NOSE & SINUSES:

Sinusitis is the most common chronic medical condition in the country. This disorder of the upper airway affects 37 million Americans and leads to debilitating pain and a decline in quality-of-life.

1.Causes of Sinus Pain

2.20 Questions About Your Sinuses

3.Sinus Surgery

4.Sinus Pain: Can Over-the-Counter Medications Help?

5.Pediatric Sinusitis

 

Causes of Sinus Pain :

You don't have a cold or allergy–you have a sinus condition. What does that mean?

An ear, nose, and throat specialist will determine if your sinus pain results from:

Click here to Donate now and make a Difference

20 Questions About Your Sinuses :

Q. How common is sinusitis?

A. More than 37 million Americans suffer from at least one episode of acute sinusitis each year. The prevalence of sinusitis has soared in the last decade due to increased pollution, urban sprawl, and increased resistance to antibiotics. Q. What is sinusitis? A. Sinusitis is an inflammation of the membrane lining of any sinus, especially one of the paranasal sinuses. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants; chronic sinusitis is characterized by at least four recurrences of acute sinusitis. Either medication or surgery is a possible treatment. Q. What are the signs and symptoms of acute sinusitis? A. For acute sinusitis, symptoms include facial pain/pressure, nasal obstruction, nasal discharge, diminished sense of smell, and cough not due to asthma (in children). Additionally, sufferers of this disorder could incur fever, bad breath, fatigue, dental pain, and cough (in adults).Acute sinusitis can last four weeks or more. This condition may be present when the patient has two or more symptoms and/or the presence of thick, green or yellow nasal discharge. Acute bacterial infection might be present when symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection. Q. How is acute sinusitis treated? A. Acute sinusitis is generally treated with 10 to 14 days of antibiotic care. With treatment, the symptoms disappear and antibiotics are no longer required for that episode. Oral and topical decongestants also may be prescribed to alleviate the symptoms. Q. What are the signs and symptoms of chronic sinusitis? A. Victims of chronic sinusitis may have the following symptoms for 12 weeks or more: facial pain/pressure, facial congestion/fullness, nasal obstruction/ blockage, thick nasal discharge/ discolored post-nasal drainage, pus in the nasal cavity, and at times, fever. They may also have headache, bad breath, and fatigue. Q. What measures can be taken at home to relieve sinus pain? A. Warm moist air may alleviate sinus congestion. A vaporizer or steam from a pan of boiled water (removed from the heat) are both recommended (humidifiers should have a clear filter to preclude spraying bacteria or fungal spores into the air). Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose drops are safe for use at home. Q. How effective are non-prescription nose drops or sprays? A. Use of nonprescription drops or sprays might help control symptoms. However, non-prescription drops should not be used beyond their label recommendation. Q. How does a physician determine the best treatment for acute or chronic sinusitis? A. To obtain the best treatment option, the physician needs to properly assess the patient’s history and symptoms and then progress through a structured physical examination. Q. What should one expect during the physical examination for sinusitis? A. At a specialist’s office, the patient will receive a thorough ear, nose, and throat examination. During that physical examination, the physician will explore the facial features where swelling and erythema (redness of the skin) over the cheekbone exists. Facial swelling and redness are generally worse in the morning; as the patient remains upright, the symptoms gradually improve. The physician may feel and press the sinuses for tenderness. Additionally, the physician may tap the teeth to help identify an inflamed paranasal sinus. Q. What other diagnostic procedures might be taken? A. Other diagnostic tests may include a study of a mucus culture, endoscopy, x-rays, allergy testing, or CT scan of the sinuses. Q. What is nasal endoscopy? A. An endoscope is a special fiberoptic instrument for the examination of the interior of a canal or hollow viscus. It allows a visual examination of the nose and sinus drainage areas. Q. Why does a physician specialist carry out nasal endoscopy? A Nasal endoscopy offers the physician specialist a reliable, visual view of all the accessible areas of the sinus drainage pathways. First, the patient’s nasal cavity is anesthetized; a rigid or flexible endoscope is then placed in a position to view the structure of the nasal cavity. The procedure is utilized to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the physician specialist also looks for pus as well as polyp formation and structural abnormalities that will cause the patient to suffer from recurrent sinusitis. Q. What course of treatment will the physician recommend? A. To reduce congestion, the physician may prescribe nasal sprays, nose drops, or oral decongestants. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). Antihistamines may be recommended for the treatment of allergies. Antifungal medicine will be the treatment for any fungal infection. Q. Will any changes in lifestyle be suggested during treatment?A. Smoking is never condoned, but if one has the habit, it is important to refrain during treatment for sinus problems. A special diet is not required, but drinking extra fluids helps to thin mucus. Q. When is sinus surgery necessary? A. Mucus is developed by the body to act as a lubricant. In the sinus cavities, the lubricant is moved across mucous membrane linings toward the opening of each sinus by millions of cilia (a mobile extension of a cell). Inflammation from an allergy causes membrane swelling and the sinus opening to narrow, thereby blocking mucus movement. If antibiotics are not effective, sinus surgery can correct the problem. Q. What does the surgical procedure entail? A. The basic endoscopic surgical procedure is performed under local or general anesthesia. The patient returns to normal activities within four days; full recovery takes about four weeks. Q. What does sinus surgery accomplish? A. The surgery should enlarge the natural opening to the sinuses, leaving as many cilia in place as possible. Otolaryngologist—head and neck surgeons have found endoscopic surgery to be highly effective in restoring normal functioning to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucus. Q. What are the consequences of not treating infected sinuses? A. Not seeking treatment for sinusitis will result in unnecessary pain and discomfort. In rare circumstances, meningitis or brain abscess and infection of the bone or bone marrow can occur.Q. Where should sinus pain sufferers seek treatment?

