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Medical Hand Book -9
From Er.Sulthan
Chronic sinusitis
ஹல ோ டோக்டர்!
குசை சுல்தோன்
வழங்கும்
மருத்துவ சைலேடு-9
(ENGLISH)
Prevention is
Better than
Cure
Health Manager
Thanks to
Mayo Foundation for Medical Education and
Research (MFMER).
Presentation
From
Er.Sulthan
Chronic sinusitis
Definition
With chronic sinusitis, the cavities around nasal
passages (sinuses) become inflamed and swollen. This
interferes with drainage and causes mucus to build up.
This common condition is also called chronic
rhinosinusitis.
If you have chronic sinusitis, it may be difficult to
breathe through your nose. The area around your eyes
and face may feel swollen, and you may have throbbing
facial pain or a headache.
Chronic sinusitis may be caused by an infection but can
also be caused by growths in the sinuses (nasal
polyps) or a deviated nasal septum. While most people
have a short-lived bout of sinusitis at some point
(known as acute sinusitis), chronic sinusitis is sinusitis
that lasts more than eight weeks or keeps coming
back.
Anatomy of the Sinuses
Symptoms
Chronic sinusitis symptoms include:
Drainage of a thick, yellow or greenish discharge from the nose or down the back
of the throat
Nasal obstruction or congestion, causing difficulty breathing through your nose
Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
Aching in your upper jaw and teeth
Reduced sense of smell and taste
Cough, which may be worse at night
Other signs and symptoms can include:
Ear pain
Sore throat
Bad breath (halitosis)
Fatigue or irritability
Nausea
The signs and symptoms of chronic sinusitis are similar to acute sinusitis, except
they last longer and often cause more significant fatigue. Chronic sinusitis is
sinusitis that lasts more than eight weeks or keeps coming back. Unlike with
acute sinusitis, fever isn't a common sign of chronic sinusitis.
When to see a doctor
You may have several episodes of acute sinusitis, lasting less than four weeks,
before developing chronic sinusitis. You may be referred to an allergist or an ear,
nose and throat specialist for evaluation and treatment.
See a doctor:
If you've had sinusitis a number of times and the condition fails to
respond to treatment
If you have sinusitis that lasts more than 7 days
If your symptoms don't get better after you see your doctor
See a doctor immediately if you have symptoms that may be a sign of a serious
infection:
Pain or swelling around your eyes
A swollen forehead
Severe headache
Confusion
Double vision or other vision changes
Stiff neck
Shortness of breath
Causes
When you have sinusitis, the mucous membranes of your nose,
sinuses and throat (upper respiratory tract) become swollen. This
swelling blocks the sinus openings and prevents mucus from
draining normally.
Blocked sinuses create a moist environment that makes it easier
for infection to take hold. Sinuses that become infected and can't
drain become pus-filled, leading to symptoms such as thick,
yellowish or greenish discharge and other symptoms of infection.
Common causes of chronic sinusitis include:
Nasal polyps or tumors. These tissue growths may block the nasal
passages or sinuses.
Allergic reactions. Allergic triggers include fungal infection of the
sinuses.
Deviated nasal septum. A crooked septum — the wall between the
nostrils — may restrict or block sinus passages.
Trauma to the face. A fractured or broken facial bone may cause
obstruction of the sinus passages.
Other medical conditions. The complications of cystic fibrosis, gastroesophageal
reflux, or HIV and other immune system diseases may result in nasal blockage.
Respiratory tract infections. Infections in your respiratory tract — most commonly,
colds — can inflame and thicken your sinus membranes, blocking mucus drainage and
creating conditions ripe for growth of bacteria. These infections can be viral, bacterial or
fungal in nature.
Allergies such as hay fever. Inflammation that occurs with allergies may block your
sinuses.
Immune system cells. With certain health conditions, immune cells called eosinophils
can cause sinus inflammation.
Risk factors
You're at increased risk of getting chronic or recurrent sinusitis if you
have:
A nasal passage abnormality, such as a deviated nasal septum, or
nasal polyps
Aspirin sensitivity that causes respiratory symptoms
A medical condition such as cystic fibrosis or gastroesophageal reflux
(GERD)
An immune system disorder such as HIV/AIDS or cystic fibrosis
Hay fever or another allergic condition that affects your sinuses
Asthma — about one in 5 people with chronic sinusitis have asthma
Regular exposure to pollutants such as cigarette smoke
Complications
• Chronic sinusitis complications include:
• Asthma flare ups. Chronic sinusitis can trigger an asthma
attack.
• Meningitis, an infection that causes inflammation of the
membranes and fluid surrounding your brain and spinal
cord.
• Vision problems. If infection spreads to your eye socket,
it can cause reduced vision or even blindness that can be
permanent.
