How
will the doctor treat sinusitis?
Acute sinusitis: Treatment of acute sinusitis
is designed to relieve blockage of the sinus opening and restore
cilial functions. Antihistamine/decongestants can reduce inflammation
and decrease fluid production. Bacteria can be treated with
antibiotics and should be taken for the full course as prescribed
by your doctor.
Chronic sinusitis: Drugs may releive congestion
in the sinuses by reducing fluid secretion and swelling. Sinus irrigation
may be recommended to clean out old mucus. Antibiotics can treat
recurrent bacterial infections, but your doctor many also recommend
an allergy control program for long-term management. In some cases,
nasal and/or sinus surgery may be needed to improve sinus drainage
or to remove nasal obstructions.
Diagnosis of sinusitis: The diagnosis
of chronic sinusitis is usually made on the basis of
a medical history. Examination, x-rays, or CT scan
help to reveal thickened mucosa, blocked sinus openings,
and obstructions such as a deviated septum, polyps,
and inflamed turbinates that can interfere with drainage.
When is surgery necessary?
Only a small percentage of adults with severe or persistent sinusitis require
surgery to relieve symptoms that do not respond to medical therapy. Using
an instrument called an endoscope, the ENT surgeon opens the natural drainage
pathways of your sinuses and makes the narrow passages wider. This also
allows for culturing so that antibiotics can be directed specifically against
your sinus infection. Opening up the sinuses and allowing air to circulate
usually results in a reduction in the number and severity of sinus infections.
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.
You
and Your Stuffy Nose
Nasal congestion, stuffiness, or obstruction to nasal breathing is one
of man's oldest and most common complaints. While it may be a mere nuisance
to some persons, to others it is a source of considerable discomfort, and
it detracts from the quality of their lives.
Medical writers have classified the causes of nasal obstruction into four
categories, recognizing that overlap exists between these categories and
that it is not unusual for a patient to have more than one factor involved
in his particular case.
Infection
An average adult suffers a common "cold" two to three times per
year, more often in childhood and less often the older he gets as he develops
more immunity. The common "cold" is caused by any number of different
viruses, some of which are transmitted through the air, but most are transmitted
from hand-to-nose contact. Once the virus gets established in the nose,
it causes release of the body chemical histamine, which dramatically increases
the blood flow to the nose, causing swelling and congestion of nasal tissues,
and stimulating the nasal membranes to produce excessive amounts of mucus.
Antihistamines and decongestants help relieve the symptoms of a "cold," but
time alone cures it.
During a virus infection, the nose has poor resistance against bacterial
infections, which explains why bacterial infections of the nose and sinuses
so often follow a "cold." When the nasal mucus turns from clear
to yellow or green, it usually means that a bacterial infection has taken
over and a physician should be consulted.
Acute sinus infections produce nasal congestion, thick discharge, and pain
and tenderness in the cheeks and upper teeth, between and behind the eyes,
or above the eyes and in the forehead, depending on which sinuses are involved.
Chronic sinus infections may or may not cause pain, but nasal obstruction
and offensive nasal or postnasal discharge is often present. Some persons
develop polyps (fleshy growths in the nose) from sinus infections, and
the infection can spread down into the lower airways leading to chronic
cough, bronchitis, and asthma. Acute sinus infection generally responds
to antibiotic treatment; chronic sinusitis usually requires surgery.
Structural Causes
Included in this category are deformities of the nose and the nasal septum,
which is the thin, flat cartilage and bone that separates the nostrils
and nose into its two sides. These deformities are usually due to an injury
at some time in one's life. The injury may have been many years earlier
and may even have been in childhood and long since forgotten. It is a fact
that 7 percent of newborn babies suffer significant nasal injury just from
the birth process; and, of course, it is almost impossible to go through
life without getting hit on the nose at least once. Therefore, deformities
of the nose and the deviated septum should be fairly common problems --
and they are. If they create obstruction to breathing, they can be corrected
with surgery.
One of the most common causes for nasal obstruction in children is enlargement
of the adenoids: tonsil-like tissues that fill the back of the nose up
behind the palate. Children with this problem breath noisily at night and
even snore. They also are chronic mouth breathers, and they develop a "sad" long
face and sometimes dental deformities. Surgery to remove the adenoids and
sometimes the tonsils may be advisable.
Other causes in this category include nasal tumors and foreign bodies.
Children are prone to inserting various objects such as peas, beans, cherry
pits, beads, buttons, safety pins, and bits of plastic toys into their
noses. Beware of one-sided foul smelling discharge, which can be caused
by a foreign body. A physician should be consulted
Allergy
Hay fever, rose fever, grass fever, and "summertime colds" are
various names for allergic rhinitis. Allergy is an exaggerated inflammatory
response to a foreign substance which, in the case of a stuffy nose, is
usually a pollen, mold, animal dander, or some element in house dust. Foods
sometime play a role. Pollens cause problems in spring (trees) and summer
(grasses) or fall (weeds) whereas house dust allergies and mold may be
a year-around problem. Ideally the best treatment is avoidance of these
substances, but that is impractical in most cases.