A. If you suffer from severe sinus pain, you should seek treatment from a physician who can treat your condition with medical and/or surgical remedies.

Click here to Donate now and make a Difference
 
Sinus Surgery

An otolaryngologist—head and neck surgeon will, for the most part, advocate surgery when antibiotics and other medical treatments fail to alleviate chronic sinusitis or multiple episodes of acute sinus infection. Before considering surgery, the otolaryngologist will typically prescribe four to six weeks of antibiotics plus sprays, decongestants, and possibly antihistamines and steroids.

Surgery for Acute Sinusitis

Antibiotics are generally effective for most cases of acute sinusitis resulting in severe facial pain and pressure. Other treatments for lingering symptoms include sinus irrigation, which requires the placement of an instrument in the maxillary sinus to flush out that cavity with salt water. Two types of acute sinus infection require special attention from a specialist. A severe infection of the frontal (forehead) or sphenoid sinus (behind the eyes) can be very serious.

If oral or intravenous antibiotics are not effective, surgical drainage of the sinus may be undertaken. The sphenoid sinus can be accessed surgically through the nose or through an incision under the eyebrow. The latter procedure requires hospitalization.


Surgery for Chronic Sinusitis
Most surgeries on the sinuses are conducted to relieve a chronic condition. In the past, operations on the sinuses were conducted externally through incisions on the face. Incisions were made under the upper lip through the gum (the Caldwell-Luc operation) or an external ethmoidectomy, a removal of the sinuses between the eyes through an incision in the face. However, most surgical procedures for the sinuses are now carried out using endoscopic sinus surgery.

Endoscopic Sinus Surgery
Twenty years ago, otolaryngologist —head and neck surgeons would perform surgery on the individual sinuses that had become infected, leading to the use of procedures such as the Caldwell-Luc operation.

Since then, the development of endoscopic sinus surgery (ESS) ushered in a new philosophy allowing the surgeon to target the ostiomeatal complex (OMC), an area in the anterior ethmoid sinus region. Obstruction in the OMC can lead to subsequent infection of the maxillary, frontal, and sphenoid sinuses. Accordingly, endoscopic sinus surgery, a procedure through the nose, removes thickened and diseased tissue that blocks the OMC. Most of the healthy tissue in the sinuses is undisturbed allowing rapid recovery.

Endoscopic surgery can also be utilized for removal of polyps and to straighten the septum thus restoring a normal flow from the sinuses. Unlike other sinus surgical procedures, endoscopic sinus surgery has minimal and usually temporary effect on the patient's appearance.

What to expect from endoscopic surgery

The endoscopic procedure usually lasts from one to three hours and is performed using general or local anesthesia. Generally, the patient goes home after surgery unless other medical conditions complicate recovery.