• Aneurysms or blood clots. Infection can cause problems
in the veins surrounding the sinuses, interfering with blood
supply to your brain putting you at risk of a stroke.
Tests and diagnosis
• To look for the cause of your symptoms, your doctor will
feel for tenderness in your nose or throat. Your doctor may
use a tool to hold your nose open and apply medication
that constricts blood vessels in your nasal passages. This
makes it easier to see inside your nasal passages. Your
doctor will then shine a light into your nasal passages to
look for inflammation or fluid. This visual inspection will
also help rule out physical conditions that trigger sinusitis,
such as nasal polyps or other abnormalities.
• Your doctor may use several methods to help screen for
chronic sinusitis:
• Nasal endoscopy. A thin, flexible tube (endoscope) with a
fiber-optic light inserted through your nose allows your
doctor to visually inspect the inside of your sinuses.
• Imaging studies. Images taken using computerized
tomography (CT) or magnetic resonance imaging (MRI) can
show details of your sinuses and nasal area. These may
identify a deep inflammation or physical
• obstruction that's difficult to detect using
• an endoscope.
Nasal and sinus cultures. Laboratory tests are generally unnecessary for diagnosing
chronic sinusitis. However, in cases in which the condition fails to respond to treatment
or is progressing, tissue cultures may help pinpoint the cause, such as identifying a
bacterial pathogen.
An allergy test. If your doctor suspects that the condition may be brought on by
allergies, an allergy skin test may be recommended. A skin test is safe and quick and
can help pinpoint the allergen that's responsible for your nasal flare-ups.
Treatments and drugs
• Endoscopic sinus surgery
The goal of treating chronic sinusitis is to:
Reduce sinus inflammation
Keep your nasal passages draining
Eliminate the underlying cause
Reduce the number of sinusitis flare-ups you have
Treatments to relieve symptoms
Your doctor may recommend treatments to help relieve sinusitis symptoms.
These include:
Saline nasal spray, which you spray into your nose several times a day to
rinse your nasal passages.
Nasal corticosteroids. These nasal sprays help prevent and treat
inflammation. Examples include fluticasone (Flonase), budesonide (Rhinocort
Aqua), triamcinolone (Nasacort AQ), mometasone (Nasonex) and
beclomethasone (Beconase).
Oral or injected corticosteroids. These medications are used to relieve
inflammation from severe sinusitis, especially if you also have nasal polyps.
Examples include prednisone and methylprednisolone. Oral corticosteroids can
cause serious side effects when used long term, so they're only used to treat
severe asthma symptoms.
Decongestants. These medications are available in over-the-counter (OTC) and
prescription liquids, tablets and nasal sprays. Examples of OTC oral decongestants
include Sudafed and Actifed. Nasal sprays include phenylephrine (Neo-Synephrine) and
oxymetazoline (Afrin). These medications are generally only taken for a few days at
most; otherwise they can cause the return of more severe congestion (rebound
congestion).
Over-the-counter pain relievers such as aspirin, acetaminophen (Tylenol, others) or
ibuprofen (Advil, Motrin, others). Because of the risk of Reye's syndrome — a potentially
life-threatening illness — never give aspirin to children.
Aspirin desensitization treatment, if you have reactions to aspirin that cause sinusitis.
However, this treatment can have serious complications such as intestinal bleeding or
severe asthma attacks.
Antibiotics
Antibiotics are sometimes necessary for sinusitis if you have a bacterial infection.
However, chronic sinusitis is usually caused by something other than bacteria and
antibiotics won't help.
Antibiotics used to treat chronic sinusitis caused by a bacterial infection include
amoxicillin (Amoxil, Trimox, others), doxycycline (Doryx, Monodox, others) or the
combination drug trimethoprim-sulfamethoxazole (Bactrim, Septra, others). If the
infection doesn't subside or if the sinusitis comes back, your doctor may try a different
antibiotic.
If your doctor does prescribe antibiotics, it's critical to take the entire course of
medication. Generally, this means you'll need to take them for 10 to 14 days or even
longer — even after your symptoms get better. If you stop taking them early, your
symptoms may come back.
Immunotherapy
If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help
reduce the body's reaction to specific allergens may help treat the condition.
Surgery
In cases that continue to resist treatment or medication, endoscopic sinus surgery may
be an option. For this procedure, the doctor uses an endoscope, a thin, flexible tube with
an attached light, to explore your sinus passages. Then, depending on the source of
obstruction, the doctor may use various tools to remove tissue or shave away a polyp
that's causing nasal blockage. Enlarging a narrow sinus opening also may be an option
to promote drainage.
