Management of sinusitis has witnessed fundamental chagne in the last two decades. Nasal endoscopy and CT scan has revolutionized visualization of nose and sinuses.
- Basic understanding--(What is sinus?) Human skull contains four pairs of hollow air filled caivities connected to the space between npstril and nasal passages; these are called sinuses(or para nasal sinuses). Sinuses help insulate the skull, reduces its weight and add resonance to voice.
There is 4 major pair of sinuses-frontal (in the forhead), maxillary (behind the cheek bones), Ethmoid (between the eyes) and sphenoid (behind the eyes).
Sinuse are lined by respiratory epethelium with Goblet cells to secrete mucus and fine cilia to help trap and propel pollutant and bacteria outward to nose through opening of sinuses (sinus-osteum). Most of he sinuses drain into a key area (osteomeatal complex). Thus treatment of sinusitis is focused on this area.
Acute sinusitis-
Infection of sinuses is called sinusitis - acute or chronic based on time span. Sinusitis may be caused by anything that interfere with airflow into the sinuses and mucus drainage out of the sinuses, usualyy follow a viral infection, allergy, or irritants.
Signs and symptoms of sinusitis depend on which sinus is involved-usually present with nasal congestion and discharge or post nsal drip, headache, facial pain or pain under or around the eyes, fever.
Treatment of acute sinusitis:-
Aims of management are--
1. To achieve normal healthy sinuses
2. To decrease duration of symptoms
3. To prevent complications
4. To prevent development of chronic sinusitis.
Most patients of acute sinusitis can be benefitted wihout many investigations as diagnosis is mainly clinical. Proper visualization of noe and sinues by Nasal endoscopy is important for appropriate management. Endoscopic assessment of nose guides the surgery and at the same time accurate pus-swab can be obtained for bacteriological examination.
Sometimes if symptoms persist for longer duration further investigations may be required like Ct scan of sinuses, examination of mucocilliary mechanism, allergic and immune status of patient.
Medical management-
Antibiotics, analgesics, decongestant, mucolytics and/or steroids may be given to reduce swelling and thus increase clearance and drainage from the sinuses.
Antibiotics- studies confirm that sinusitis treated with antibioticshave more rapid resolution of symptoms. A effective antibiotic for a period of 10 days is usually required but in some cases especially recurrent cases up to 2 weeks course may be given.
Nasal decongestant drops- nasal decongestant drops are used to decongest sinus-osteum and thus encourage drainage. Nasal drops should not be used for for longer duration because it backfires as it has rebound effect.
Oral decongestants or mucolytics-May be used to decongest mucosa or to help thinning of secretion for easy drainage.
Analgesics-Any suitable and safe pain killer medicine may be taken.
Home care-
Steam inhalation- Plain water or medicated steam with menthol has soothing effect and helps in improving sinus drainage.
Hot fomentation-application of warm cloth, hot water bottle or gel pack to face for 5-10 minutes relieves pain and inflammation to some extent.
Saline irrigation- nose and sinuses should be washed by 1/4 tsf salt in 1 cup water using bulb syringe, alternatively commercially availabe saline nasal sprays can be used.
Adequate hydration.
Hot fluid like soups helps.
Avodance of allergen if any.
Avoidance of irriants/smoking
Use of humidifier.
Surgical management-
Usually acute sinusitis is treated by medicines. Most cases resolve with proper and effective management.
Surgical treatment is reserved for-Failure of medical management, Severe pain, or Impending complications.
Surgical management aim at cleaning the sinuses by antral lavage, endoscopic cleaning or frontal sinus wash out.
Functional endoscopic sinus surgery--
Recurent acute bacterial sinusitis or sinusitis of long duration unresponsive to medicine is major indication for endoscopic sinus surgery. Endoscopic surgery is minimal invasive surgery done by endoscope inserted through nose, it does not require skin incision.CT scanning is must before surgery.One thing is to be remembered -meticulous post oprative cleanig is equally important for success as is the expertise of operating surgeon.
Treatment plan for acute sinusitis may vary according to experience of treating physician but it is crucial to undersatnd the importance of "osteomeatal region".Effective medical mangement require good docto-patient understanding. Medical prefessional should take time for patient to educate them on importance of taking antibiotics regularly and in proper doses as advised. Often it is irregular time interval and missed doses which creates resistant bacteria and failure of medical treatment.
From my article at helium.com- http://www.helium.com/items/1269826-treatment-of-acute-sinusitis
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