Full recovery may take several weeks. Dry blood, mucus, and crusting in the nose may occur, presenting symptoms of a severe cold or sinus infection. Nasal irrigation or salt-water sprays and antibiotic lubricants as recommended by the surgeon to facilitate normal sinus activity. Proper post-operative care is essential to prevent scar formation and allow normal healing. The surgeon performing the procedure will generally perform all required follow-up procedures.

Patients who depend on their voice for their livelihood should be warned that endoscopic sinus surgery may have an effect on their resonance. Additionally, some patients may have underlying nasal mucosal problems that remain after surgery. This is seen in highly allergic individuals or asthmatics.

 
 

Sinus Pain: Can Over-the-Counter Medications Help?

Why do we suffer from nasal and sinus discomfort?

The body’s nasal and sinus membranes have similar responses to viruses, allergic insults, and common bacterial infections. Membranes become swollen and congested. This congestion causes pain and pressure; mucus production increases during inflammation, resulting in a drippy, runny nose. These secretions may thicken over time, may slow in their drainage, and may predispose to future bacterial infection of the sinuses. Congestion of the nasal membranes may even block the eustachian tube leading to the ear, resulting in a feeling of blockage in the ear or fluid behind the eardrum. Additionally, nasal airway congestion causes the individual to breathe through the mouth. Each year, more than 37 million Americans suffer from sinusitis, which typically includes nasal congestion, thick yellow-green nasal discharge, facial pain and pressure. Many do not understand the nature of their illness or what produces their symptoms. Consequently, before visiting a physician, they seek relief for their nasal and sinus discomfort by taking non-prescription or over-the-counter (OTC) medications.
What is the role of OTC medication?
There are many different OTC medications available to relieve the common complaints of sinus pain and pressure, allergy problems, and nasal congestion. Most of these medications are combination products that associate either a pain reliever such as acetaminophen with a decongestant or an antihistamine. Knowledge of these products and of the probable cause of symptoms will help the consumer to decide which product is best suited to relieve the common symptoms associated with nasal or sinus inflammation. OTC nasal medications are designed to reduce symptoms produced by the inflammation of nasal membranes and sinuses. The goals of OTC medications are to: (1) reopen to nasal passages; (2) reduce nasal congestion; (3) relieve pain and pressure symptoms; and (4) reduce potential for complications. The medications come in several forms.
Nasal saline sprays: non-medicated nasal sprays Nasal saline is an invaluable addition to the list of over-the-counter medications. It is ideal for all types of nasal problems. The added moisture produced by the saline reduces thick secretions and assists in the removal of infectious agents. There is no risk of becoming “addicted” to nasal saline. It should be applied as a mist to the nose up to six times per day. Nasal saline can also be made at home: use one cup of boiled water and ¼ tsp. of non-iodized salt with or without ¼ tsp. of baking soda.

Nasal decongestant sprays: medicated nasal sprays Afrin nasal spray, Neo-Synephrine, Otrivin, Dristan nasal spray, and other brands decongest the swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating the initial stages of a common cold or viral infection. Nasal decongestant sprays are safe to use, especially appropriate for preventing eustachian tube problems when flying, and to halt progression of sinus infections following colds. However, they should only be utilized for 3-5 days because prolonged use leads to rebound congestion or “getting hooked on nasal sprays.” The patient with nasal swelling caused by seasonal allergy problems should use a cromolyn sodium nasal spray. The spray must be used frequently (four times a day) during allergy season to prevent the release of histamine from the tissues, which starts the allergic reaction. It works best before symptoms become established by stabilizing the nasal membranes and has few side effects.

Decongestant medications Pressure and congestion are common symptoms of nasal passage swelling. Decongestant medications are OTC products that relieve nasal swelling, pressure, and congestion but do not treat the cause of the inflammation. They reduce blood flow to the nasal membranes leading to improved airflow, less breathing through the mouth, decreased pressure in the sinuses and head, and subsequently less discomfort. Decongestants do not relieve drippy noses. Their side effects may include light headedness or giddiness and increased blood pressure and heart rate. (Patients with high blood pressure or heart problems should consult a physician before use.) In addition, other medications may interact with oral decongestants causing side effects. The most common decongestants are pseudoephedrine (Sudafed) and phenylpropanolamine. Both of these are available as single products or in combination with a pain reliever or an antihistamine. They are labeled as “non-drowsy” due to a side effect of stimulation of the nervous system.

