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05.01.2016
American College of Physicians, PIER: Physicians Information and Education Resource web site. Jim Young, PhD, biostatistician, Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland. When the swelling becomes severe and blocks these cavities, trapping mucus and air inside, sinusitis can become a condition that is defined by extreme pressure and pain. Sinusitis is a common condition, affecting 37 million people in the United States and costing $5.7 billion every year. Depending on your symptoms, their intensity, and the manner in which they are presented, your doctor may decide to recommend an imaging test, such as X-rays, CT scans, or MRIs. Although approximately two out of three sinusitis problems are resolved on their own, many people still need treatment.
Common remedies include antibiotics, painkillers, decongestants, allergy medicines, and steroids. If you are suffering from a bacterial infection, your sinus doctor may prescribe an antibiotic. Decongestants are also useful in that they can aid in the reducing the amount of mucus in your sinuses. Sprays should not be used for more than three days, as this can sometimes worsen congestion. Oral steroids may be used when inflammation is severe, and in cases of chronic sinusitis steroid inhalants may be prescribed. If you have been suffering from sinusitis and live in this region of Florida, take time to make an appointment with one of the experienced ENT Specialist in West Palm Beach. Computed tomography (CT scans or CAT scans) are utilized to aid in the diagnosis of chronic sinusitis. Plain x-rays are no longer utilized as the quality and sensitivity are poor for diagnosing chronic sinus conditions. All information and advice on this website is of a general nature and may not apply to you. As part of the same air passages, and lined by the same mucous membrane, the nose and sinuses tend to be affected by the same problems.
Normal opening into left maxillary sinus (the natural ostium) seen through a nasal endoscope. Sphenoid – At the very back of the nose, above the throat, behind the eyes, at the base of the brain.
Under extremely high powered magnification, the surface of the mucous membrane looks hairy – tiny, short hairs, like a velvet lawn, or a carpet pile. The mucus, and anything stuck in it, are swept to the back of the nose by the cilia (silly – ah). The cilia must work together, all beating in the same direction, otherwise they won’t achieve much.
The contaminated mucus is either swallowed, spat, sneezed or coughed out, while fresh mucus is produced by the mucous membrane.
As well as the physical mechanism of mucociliary clearance, there are chemical defences in the mucus. Anything which interferes with the normal functions of the mucous membrane predisposes to rhinosinusitis. It is much commoner for the mucous membrane to be damaged during the course of life, rather than being born with a defect. Broken nose with sharp spur of deviated nasal septum pressing on root of left inferior turbinate.
Physical narrowing of the sinus openings and mucociliary clearance pathways can also predispose to recurrent sinusitis. Same patient’s large polyps seen by simple examination with a Thudichum speculum in the nostril.
Same patient’s CT scan showing nasal bones pushed apart by mass of polyps filling and blocking the nose. Ethmoiditis causes pain between or behind the eyes and pressure over the bridge of the nose.
If the mucus from an infected sinus is able to drain, rather than being blocked up, thick green or yellow mucus appears. Earache, discharge and deafness results from middle ear disease, caused by interference with the Eustachian tube. Sore throat and hoarseness are symptoms of laryngitis, caused by the infected post nasal drip. Orbital cellulitis due to spread of infection from the right ethmoid sinus into the soft tissues around the eye in a four year old child. Severe headache with vomiting – indicates the possibility of meningitis or spread of infection into the brain.
Swelling of the cheek is hardly ever caused by sinusitis, dental infection is much more likely. Although most cases resolve completely, sinusitis can, rarely, have serious complications, especially in children.
Spread of infection into the brain or its coverings can result in meningitis, brain abscess and death. Prior to the discovery of antibiotics, sinusitis was a killer disease, and major surgery was often necessary to treat it. Mists, sprays, steam inhalations and mineral rinses are traditional remedies for sinus problems.
Herbal extracts such as menthol and eucalyptus stimulate the sensation of nasal airflow, making your nose feel clearer.
Traditional washing of the nasal lining with salt water, alkaline nasal douches (sodium bicarbonate and salt) and various mineral extracts is useful when the mucus is abnormally thick, and in dry arid environments. Antibiotics can be taken by mouth, intravenously for severe acute cases, or topical creams & sprays as a preventive measure. Decongestant nose drops and sprays such as Otrivine and Vicks Sinex should only be used for short periods – a week at most. They are very effective at shrinking the swollen lining of the nose, which improves breathing and helps open the sinuses. Damage to the lining of the nose caused by prolonged use of decongestants is known as rhinitis medicamentosa. Decongestants are not suitable for prolonged use as they will cause rhinitis medicamentosa. Where blockage of the nose is a prominent symptom, steroid nose drops or sprays are the most useful medical treatment for chronic rhinosinusitis. Sometimes a short, sharp course of steroid tablets such as Prednisolone ec is used to shrink polyps.
