attack the fungus by releasing inflammation-inducing substances, such as major basic protein (MBP), the presence of which irritates the sinus lining and puts patients at risk for a secondary bacterial infection. Treatment that focused on eliminating fungi, they said, would help huge numbers of patients whose sinusitis never seemed to go...
If in 1975 a person with sinusitis somehow magically fast-forwarded herself to the office of a present-day ENT doctor, she would be in for some pleasant surprises. Between CT scans, nasal endoscopes, and advances in surgery, the diagnostic and treatment options for sinusitis have improved dramatically.
Acute sinusitis sinusitis that lasts three months or less allergic fungal sinusitis type of sinusitis caused by a reaction to fungus in the sinuses allergy sensitivity to certain substances in the environment, such as pollens, foods, or microorganisms, that trigger a response by the immune system may cause nasal congestion, sneezing, and itching may trigger sinusitis amoxicillin antibiotic frequently prescribed for sinus infections a variant of penicillin atypical facial pain diagnosis given when facial pain has an unknown cause may be mistaken for sinusitis bromelain compound present in pineapples that may reduce sinusitis symptoms cephalosporin class of antibiotic often used to treat sinusitis an alternative to penicillin variants chronic sinusitis sinusitis that lasts more than three months congeners natural by-products of the fermentation process that are found in alcoholic beverages may trigger sinusitis symptoms cystic fibrosis hereditary disease characterized by the production...
I can't tell you how to keep your car on the road, but I can help you understand the chain of events that leads to sinusitis. In this chapter, we'll look at the causes of sinusitis and the resulting symptoms. Although there are many root causes of sinusitis, they all fall into one of three broad categories anatomical, genetic, and environmental (as shown in Table 3.1). TABLE 3.1 Root Causes of Sinusitis Normal flow of mucus from inside the sinuses through the ostia and into the nasal cavity is shown on the left side of the diagram. Note that in the maxillary sinus, the mucus flows upward to reach the natural drainage ostium before turning downward to flow into the nose. The right side shows what happens when mucosa lining the sinuses becomes inflamed and blocks the OMC. Mucus trapped within the maxillary and frontal sinuses leads to bacterial overgrowth and sinusitis. Although it may not seem obvious, the process that leads to sinusitis resembles what can happen almost anywhere in...
Causes the inside of your nose to swell, including allergies and sinusitis, can also cause the Eustachian tubes to swell shut, leading to ETD. With sinusitis, the increased mucus produced during an infection typically drains over the Eustachian tubes as it flows from the nose into the throat. This bacteria-laden drainage causes membranes that surround the Eustachian tubes to become inflamed, which prevents the tubes from opening. If fluid builds up in the ear, you can develop an ear infection on top of the sinus infection. The same antibiotics prescribed to treat sinus infections usually take care of ear infections as well.
The most common nonnarcotic cough suppressant is dex-tromethorphan, the active ingredient found in Robitussin and other cough medicines. More potent cough suppressants contain narcotics, such as codeine, requiring a prescription. Although coughing is not one of the more common sinusitis symptoms, it does occur when postnasal drip drains into the chest, especially when you are lying down at night.
It's important to have realistic expectations of what the procedure is likely to accomplish. Bear in mind that for most patients, sinus surgery does not provide a complete cure. Some sinus infections will still occur, but the frequency and severity of infections will be reduced. If you've had five or six sinus infections each year, surgery often can reduce the number to two or three. Not every cold will turn into another case of sinusitis. And if the procedure is successful, infections that do occur will be of shorter duration a briefer course of antibiotics will control your symptoms. One thing that's hard to predict is whether patients whose sense of smell has been impaired by sinusitis will regain this function. It depends on the cause of the defect. If repeated infections and polyp growth have severely eroded the nerve endings on olfactory receptors, then smell is not likely to return after surgery. If, on the other hand, loss of smell is caused by polyps and swollen tissue that...
Less severe but more common immune deficiencies also exist, and they may affect the sinuses. One example is a disorder known as IgG subclass deficiency. IgG is the name of the most common type of antibody. People with low levels of this antibody often have a history of recurrent bouts of pneumonia and sinusitis. A diagnosis of immune deficiency may be considered in cases in which a CT scan fails to show any obstructions that would trigger sinus infections. In other words, the sinus doors are open and the ostiomeatal complex is clear, but the person's sinuses nonetheless are perpetually infected. Such infections are believed to occur in these people because their immune systems are incapable of keeping the bacteria that normally exist in the sinuses in check.