Decongestant-combination products Some medications are combined to reduce the number of pills. Tylenol–Sinus or Advil Cold and Sinus exemplify products that join a pain reliever (acetaminophen or ibuprophen) with a decongestant (pseudoephedrine). These products relieve both sinus and cold/flu symptoms yet retain all the attributes of the individual drug including side effects.

Antihistamine medications Antihistamines combat allergic problems leading to nasal congestion. OTC antihistamines such as diphenhydramine (Benadryl), or clemastine (Tavist) may be used for relieving allergic symptoms of itching, sneezing, and nasal congestion. They relieve the drainage associated with the allergic inflammation but not obstruction or congestion. Antihistamines have a potential for sedation causing grogginess and dryness after use. Newer nonsedating antihistamines are available.

Antihistamine-decongestant combination products

Antihistamines and decongestant products are often combined to relieve multiple symptoms of congestion and drainage and reduce the side effects of both products. Antihistamines produce sedation; decongestants are added to make them “non-drowsy.” The combined allergy product then relieves congestion and a runny nose.

Pediatric Sinusitis

Your child’s sinuses are not fully developed until age 20. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms can be subtle and the causes complex.

How do I know when my child has sinusitis?
The following symptoms may indicate a sinus infection in your child:

  • a “cold” lasting more than 10 to 14 days, sometimes with a low-grade fever;
  • thick yellow-green nasal drainage;
  • post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting;
  • headache, usually not before age 6;
  • irritability or fatigue;
  • swelling around the eyes.

Young children have immature immune systems and are more prone to infections of the nose, sinus, and ears, especially in the first several years of life. These are most frequently caused by viral infections (colds), and they may be aggravated by allergies. However, when your child remains ill beyond the usual week to ten days, a serious sinus infection is likely.

You can reduce the risk of sinus infections for your child by reducing exposure to known environmental allergies and pollutants such as tobacco smoke, reducing his/her time at day care, and treating stomach acid reflux disease.

How will the doctor treat sinusitis?

Acute sinusitis

Most children respond very well to antibiotic therapy. Nasal decongestants or topical nasal sprays may also be prescribed for short-term relief of stuffiness. Nasal saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane function. If your child has acute sinusitis, symptoms should improve within the first few days. Even if your child improves dramatically within the first week of treatment, it is important that you continue therapy until all the antibiotics have been taken.

Your doctor may decide to treat your child with additional medicines if he/she has allergies or other conditions that make the sinus infection worse.

Chronic sinusitis

If your child suffers from sinus symptoms that last for two to three months, this is known as chronic sinusitis. If your child has chronic sinusitis or recurrent episodes of acute sinusitis numbering more than four to six per year, you should seek consultation with an ear, nose, and throat (ENT) specialist. The ENT may recommend surgical treatment of the sinuses.

Diagnosis of sinusitis

If your child sees an ENT specialist, the doctor will examine his/her ears, nose, and throat. A thorough history and examination usually leads to the correct diagnosis. Occasionally, special instruments will be used to look into the nose during the office visit. An x-ray called a CT scan may help to determine how your child's sinuses are formed, where the blockage has occurred, and the reliability of a sinusitis diagnosis.

When is surgery necessary?
Surgery is considered for the small percentage of children with severe or persistent sinusitis symptoms despite medical therapy. Using an instrument called an endoscope, the ENT surgeon opens the natural drainage pathways of your child's sinuses and makes the narrow passages wider. This also allows for culturing so that antibiotics can be directed specifically against your child's sinus infection. Opening up the sinuses and allowing air to circulate usually results in a reduction in the number and severity of sinus infections.

Also, your doctor may advise removing adenoid tissue from behind the nose as part of the treatment for sinusitis. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue, called adenoiditis, or obstruction of the back of the nose can cause many of the symptoms that are similar to sinusitis, namely, runny nose, stuffy nose, post-nasal drip, bad breath, cough, and headache.

Summary
Sinusitis in children is different than sinusitis in adults. Children more often demonstrate a cough, bad breath, crankiness, low energy, and swelling around the eyes along with a thick yellow-green nasal or post-nasal drip. Once the diagnosis of sinusitis has been made, children are successfully treated with antibiotic therapy in most cases. If medical therapy fails, surgical therapy can be used as a safe and effective method of treating sinus disease in children.