The general principle of steroid treatment is to use the minimum amount which will keep things under control. Lying on your stomach, head over the side of the bed, produces the correct position for nose drops. You may be advised to use steroid drops such as Flixonase Nasules™ in the head down and forward position.


After putting in the drops, keep your head down for at least one minute to allow them to percolate into the narrow spaces. Lying on your back, and tipping your head backwards over the edge of the bed, is another option. Sinus endoscopy (sometimes called FESS) is the modern way to diagnose rhino-sinusitis and plan treatment. A small instrument, like a silver pencil with a light on the end of it, is passed gently along the nose. The rigid nasal sinus endoscope has an angled lens which lets the surgeon see into all the nooks and crannies of the nose, showing the exact location of any narrowings, bony deformities, polyps and the source of any pus drainage.
Josephson, MD, director, New York Nasal and Sinus Center and author, Sinus Relief Now, Perigee Trade, December 2006.
It is intended for general informational purposes only and does not address individual circumstances. The most common one is sinusitis, which can make you uncomfortable, cause irritation, and become painful. Whether you have acute sinusitis, which can last up to four weeks, or chronic sinusitis, which can last more than twelve weeks, you need treatment. If you experience symptoms related to this condition and they last for more than a few days, it is a good idea to make an appointment to see an ENT.
A sinus doctor will often recommend utilizing some form of medication, as well as self-care. A course of antibiotics lasting ten to fourteen days can be prescribed for acute sinusitis, while a longer regimen may be utilized for a chronic problem. Nasal sprays, such as Afrin and Dristan, and decongestants in the form of pills, such as Contac and Sudafed, are effective.
Light serves in Jupiter, Boca Raton, Boynton Beach, West Palm Beach, Boca Del Mar, Delray Beach, Greenacres, Lake Worth, Royal Palm Beach, Wellington and all of South Florida.
CT scans are thin slices through the sinuses that provide detailed pictures of sinus and nasal anatomy.
This medical information is provided to enhance and support, not replace, individual advice from a qualified medical practitioner.
It is a very active organ, constantly working to provide clean, humidified air at the correct body temperature to the lungs. Like the fins on a radiator, they increase the surface area of mucous membrane in contact with the air. Your nose can turn dry air fully humidified, and raise freezing cold air to body temperature, in under a second, before it reaches the throat.
Sensitive organs and nerve endings in the mucous membrane trigger automatic reflex changes. Natural antibacterial and antiviral substances are produced, together with white blood cells which can recognize and destroy foreign material. The left middle turbinate is swollen and inflamed, blocking normal mucociliary clearance from the ethmoid and maxillary sinuses. The cilia, instead of being lined up in proper patterns to sweep the nose, sinuses and bronchial tree, are arranged at random. No inflammation at time of photograph, but patient had a history of recurrent episodes of sinusitis, always on the left side. The polyp is the paler, softer looking, more gelatinous structure hanging below the middle turbinate. The site of pain depends on which sinuses are involved, but often more than one set of sinuses is involved at the same time.
Thick sticky discharge streaming from the back of the nose over the left Eustachian tube, causing secondary glue ear. Urgent hospital treatment with intravenous antibiotics, and surgical drainage prevented blindness in this case. They can thin down thick sticky mucus, helping your natural mucociliary clearance system to work better. They should not be confused with dangerous anabolic steroids abused by some athletes – you will be perfectly eligible for the Olympics on these treatments.
The risks of steroid side-effects from short courses of treatment are fairly small, but long term steroid tablets are likely to give rise to serious side-effects. If there is a bony narrowing, or polyps which are too large and established to be shrunk by steroids, surgical treatment may be needed. This is because most cases of sinusitis start with swollen mucosa high up in the nose and ethmoid sinuses, between the eyes. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Sinusitis, which may be acute or chronic, is an inflammation of the tissue that lines the small cavities in the skull that are normally filled with air. It is important to remember, however, that you should not take such painkillers for more than ten days.
Also, better control of environmental factors, such as reducing dust and controlling the development of mold, can be useful in reducing allergic reactions. Light and his team of medical professionals are ready to serve you and help you finally find relief from allergy symptoms. Most cases of sinusitis start off as rhinitis, so we usually get rhinosinusitis rather than pure sinusitis. The bone separating the sinuses from the eye sockets is paper thin – like an eggshell.