Sinus infections are common among people with Wegener's, and the disease is often diagnosed during treatment for sinusitis. An ENT doctor who suspects a patient has Wegener's will order a series of blood tests, including one that detects the presence of antineutrophil cytoplasmic antibody, a marker for Wegener's. The diagnosis can also be confirmed with a biopsy of tissue from a turbinate.
The first study, published in 1997, followed more than one hundred patients who underwent surgery for chronic sinusitis. They rated their symptoms (such as headache, congestion, and drainage) before surgery and afterward at regular intervals for one year. They also reported on use of sinus medications and completed questionnaires about how sinusitis affected their quality of life. Overall, 82 percent of patients were found to have significant improvement following sinus surgery.
Acute sinusitis will make you feel lousy for several days. Here are some things you can do to ease the discomfort while the infection runs its course Irrigate your nose. Rinsing your nasal passages with salt water, a practice known as nasal irrigation, can help drain infected mucus. I'll discuss this technique in detail in Chapter 7. If you're in the midst of a bout with acute sinusitis, feel free to jump ahead to that section.
Penicillin and amoxicillin were once effective antibiotics for the treatment of sinusitis. During the past thirty years, however, many bacteria have developed resistance to these antibiotics. Although amoxicillin is still commonly prescribed as a first-line antibiotic for patients with acute sinusitis, it fails to clear the infection in up to 30 percent of cases. Many doctors now prescribe Augmentin, which contains amoxicillin and another medication, clavulanate. The addition of clavulanate ensures elimination of resistant strains of H flu and M cat. A doctor may choose a different antibiotic for patients who are allergic to amoxicillin, such as azithromycin (Zithromax), clarithromycin (Biaxin), or telithromycin (Ketek). Although most antibiotics are prescribed for ten days, azithro-mycin comes in both three-day (Tri-Pak) and five-day (Z-Pak) preparations these are adequate for many cases of acute sinusitis. Other commonly prescribed antibiotics include cefpodoxime (Vantin) and...
An episode of acute sinusitis can be painful and frustrating. But in most cases, it eventually goes away either with or without the aid of a physician. If the infection does not subside or keeps returning, then you may have chronic sinusitis, the subject of the remainder of this book. In the next chapter, I'll explain how chronic sinusitis is actually many different diseases what I call the Sinusitis Spectrum and help you develop a treatment plan that's right for you.
Locals have a straightforward anatomical problem. Examples include people whose sinusitis can be traced to any of the your postnasal drip and other symptoms completely clear between sinus infections If medications don't work, or if you do not wish to take them indefinitely, surgery to correct the anatomical problem is often effective. Such treatment might include a procedure known as a septoplasty to straighten the deviated septum, extraction of an infected tooth, or sinus surgery to clear an obstruction of the OMC. Locals are more likely than those with other forms of sinusitis to be cured by surgery for this reason, it's often recommended early in the treatment course if nasal endoscopy or CT scans reveal an anatomical defect.
If your mother sent you off to school as a child with the admonition to keep your nose clean, she was unwittingly giving you sage advice that can help in your struggle with sinusitis. Keeping your nose clean through a practice known as nasal irrigation can be a key to reducing sinusitis symptoms. Nasal irrigation washes out excess mucus that might otherwise lead to bothersome drainage or blocked breathing. Along with the mucus, you're also flushing out unwanted debris (including bacteria, mold, dust, and other irritants) that can cause nasal tissues to swell. So nasal irrigation really achieves two goals it opens more room to breathe and clears obstructions that might predispose you to sinusitis (see the sidebar Researchers Agree Irrigation Really Works ). 165 Eight randomized, controlled studies have assessed nasal irrigation. All eight reported significant positive outcomes on a variety of measures, according to a February 2004 letter to the Journal of Family Practice by Dr. David...
As effective as irrigations are at relieving nasal symptoms, most people with sinusitis need additional measures to obtain the relief they seek. Your local drugstore carries dozens of products intended to help people with sinusitis and other congestion-related ailments. Table 8.1 provides information on some of these products, including brand names, benefits and drawbacks, and general pricing information. Whether a particular product will help you depends on your specific symptoms and their cause. Let's take a look at what's available.
Decongestant medications are available in both spray and pill form. Spray decongestants such as Afrin, Dristan, Vicks, and Neo-Synephrine contain either oxymetazoline or phenylephrine. Although these sprays provide rapid relief of nasal congestion, I do not recommend them for people with chronic sinusitis because they offer a high potential for nasal rebound if used for more than three days (see Chapter 5).