Picture of the anatomy of the sinuses
Lifestyle and home remedies
• These self-help steps can help relieve sinusitis symptoms:
• Get plenty of rest. This will help your body fight infection and
speed recovery.
• Drink plenty of fluids, such as water or juice. This will help
dilute mucous secretions and promote drainage. Avoid beverages
that contain caffeine or alcohol, as they can be dehydrating.
Drinking alcohol can also worsen the swelling of the lining of the
sinuses and nose.
• Steam your sinus cavities. Drape a towel over your head as you
breathe in the steam from a bowl of hot water. Keep the steam
directed toward your face. Or take a hot shower, breathing in the
warm, moist air. This will help ease pain and help mucus drain.
• Apply warm compresses to your face. Place warm, damp
towels around your nose, cheeks and eyes to ease facial pain.
• Rinse out your nasal passages. Use a specially designed
squeeze bottle (Sinus Rinse, others), bulb syringe or neti pot to
rinse your nasal passages. This home remedy, called nasal lavage,
can help clear your sinuses.
• Sleep with your head elevated. This will help your sinuses
drain, reducing congestion.
Prevention
• Take these steps to reduce your risk of getting
chronic sinusitis:
• Avoid upper respiratory infections. Minimize
contact with people who have colds. Wash your
hands frequently with soap and water, especially
before your meals.
• Carefully manage your allergies. Work with
your doctor to keep symptoms under control.
• Avoid cigarette smoke and polluted air.
Tobacco smoke and air contaminants can irritate
and inflame your lungs and nasal passages.
• Use a humidifier. If the air in your home is dry,
such as it is if you have forced hot air heat,
adding moisture to the air may help prevent
sinusitis. Be sure the humidifier stays clean and
free of mold with regular, thorough cleaning.
Antibiotics: Use them wisely
Antibiotics are the first line of defense against many infections. But overusing or
misusing antibiotics can cause more harm than good.
Your head throbs, your nose is stuffy, and you're too tired to do anything but flop into bed
at the end of the day. You're probably coming down with a cold or the flu. But if you think
that antibiotics will help you feel better, think again. Antibiotics won't do a thing for viral
illnesses such as colds, flu and most sore throats. What's more, taking antibiotics when
you don't need them actually can be harmful. Here's more information on what
antibiotics are, when they should and shouldn't be used, and what you can do to combat
antibiotic resistance.
What are antibiotics?
Antibiotics are powerful drugs used for treating many serious and life-threatening
infectious diseases, but taking them when you don't need to can lead to antibiotic-
resistant germs. Antibiotics are only effective against bacterial infections, certain fungal
infections and some kinds of parasites. Most infections result from either bacteria or
viruses. Antibiotics can't help you if a virus is responsible for your illness.
Bacterial infections cause: Viral infections cause:
Some ear infections Most ear infections
Severe sinus infections Colds
Strep throat Influenza (flu)
Urinary tract infections Most coughs
Many wound and skin infections Most sore throats
Bronchitis
Stomach flu (viral gastroenteritis)
Superbugs: How antibiotic resistance develops
Since penicillin was introduced in the 1940s, scientists have developed more than 150
antibiotics to help stop the spread of infectious disease. But although these drugs have
saved millions of lives, the misuse of antibiotics has caused problems. Their frequent
use, often for conditions or infections that aren't caused by bacteria, has given rise to
bacteria that are resistant to many commonly used antibiotics.
Superbugs emerge when an antibiotic fails to kill all of the bacteria it targets, and the
surviving bacteria become resistant to that particular drug and frequently other
antibiotics as well. Doctors then prescribe a stronger antibiotic, but the bacteria quickly
learn to withstand the more potent drug as well, perpetuating a cycle in which
increasingly powerful drugs are required to treat infections.
Antibiotic-resistant strains of bacteria began to appear soon after penicillin was
introduced. Today, antibiotic-resistant strains have become common, and bacteria
resistant to a number of antibiotics have developed. Once only seen in hospitals,
outbreaks of some resistant strains — such as methicillin-resistant Staphylococcus
aureus (MRSA) — are appearing in the wider community.
For years, the potent antibiotic vancomycin (Vancocin) was a reliable last defense
against certain severe infections, notably those caused by staphylococcus bacteria.
But in recent years, some superbugs have become able to resist vancomycin.
While experts are working to develop new antibiotics and other treatments to keep
pace with antibiotic-resistant strains of bacteria, infectious organisms adapt quickly.
Antibiotic-resistant bacteria will continue to be a global health concern — and using
antibiotics wisely is an important part of preventing their spread.
While experts are working to develop new antibiotics and other treatments to keep
pace with antibiotic-resistant strains of bacteria, infectious organisms adapt quickly.
