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 "sinus 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 With
regard to sinus 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 Sinus treatment consists of doing
steam inhalation frequently and for 10 minutes at a time. This 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. 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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