In the allergic patient, the release of histamine and similar substances
results in congestion and excess production of watery nasal mucus. Antihistamine
Help relieve the sneezing and runny nose of allergy. Many antihistamines
are now available without a prescription. The most familiar brands include
Chlor-Trimeton®, Benadryl®, Clarinex®, Claritin®, Allegra®,
and Zyrtec® (although most are also available in generic forms). Decongestants,
such as Sudafed® (also available in generic forms) shrink congested
nasal tissues. Combinations of antihistamines with decongestants are also
available; for example, Actifed®, Allegra D®, Chlortrimetron D®,
Claritin D®. All these preparations have potential side effects, and
patients must heed the warnings of the package or prescription insert.
This is especially important if the patient suffers from high blood pressure,
glaucoma, irregular heart beats, difficulty in urination, or is pregnant.
Allergy shots are the most specific treatment available, and they are highly
successful in allergic patients. Skin tests or at times blood tests are
used to make up treatment vials of substances to which the patient is allergic.
The physician determines the best concentration for initiating the treatment.
These treatments are given by injection. They work by forming blocking
antibodies in the patient's blood stream, which then interfere with the
allergic reaction. Many patients prefer allergy shots over drugs because
of the side effects of the drugs.
Patients with allergies have an increased tendency to develop sinus infections
and require treatment as discussed in the previous section.
Vasomotor Rhinitis
''Rhinitis" means inflammation of the nose and nasal membranes. "Vasomotor" means
blood vessel forces. The membranes of the nose have an abundant supply
of arteries, veins, and capillaries, which have a great capacity for both
expansion and constriction. Normally these blood vessels are in a half-constricted,
half-open state. But when a person exercises vigorously, his/her hormones
of stimulation (i.e., adrenaline) increase. The adrenaline causes constriction
or squeezing of the nasal membranes so that the air passages open up and
the person breathes more freely.
The opposite takes place when an allergic attack or a ''cold'' develops:
The blood vessels expand, the membranes become congested (full of excess
blood), and the nose becomes stuffy, or blocked.
In addition to allergies and infections, other events can also cause nasal
blood vessels to expand, leading to vasomotor rhinitis. These include psychological
stress, inadequate thyroid function, pregnancy, certain anti-high blood
pressure drugs, and overuse or prolonged use of decongesting nasal sprays
and irritants such as perfumes and tobacco smoke.
In the early stages of each of these disorders, the nasal stuffiness is
temporary and reversible. That is, it will improve if the primary cause
is corrected. However, if the condition persists for a long enough period,
the blood vessels lose their capacity to constrict. They become somewhat
like varicose veins. They fill up when the patient lies down and when he/she
lies on one side, the lower side becomes congested. The congestion often
interferes with sleep. So it is helpful for stuffy patients to sleep with
the head of the bed elevated two to four inches accomplish this by placing
a brick or two under each castor of the bedposts at the head of the bed.
Surgery my offer dramatic and long time relief.
Summary
Stuffy nose is one symptom caused by a remarkable array of different disorders,
and the physician with special interest in nasal disorders will offer treatments
based on the specific causes.
Allergic
Rhinitis (Hay Fever)
- Causes
- Symptoms
- When to see a doctor
- Treatment
Allergic rhinitis (hay fever) is an especially common chronic nasal problem
in adolescents and young adults. Allergies to inhalants like pollen, dust,
and animal dander begin to cause sinus and nasal symptoms in early childhood.
Infants and young children are especially susceptible to allergic sensitivity
to foods and indoor allergens.
What causes allergic rhinitis?
Allergic rhinitis typically results from two conditions: family history/genetic
predisposition to allergic disease and exposure to allergens. Allergens
are substances that produce an allergic response.
Children are not born with allergies but develop symptoms upon repeated
exposure to environmental allergens. The earliest exposure is through food—and
infants may develop eczema, nasal congestion, nasal discharge, and wheezing
caused by one or more allergens (milk protein is the most common). Allergies
can also contribute to repeated ear infections in children. In early childhood,
indoor exposure to dust mites, animal dander, and mold spores may cause
an allergic reaction, often lasting throughout the year. Outdoor allergens
including pollen from trees, grasses, and weeds primarily cause seasonal
symptoms.
The number of patients with allergic rhinitis has increased in the past
decade, especially in urban areas. Before adolescence, twice as many boys
as girls are affected; however, after adolescence, females are slightly
more affected than males. Researchers have found that children born to
a large family with several older siblings and day care attendance seem
to have less likelihood of developing allergic disease later in life.