Most antihistamines used to treat sinusitis are taken in pill form. There are two types of these oral antihistamines available sedating and nonsedating. The sedating side effect of these antihistamines can also be their benefit. Many patients take antihistamines at nighttime to help them fall asleep while controlling sinusitis symptoms.
Is that side effects are minimized because it's applied directly to the nasal passages, with little absorption into the bloodstream. Although it works well for some people with sinusitis and allergies, I've not found it to be as effective as oral antihistamines are for most. Also, it has an unpleasant taste that some people find intolerable.
Nasal steroid sprays are a logical and common next step for many sinusitis patients whose symptoms do not respond to over-the-counter treatments. Spraying steroids directly into your nose delivers the steroid in relatively high concentration to the nasal membranes, where it can block inflammation from allergies and other causes. A topical steroid spray can
Old-fashioned penicillin is no longer used for sinusitis, because it has lost its effectiveness against numerous bacteria. Instead, we now use amoxicillin, a variant of penicillin. Amoxicillin is usu- TABLE 11.1 Antibiotics Used to Treat Sinusitis TABLE 11.1 Antibiotics Used to Treat Sinusitis ally effective, but about one-third of patients will have resistant bacteria. Even so, because of its low cost and minimal side effects, amoxicillin is often the first antibiotic prescribed when someone is diagnosed with chronic sinusitis. If amoxicillin fails or if a physician believes it might a common alternative is Augmentin, which combines amoxicillin with clavulanate, a drug that inhibits an enzyme that would ordinarily render amoxicillin inactive. A ten- to twenty-one-day course of Augmentin is effective treatment for most people with chronic sinusitis who develop an infection.
A few other antibiotics are also used for sinusitis. The combination of trimethoprim and sulfamethoxazole (Septra, Bactrim) is effective but contains sulfa, which is a common cause of allergic reactions, some of which can be serious. Clindamycin (Cleocin) is particularly active against a robust type of bacteria known as anaerobes, which do not need oxygen to survive. With prolonged use, this antibiotic can cause a severe form of diarrhea. Linezolid (Zyvox) is effective in treating sinusitis caused by a resistant form of staph (called methicillin-resistant Staph aureus, or MRSA) but is extremely expensive, so it's reserved for the most difficult cases.
Strong perfumes and colognes are another potential workplace hazard for people with sinusitis, especially in offices where everyone is crammed side by side into small cubicles. Such unintended sharing of personal air space can cause what might be called sick cubicle syndrome. If you have a particular sensitivity to strong fragrances, you might experience an eruption of nasal and sinus symptoms, including itchy eyes and nose, runny nose, and congestion, all of which can lead to a full-blown case of sinusitis.
Here, the key issue is quality of life. Think about how sinusitis affects your day-to-day ability to function. How many sick days from work do you take Does sinusitis affect your social life Are you often tired How do you feel about the amount of medication you take Would your enjoyment of life change appreciably if you had fewer infections It's a very personal decision. One individual may find that missing two to three weeks of work each year for sickness is acceptable, while another feels it prevents him or her from reaching important career goals. The more you feel sinusitis is affecting your quality of life, the more the pendulum swings in favor of surgery.
Neuritis refers to inflammation of nerve endings that can trigger pain anywhere in the body. When the pain involves nerves in the face or head, it can be mistaken for a symptom of sinusitis. There are many causes of neuritis, including viral infection, diabetes, immune disorders, and trauma. Neuritis affecting nerves in the nose can sometimes occur after sinus surgery.
Neuralgia literally means nerve pain. Like neuritis, it has many different causes and can be confused with sinusitis when it affects the face or head. Trigeminal neuralgia a condition affecting the trigeminal nerve, which supplies sensation to much of the face is the most common type of neuralgia in this region. It usually involves intermittent episodes of brief, sharp, intense pain affecting one side of the face.
While computers will help make surgery safer and more efficient, I expect that operations for sinusitis will actually become much less common in the future. Surgery will still be needed for those whose sinusitis stems from anatomical abnormalities present at birth or caused by trauma later in life. But most of the people we currently consider Intermediates and Systemics won't need surgery, because of the introduction of new medications and techniques that address the root cause of an individual's sinusitis. The continued development of longer-acting and more broad-spectrum antibiotics is one example where drug development will be helpful in the near future. But the biggest impact on sinusitis over the next ten years is likely to be the development of whole new classes of medications that reduce inflammation and shrink or prevent polyps. Trials are currently under way to test the effectiveness of drugs that block the inflammatory response (including one called anti-IL5) and inhibit the...
