sinusitis – cold the · sinusitis, medical therapy using antibiotics is the mainstay of...
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How do you get sinusitis?Typically sinusitis presents like a
cold that does not clear after a
week. There is usually a history of a viral
upper respiratory tract infection. The patient
remembers having a sore throat occasionally
with fever and muscle aches or tiredness
about 1 week to 10 days, previously. This is
usually followed by persistent nasal blockage,
colored nasal discharge & phlegm in the throat
and cough. Some patients will ignore these
symptoms as they see them just as an irritation
and not something serious. These symptoms
then persist for months and progressively
develop into chronic sinusitis.
What are the sinuses?The nasal sinuses are pockets that
develop from the nose cavity proper
into the facial bones. The lining of the sinuses
consists of pseudo stratified columellar
epithelium that produces mucus and have
cilia. The mucus coats the cilia at the surface
lining and the cilia is continuously moving
the layer of mucus from within the sinus to
outside where it opens into the nasal cavity.
This mucociliary conveyor belt mechanism
is so efficient that normally the contents
of our sinuses are sterile in health. Because
of that, there is no chance of finding any
environmental pollutant like soot, bacteria or
even viral particles within the sinuses.
Sinusitis –
ColdThe
that never goes away
What sort of mucolytics is best?You would need one that regulates
the excess mucus production seen & that
normalizes the mucous viscosity. It should
restore the ventilation & drainage of the sinuses
& eliminate stagnation of mucus in the sinus by
restoring the mucociliary clearance.
You would also need one that has no
interaction with other drugs & without any
gastric irritation. It should work in synergy with
the common antibiotics used. Finally it should
be safe in children and in pregnancy, and
suitable for long term treatment.
What is the common cause of delayed response or failure to respond to medical therapy?
• Inappropriate antibiotics use with antibiotic
bacterial resistance.
• Inappropriate antihistamine use with
secretions getting more viscous and drainage
of the sinuses affected with stagnation of
secretions within.
• Failure to take adequate rest & hydration.
• Secondary Smoke & Other Environmental
Irritants/Allergens.
• Failure to use adjuvant treatment like
mucolytics.
In a diseased and unhealthy state, the sinuses
conveyer belt mechanism fails from damage
to the cilia, quality change of the mucus or
swelling of the sinonasal lining cells due to
inflammation. This causes accumulation of
mucus and pus from secondary infections and
builds up pressure within the sinus, resulting in
acute discomfort and pain. When this infection
and inflammation prolongs and if treatment
is not sought early, it will lead to chronic
persistent blockage and ache.
How do you treat & get well from sinusitis?The goal of medical therapy is to
restore mucociliary clearance, drainage and
aeration of the sinuses. For acute & chronic
sinusitis, medical therapy using antibiotics is the
mainstay of treatment.Adjuvant therapy with
nasal saline rinse, topical & oral decongestant,
anti-histamines, topical & oral steroids, &
mucolytics is considered.
Exactly what adjuvant therapy is dependent
on the patient’s symptoms.
If there is a lot of nasal itch and sneezing
then an antihistamine is considered. However
this is rare in sinusitis and anti-histamines are
rarely used. If there is nasal congestion and
blockage with post nasal drip & cough, then
topical steroids & mucolytics are used. Most
cases of infective sinusitis present as the latter
symptom complex. Dr A B JohnConsultant Ear Nose & Throat SurgeonMBBS, FRCS, FAMS.
A. B. John Ear Nose & Throat (ENT) Clinic & Surgery3 Mount Elizabeth #15-10 Mount Elizabeth Medical Centre Tel: 6735 9654 www.sinonasal.com
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January 2011 | ezyhealth&beauty 23
medical
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