Those Painful Sinuses

Doctors have a lot of work in the winter months with the low temperatures, the monsoon, and the festivals with smoky fireworks. Almost everyone complains of colds and “sinusitis”.

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We have four pairs of sinuses that drain into the nasal cavity: frontal above the nose, maxillary in the cheekbone area, ethmoidal at the roof of the nose and between the orbits of the eyes, and sphenoidal on the sides of the forehead near the corner of the eyes. Sinuses are present at birth and continue to grow and develop until adolescence. They are, in fact, useful as they contain air, which helps to modulate the pitch and timber of the voice. They also reduce the total weight of the skull, which would otherwise be composed of heavy solid bone. They are lined with mucous membranes similar to that in the nose.

Sinuses may become inflamed as a result of viral infections, which are likely to occur with seasonal changes. A “cold” causes the nose to clog up and the natural orifices through which secretions from the sinus drain get blocked. Acute allergies to pollen, smoke, room fresheners and mosquito repellents compound the blockage. As the membrane swells, it exudes mucoid secretions which fill the sinus.

The space in the sinus is limited on all sides by rigid bone, leaving no room for expansion. The typical throbbing headache develops, and worsens on changing positions as the mucous shifts around. These clogged secretions may become secondarily infected by bacteria.

Sinusitis produces a nasal block, a thick yellow or green discharge, a troublesome sleep-disturbing night cough, fever and swelling over the affected sinuses. It can also cause bad breath, which persists despite brushing the teeth or using mouthwashes.

Acute sinusitis can be completely cured in 30 days with treatment — adequate doses of appropriate antibiotics for 10-14 days. If the treatment is discontinued after a few doses as relief is obtained, the infection tends to recur.

Recurrent sinusitis occurs in cycles with at least a 10-day, symptom-free intervening period. It occurs when there is exposure to the allergen again and again, perpetuating a cycle of nose blocks, infections, treatment and relief.

Sinusitis is labelled as chronic only if it persists for more than 90 days. It can be caused by a variety of bacteria or even fungi. It is rare in normal healthy individuals unless there is an aggravating factor. Pus from an infected untreated tooth, particularly in the upper jaw, can burrow into the maxillary sinus.

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Some people have a deviated nasal septum (the partition between the two halves of the nose is not straight). This can be present from birth. It may develop as a result of injury. The small openings draining the sinuses may become blocked by the bent nose. Allergies, which are untreated and chronic, can cause permanently swollen nasal mucosa. This can form grape-like swellings called polyps. Children sometimes insert stones, peas, erasers and other objects into their nose. They can remain wedged, unsuspected and undiagnosed, causing a permanent nose block and sinusitis. Swollen adenoids can also perpetuate sinusitis.

Treatment of sinusitis is likely to succeed only if the aggravating factors are removed. Drainage of the infected material also has to be facilitated. This can be done by using nasal drops. Saline nasal drops are the safest and can be used as often as required. Nasal drops containing chemicals like oxymetaxoline, xylometazoline or ephedrine should be used 3-4 times a day only for the first three to four days, if at all.

Although immediate relief is obtained, in the long run habituation occurs. The nose does not open up even when the drops are used.

Continuous use can also cause rebound congestion. If the nasal mucosa is permanently swollen because of chronic allergy, the newer, non-absorbed steroid nasal sprays are helpful. Steam inhalations and humidifiers also help with liquefaction of the secretions and drainage.

Pain over the sinuses, fever and headache all respond well to paracetemol, which is sold under a variety of trade names. The dose of paracetemol is 500mg three to four times a day for adults and 10-15mg/kg/dose for children.

Sinusitis because of allergy or a viral infection does not need antibiotics. Antbiotics should be used for bacterial infections. Eradication of an infection is difficult, as sinuses are closed spaces. Antibiotics have to be carefully selected and need to be given for 10-14 days for a complete cure. Immunisation covers two of the organisms (H. Influenza and pneumococcus) which can cause sinusitis. This means that children who have been completely immunised are unlikely to be infected by these organisms.

Decongestants and mucous liquefying agents are also helpful if used in addition to other medicines. Antihistamines are not useful, as they tend to dry up the secretions, making them sticky and adherent.

Sinusitis, allergies and respiratory ailments all decrease in frequency and intensity with regular aerobic exercise, like 40 minutes of jogging, swimming or running daily.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Sources: The Telegraph (Kolkata, India)

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