I hope you benefited from reading this book and will now be spurred to pursue the care best suited for your sinusitis. Whether it's sinus irrigation, a new medication, a change in diet, or surgery, the important thing is to never give up. I can't tell you how many times patients who have struggled with sinusitis for years ultimately find relief through the treatments discussed in this book. I wish you the best of luck at healing your sinuses.
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You've probably seen pro football players on the sidelines wearing odd-looking pieces of tape across the bridge of their noses. Although the strips' effectiveness in enhancing athletic performance through better nasal breathing is doubtful, they can help relieve nasal obstruction in a subset of sinusitis sufferers whose obstruction is caused by a very specific problem a narrowed nasal valve.
The polyps associated with triad asthma usually grow so large that they obstruct nasal breathing and impair sense of smell. Although postnasal drainage is typically present, pain is usually minimal or absent. The standard regimen of sinusitis medications, including steroid sprays, are effective in some patients, but most require oral steroids, such as prednisone, to shrink their polyps significantly. Many of those with triad asthma elect to undergo surgery to remove the polyps and improve their quality of life. But no matter the treatment, the polyps usually regrow, requiring future courses of oral steroids and or surgery.
In some cases, people find out they have sarcoidosis after surgery for sinusitis, when microscopic examination of the removed tissue reveals granulomas. More commonly, it's picked up during a routine chest x-ray. Sarcoidosis produces a cobblestone appearance of the nasal mucosa, which is visible during endoscopic examination. If an ENT doctor suspects sarcoidosis as a cause of sinusitis, the diagnosis can be confirmed by a biopsy of the nasal tissue. The diagnosis can also be confirmed by a blood test known as an ACE level, which measures the amount of angiotensin converting enzyme in the blood, a substance known to be elevated in those with this disease.
A general consensus exists among physicians that oral deconges-tants and mucus-thinning agents benefit many patients with sinusitis. By contrast, the role of antihistamines is more controversial. Because antihistamines can dry out your nasal passages and thicken secretions, some doctors believe people with sinusitis should never take them. I don't share this view. I believe antihistamines do have a role for many people with sinusitis, particularly those whose infections seem to be related to allergies. And even if you don't have a history of environmental allergies, a trial of antihistamines should be considered if pseudoephedrine and guaifenesin haven't provided relief.
The incidence of sinusitis and asthma has increased during the past decade. Although the cause for this increase remains unknown, one theory is that it's because more people are working in sealed buildings where they can't open a window to let in fresh air. Instead, the interior air is constantly recirculated. As a result, it tends to be quite dry. And if the building is contaminated with indoor pollutants such as mold and spores, fibers from carpeting and upholstery, and chemicals in insulation and copy machines then the ventilation system serves to recirculate the impurities. Tainted air can irritate the lining of your nose, lungs, and sinuses, blocking breathing and setting the stage for an infection. This reaction can be due to a true allergic response in which your body's immune system triggers the release of a host of inflammatory factors. It can also result from direct inflammation in which a chemical, for example, burns or irritates the nasal mucosa. Some of my patients who...
The middle turbinates also can become large and block breathing. Unlike the inferior turbinates, however, their growth is usually the result of enlargement of the bone, not the membranes. The turbinate bone expands when an air-filled compartment develops inside of it. A widened middle turbinate, referred to as a concha bullosa, can compress the adjacent OMC, leading to recurrent bouts of sinusitis. Enlarged middle turbinates that are believed to be causing sinusitis are often trimmed or removed during sinus surgery.
It's not uncommon for people with sinusitis to develop a new infection or see their symptoms flare up within twenty-four hours of drinking an alcoholic beverage. The problem is not the alcohol itself but the presence of impurities known as congeners, which are the by-products of the fermentation and aging process. Congeners provide much of the beverage's taste and aroma, but some have histamine-like properties. Similar to what happens with an allergic reaction to pollen or dust, individuals who are sensitive to these impurities can experience nasal congestion, drainage, and headaches.
A migraine can be confused with sinusitis because nasal discharge often accompanies the headache. However, unlike sinusitis, the drainage from a migraine is usually clear and one-sided. Also, the pain from migraines is more likely to be located on the side of the head, whereas sinus headaches tend to occur in the forehead region or the back of the head. In addition, migraines are likely to affect only one side of the head, whereas sinus headaches usually occur on both sides. A variant known as facial migraine can be mistaken for maxillary sinusitis because it causes pain in the cheeks and or forehead. This entity is a real possibility when patients have facial pain but their sinus CT scans are clear. Although sinusitis and migraines are two separate entities, for some people the two ailments appear to be related. It's not uncommon for sinus infections to trigger migraine headaches. In these cases, getting better control of sinusitis often leads to a reduction in the frequency of...