What are allergic rhinitis symptoms?
Symptoms can vary with the season and type of allergen and include sneezing,
runny nose, nasal congestion, and itchy eyes and nose. A year-long exposure
usually produces nasal congestion (chronic stuffy nose).
In children, allergen exposure and subsequent inflammation in the upper
respiratory system cause nasal obstruction. This obstruction becomes worse
with the gradual enlargement of the adenoid tissue and the tonsils inherent
with age. Consequently, the young patient may have mouth-breathing, snoring,
and sleep-disordered breathing such as obstructive sleep apnea. Sleep problems
such as insomnia, bed-wetting, and sleepwalking may accompany these symptoms
along with behavioral changes including short attention span, irritability,
poor school performance, and excessive daytime sleepiness.
In these patients, upper respiratory infections such as colds and ear infections
are more frequent and last longer. A child’s symptoms after exposure
to pollutants such as tobacco smoke are usually amplified in the presence
of ongoing allergic inflammation.
When should my child see a doctor?
If your child’s cold-like symptoms (sneezing and runny nose) persist
for more than two weeks, it is appropriate to contact a physician.
Emergency treatment is rarely necessary except for upper airway obstruction
causing severe sleep apnea or an anaphylactic reaction caused by exposure
to a food allergen. Treatment of anaphylactic shock should be immediate
and requires continued observation and care.
What happens during a physician visit?
The doctor will first obtain an extensive history about the child, the
home environment, possible exposures, and progression of symptoms. Family
history of atopic/allergic disease and the presence of other disorders
such as eczema and asthma strongly support the diagnosis of allergic rhinitis.
The physician will seek a link between the symptoms and exposure to certain
allergens.
The physician will examine the skin, eyes, face and facial structures,
ears, nose, and throat. In some cases, a nasal endoscopy may be performed.
If the history and the physical exam suggest allergic rhinitis, a screening
allergy test is ordered. This can be a blood test or a skin prick test.
In most children it is easier to obtain a blood test known as the RadioAllergoSorbent
Test or RAST. This test measures the amount of specific Immunoglobulin
E antibodies (IgE) in the blood responding to various environmental and
food allergens.
The skin test results, often immediately available, may be affected by
the recent use of antihistamines and other medications, dermatologic conditions,
and age of the patient. The blood test is not affected by medication, and
results are usually available in several days.
How is allergic rhinitis treated?
The most common treatment recommendation is to have the child avoid the
allergens causing the allergic sensitivity. The physician will work with
caregivers to develop an avoidance strategy based on the nature of the
allergen, exposure, and availability of avoidance measures.
Cost and lifestyle are important factors to consider. For mild, seasonal
allergies, avoidance could be the most effective course of action. If pet
dander is the offender, consideration should be given to removing the pet
from the child’s environment.
Severe symptoms, multiple allergens, year-long exposure, and limited resources
for environmental control may call for additional treatment measures. Nasal
saline irrigations, nasal steroid sprays, and non-sedating antihistamines
are indicated for symptom control. Nasal steroids are the most effective
in reducing nasal symptoms of allergic rhinitis. A short burst of oral
steroids may be appropriate for some patients with severe symptoms or to
gain control during acute attacks.
If symptoms are severe and due to multiple allergens, the child is symptomatic
more than six months in a year, and if all other measures fail, then immunotherapy
(IT) (or desensitization) may be suggested. IT is delivered by injections
of the allergen in doses that are increased incrementally to a maximum
that is tolerated without a reaction. Maintenance injections can be delivered
at increasing intervals starting from weekly to bi-weekly to monthly injections
for up to three to five years. Children with pollen sensitivities benefit
most from this treatment. IT is also effective in reducing the onset of
pollen-induced asthma.
Fact
Sheet: 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 possibly 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.
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 ten 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. Experts recommend
a vaporizer or steam from a pan of boiled water (removed from the heat).
Humidifiers should be used only when a clean filter is in place 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 also helpful
in moisturizing nasal passages.
Q. How effective are non-prescription nose drops or sprays?
A. Use of nonprescription drops or sprays might help control symptoms.
However, extended use of non-prescription decongestant nasal sprays could
aggravate symptoms and should not be used beyond their label recommendation.
Saline nasal sprays or drops are safe for continuous use.
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 exist. 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 mucous culture,
endoscopy, x-rays, allergy testing, or CT scan of the sinuses.
Q. What is nasal endoscopy?
A. An endoscope is a special fiber optic 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 an ear, nose, and throat specialist perform 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 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 may cause 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.
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 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 function 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 an otolaryngologist--head and neck surgeon, a specialist who can treat
your condition with medical and/or surgical remedies.