Antibiotic-resistant bacteria will continue to be a global health concern — and using
antibiotics wisely is an important part of preventing their spread.
Consequences of antibiotic resistance
When more and more bacteria become resistant to first line treatments, the
consequences are severe. Illnesses last longer, and the risk of complications and death
increases. In the United States alone, thousands of people die each year of infections
they contract in the hospital from antibiotic-resistant bacteria. The inability to treat a
particular infection leads to longer periods in which a person is contagious and able to
spread the resistant strains to others.
The failure of first line treatments also means that doctors have to resort to less-
conventional medications, many of which are much more costly and more toxic than
common drugs are. For instance, the drugs needed to treat multidrug-resistant forms of
tuberculosis (TB) are much more expensive than are the drugs used to treat
nonresistant TB. The course of treatment is long — up to two years — and the side
effects can be severe.
Other consequences are the increased costs associated with prolonged illnesses,
including the direct expense for additional laboratory tests, treatments and
hospitalization, and the indirect costs from loss of income or time away from family.
Safeguard effective antibiotics: What you can do
Using antibiotics too often or incorrectly is a major cause of the increase in resistant
bacteria. Here are some things you can do to promote proper use of antibiotics:
Understand when antibiotics should be used. Don't expect to take antibiotics every
time you're sick. Antibiotics are effective in treating most bacterial infections, but they're
not useful against viral infections, such as colds, acute bronchitis, or the flu. And even
some common bacterial ailments, such as mild ear infections, don't benefit much from
antibiotics.
Don't pressure your doctor for antibiotics if you have a viral illness. Instead, talk
with your doctor about ways to relieve the symptoms of your viral illness — a saline
nasal spray to clear a stuffy nose, for instance, or a mixture of warm water, lemon and
honey to temporarily soothe a sore throat.
Take antibiotics exactly as prescribed. Follow your doctor's instructions when taking
prescribed medication, including how many times a day and for how long. Never stop
treatment a few days early if you start feeling better — a complete course of antibiotics
is needed to kill all of the harmful bacteria. A shortened course of antibiotics, on the
other hand, often wipes out only the most vulnerable bacteria, while allowing relatively
resistant bacteria to survive.
Never take antibiotics without a prescription. If you didn't complete a full course of
antibiotics, you might be tempted to use the leftover medication the next time you get
sick or to pass it along to someone else. But this isn't a good idea. For one thing, the
antibiotic might not be appropriate for a future illness. And even if it is, you're not likely
to have enough pills to combat the germs making you sick, which can lead to more
resistant bacteria.
Protect yourself from infection in the first place. Good hygiene can go a long way
in preventing infection. Wash your hands thoroughly with soap and water, especially
after using the toilet, changing a diaper or handling raw meat or poultry. Keep food
preparation areas clean. Although antibacterial cleaners and soap are widely available,
they aren't necessary. Plain soap and water works fine to kill germs in most settings.
The scope of your responsibility
Antibiotic resistance is a pressing, global health problem. Nearly all significant
bacterial infections in the world are becoming resistant to commonly used
antibiotics. When you abuse antibiotics, the resistant microorganisms that you help
create can become widely established, causing new and hard-to-treat infections.
That's why the decisions you make about antibiotic use — unlike almost any other
medicine you take — extend far beyond your reach. Responsible antibiotic use
protects the health of your family, neighbors and ultimately the global community.
Aspirin allergy: What are the symptoms?
• I think I may have an aspirin allergy. What are the
symptoms?
• Answer
• from James T. Li, M.D.
• It's possible to have a sensitivity to aspirin. In fact, aspirin
can cause a severe asthma attack — especially in people
who have asthma or sinus problems. Reactions to aspirin
are often related to the drug itself, however, rather than to
an allergic or immunological response to the drug.
• Signs and symptoms of aspirin sensitivity — which usually
occur within a few hours of taking the medication — range
from mild to serious and may include:
• Hives
• Itchy skin
• Runny nose
• Swelling of the lips, tongue or face
• Coughing, wheezing or shortness of breath
• If you've had a reaction to aspirin, avoid all forms
of aspirin. It's also best to avoid other
nonsteroidal anti-inflammatory drugs (NSAIDs)
as well, including ibuprofen (Advil, Motrin,
others) and naproxen (Aleve, others). Keep in
mind that aspirin and other NSAIDs are found in
many over-the-counter medications — so check
labels carefully.
• If you think you might have an aspirin sensitivity,
consult your doctor or allergist for advice. Rarely,
aspirin can cause a life-threatening reaction.
Action is the proper fruit of knowledge.
The best of all medicines is resting and fasting
Health is a blessing that money cannot buy.
From Er.Sulthan
Chest infection
Medical Hand Book-10
From
Health Manager