Table 8.1 Drugstore Products That May Reduce l Sinusitis Symptoms_ One final note. Patients often ask me whether they should buy a warm- or cool-mist humidifier. Warm-mist models boil the water before it's released, and they tend to stay clean a bit longer but are more expensive. Apart from the cleaning issue, warm-mist models are of no particular benefit for people with sinusitis. The extra warmth of the inhaled mist can help individuals with respiratory problems involving the throat and lungs (such as babies with croup). But you need moisture, and cool mist is just as moist as warm mist.
Haemophilus influenzae is a common pathogen of the human respiratory tract. Isolates of H. influenzae can be divided into encapsulated and nonencapsulated, or nontypable, forms. Prior to the use of H. influenzae conjugate vaccines, capsulated strains of H. influenzae were the primary cause of childhood bacterial meningitis and a major cause of other bacteremic diseases in children. Vaccines effective against nontypable strains have not yet been developed and these strains remain important human pathogens, causing pneumonia, otitis media, sinusitis, and bronchitis. Several
A 13-year-old girl presented to the emergency department of a tertiary medical center complaining of a severe headache and her heart beating too fast. Her mother reported a 3-month history of headaches occurring 2-3 times per week, bilateral in nature, occurring with sudden onset at any time of day, and lasting less than one hour. The headaches had been increasing in severity. The patient denied nausea, vomiting, photophobia, paresthesias, and aura. She was sleeping 8-10 hours each night and was not allowed any caffeinated beverages. She had not begun menses. Over-the-counter analgesics were ineffective and used only a few times. The patient had no history of upper respiratory infection, seasonal allergies, or sinusitis during the previous 3 months. She had no significant past medical history she had received all her immunizations. Family history included hypertension, coronary artery disease, and thyroid cancer in her deceased paternal grandfather, migraine headaches in her mother,...
In a healthy pediatric patient, the most common causes of headache are caffeine withdrawal, stress tension, sleep deprivation, sinusitis, cluster headache, and migraine. Several of these etiologies were ruled out by taking a careful history. Physical exam and CT of the head demonstrated no hemorrhage, tumor, or other structural malformation.
Millions of people suffer from allergies, which ultimately affects their workplace productivity and results in billions of dollars lost each year. These reactions include respiratory diseases (asthma, sinusitis, rhinitis), adverse drug effects, and unusual skin rashes. Because allergies have an underlying immunologic component, these specialists are also experts on antibodies, antigens, and other complex
Common problems seen in infants, children and teenagers include chronic pharyngitis, sinusitis, and otitis media, hearing loss, congenital cysts and masses, aspiration and swallowing disorders, and upper airway obstruction sleep apnea. Common surgical cases in pediatric otolaryngology include tonsillectomies and adenoidectomies, myringotomy and pressure-equalization tube placement, endoscopic sinus surgery, removal of foreign bodies of the upper aerodigestive tract and ear canals, upper airway endoscopy and surgery (including tracheotomies and tracheal reconstruction), resection of branchial cleft or other congenital cysts masses, otologic surgery such as tympanoplasties and mastoidectomies, and occasionally, cochlear implants.
Sinusitis Infection of the sinuses, the air sacs next to the nasal passages, usually as a result of a cold or allergy. Sinusitis is common, especially in people with HIV infection, although the reason for this is obscure. Symptoms are pus drainage from the nose, headache, face pain, and fever. The usual treatment is with antibiotics taken by mouth, such as TRIMETHOPRIM-SULFAMETHOXZOLE, AMOXICILLIN, erythromycin, cephalexin (Keflex), ciprofloxacin (Cipro), or tetracycline. Some people do not respond to these drugs, and their sinuses need to be drained.
Major complications of the CF disease occur in the respiratory tract, causing sinusitis and respiratory failure. Severe bacterial infestation of the respiratory passage is also a major problem in CF patients. The second most common complications arise in the gastrointestinal tract. Other organ systems that are involved and show complications are the sweat glands (salt loss syndrome) and reproductive system (male infertility and reduced female fertility) (Table 26.3). The disease presentation varies from patient to patient depending upon the functional status of the CFTR protein or by the type of mutation present in the CFTR gene. In addition, new evidences suggest roles for some modifier genes and environmental factors in the development of CF.33,34 The pancreas is an important gland of the digestive and endocrine system of the body carrying out both the exocrine and endocrine function. The exocrine function is carried out by the acinar cells that produce the enzymes needed to digest...
A 48-year-old white male presented to the pain management clinic with a history of chronic sinus pain. The pain was a result of severe chronic frontal sinusitis that was refractory to medical management, including three previous endoscopic sinus surgeries and frontal sinusotomy. Chronic sinusitis is one of the most prevalent chronic illnesses that can affect people of all age groups. In the United States, chronic sinusitis affects approximately 32 million people each year and accounts for 11.6 million visits to physicians' offices.1 Chronic sinusitis is defined as a sinus infection that persists for more than 3 months.1 Common symptoms of chronic sinusitis include nasal congestion, cough, postnasal drip, facial tenderness, and pressure. Most cases are continuations of unresolved acute sinusitis. Allergic and nonallergic rhinitis, anatomic obstruction in the osteomeatal complex, and immunologic disorders are known risk factors.1 The diagnosis of sinusitis is usually confirmed using...
ABPA found in 1 -2 of pts wilti fCID 37 (Suppl 3) 37. 2003 Clinical manifestations- wheezing, putmon ary Infiltiates. bronchiectasis & librosis Airway colonization assoc. with T blood eosinophils t seium IgE,1 spectlic serum antibodies Allergic fungal sinusitis relapsing chronic sinusitis, nasal polyps wilhoul bony invasion, asthma, eczema or allergic rhinitis. T IgE levels and isolation ol Aspeigillus sp or other demaliaceous sp (Allotnana, Cladosporium, etc) In 1 report, fungal elements identilied by hislopalhology in up to 93 ot cases ot chronic sinusitis & in a DBPCT in 24 pts, intranasal amplio was assoc with a I In mucosal thickening ot 8.6 by CT scan vs ol 2 5 in placebo (LnlD 4 257. 2004) Conlioveisial aiea
The new PCV vaccine (Prevnar) protects against the organism Streptococcus pneumoniae (also known as pneumococcus), the leading cause of pneumonia, sinusitis, ear infection, and meningitis. It has been added to the recommended schedule of childhood immunizations. It is given to infants as a series of four inoculations administered at age two, four, six, and 12 to 15 months of age. If a child cannot begin the vaccine at two months, parents should discuss alternative schedules with their doctor.
Sinus surgery and rhinology deal with the medical and surgical aspects of nasal and sinus disease, as well as disorders involving the anterior skull base. Common problems include nasal obstruction and smell disturbances, chronic sinusitis and rhinitis, allergies, proptosis, and medical and surgical disease involving the anterior skull base. The advent of surgical endoscopes and modern video imaging, coupled with advancements in three-dimensional CT scan-guided surgical Common surgical cases include endoscopic sinus surgery for chronic maxillary, ethmoid, or sphenoid sinusitis or chronic polyposis, endoscopic nasal septal reconstruction, endoscopic approaches to tumors of the sella turcica (like pituitary adenomas), orbital decompressions, frontal sinus surgery (both open and endoscopic), repairs of cerebrospinal fluid leaks in the anterior skull base, and oncologic surgery. The majority of sinus surgical cases are performed on an outpatient basis anterior skull base surgery and...
Left untreated, allergic rhinitis also can lead to other serious conditions, including asthma, recurrent middle ear infections, sinusitis, sleep disorders, and chronic cough. Appropriate management of rhinitis is an important part of effectively managing these coexisting or complicating respiratory conditions.
Pneumococcal meningitis is the second most common type of bacterial meningitis, which kills one out of every five people who contract it. Children under age two are among the most easily infected. This type of meningitis occurs sporadically during the cold and flu season but not in epidemics. This bacteria is also responsible for ear infection, pneumonia, and sinusitis. There are more than 80 types of N. meningitidis.
Sinusitis, acute current terminology acute rhinosinusltls ' Pediatric doses for sinusitis (all oral) Amoxicillin ugh dose 90 mg pot kg pet day ov q8horql2h AM-CL-ES extra strength) posalnc susp 90 mg amox comp.*i nt pot kg per day dv ql2h azithro to mg pet kg tones t llien 5 mg per kg pet day tones 3 days clarithro 15 nig per kg pet day drv q12h cefpodoxlme lOmgpot kgpet day (max 400mg)dv ql2-24l cefuroxime axetll 30 mg pet kg pet day dv q 2r. cefdlnlr 14 mg per kg pet d3y once
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