Air in the sinuses lightens the structure of the head, and provides resonance for the voice. The cilia beat through the thin sol layer in coordinated waves, sweeping the surface gel layer along. They beat like tiny oars in the film of mucus, constantly moving it along, a wet sticky conveyor belt. Sometimes the inflammatory response is triggered by mistake, for no good reason, by harmless substances. Some of these are due to the formation of biofilms, persistent colonies of slow-growing bacteria and other micro-organisms which attach themselves to surfaces. Mucus can’t drain from the sinus because the pathway is blocked by swelling of the middle turbinate (see endoscope view above). Impaired mucociliary clearance then opens the way for secondary infection by resident bacteria. Cystic fibrosis patients suffer chronic rhinosinusitis as well as chronic lung disease and poor absorption of food through the gut. Often described as being like grapes, they are more like raw oysters, slippery and squashy. You may have a common complaint that sends many people to a doctor's office: sinus trouble. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site.
This condition, also referred to Read More7 Facts about Sinuses that May Surprise YouMarch 30th, 2016For most people, the topic of sinuses only comes up when a sinus infection rears its ugly head.


They lie horizontally, front to back, stacked one above the other along the side walls of the nose. Their toxic products cause more inflammation, more swelling and more blockage – a vicious circle.
Out-patient rigid nasal sinus endoscopy carried out under local anaesthetic at the same consultation revealed the cause.
What Are Sinuses?What Are Sinuses?They’re air spaces in your skull lined with mucous membranes. For those who have been diagnosed with allergies, testing may be in order, as this can help better diagnose your specific allergy. At the peak of their stroke, like an oar dipping into the water, the tips of the cilia catch onto the mucus layer and move it along.
If it isn’t kept moving, germs will breed in the mucus, like they do in a stagnant pond. This is especially the case in allergy, but excessive reactions against fungal material, and certain products of bacteria including biofilms, may well underly the development of nasal polyps and other chronic inflammatory diseases of the mucous membrane. Inflammation does not mean the same as infection, though infection is one of the commoner causes of inflammation. Half of them have their heart and other organs the wrong way round – the mechanism that causes things to line up correctly in the body is generally defective. They may form a biofilm, which is resistant to antibiotic treatment, and acts as a reservoir for recurrent infections. A complicated set of responses is designed to keep the air conditioner working efficiently. The sneeze is often followed often by excessive watery running of the nose in an attempt to wash away any remaining irritant. It depends on the temperature and humidity of the air you are breathing in, and the rate of airflow you need.
The nose can adjust very rapidly to changes in the external environment, and to the body’s requirements for airflow. The problem is when the nose mis-identifies harmless substances as irritant, and this triggers excessive and inappropriate sneezing.
If and when we reach a dose where symptoms begin to come back, the dose is increased to the previous level.
Tiny, hair-like structures called cilia (magnified here) move mucus across sinus membranes and toward an exit.
The superior turbinate is tiny in humans, it has a specialised membrane for the sense of smell.
Excessive or inappropriate triggering of normal reflexes is a cause of some nasal symptoms. Any who stray deeper into the nose are picked up and swept away by the mucociliary clearance system. The inferior turbinates are bigger than normal, they are swollen due to chronic inflammation.
The nose, sinuses, trachea (windpipe) and bronchi (tubes carrying air to lungs) are all lined with the same soft tissue mucous membrane. The turbinates are made of erectile tissue – like the sexual organs, they can swell up and shrink down considerably. If a sinus opening or mucociliary clearance pathway gets blocked by swollen mucous membrane, stagnant mucus builds up. The maxillary sinuses (antra) are seen above the roots of the teeth, both have grey swollen linings indicating inflammation. Careful regulation of bloodflow and surface area allows us to survive in a variety of climates.
Mucus that is not kept moving, like a stagnant pond, provides a fertile breeding ground for bacteria.
Polyps have no nerve endings, and are not painful, unlike the turbinates which are very sensitive.
Just a Cold … at FirstSinusitis usually starts with inflammation triggered by a cold, allergy attack, or irritant. Cities for AllergiesFebruary 8th, 2016Allergies affect sufferers at different points of the year. It constantly produces a surface coating of wet mucus, which moisturises and humidifies the air. But get it wrong, and you might end up with too much pooling of blood, swollen engorged turbinates, and a blocked nose which won’t clear when you blow it.
As soon as the mucociliary defence mechanism is down, the bacteria move in and replicate, producing toxins. The mucous membrane lining the nose and sinuses has some further modifications, to guard and protect the entrance to the lower airways and the lungs.
Unfortunately this causes yet more swelling of the mucous membrane, resulting in more congestion and blockage – a vicious circle. How It FeelsMost people have a stuffy nose and pain or pressure in several areas around the face or teeth. You may also have fatigue, trouble with sense of smell or taste, cough, sore throat, bad breath, headache, pain when you bend forward, and fever. When It Won't Go AwayInflammation of the sinuses that lasts for more than 3 months is chronic sinusitis.
Histological examination by a qualified pathologist will tell us what kind of polyps you have. Anatomy, allergies, polyps, immune system problems, and dental diseases may also be to blame. Nasal DecongestantsThese sprays open swollen nasal passages and allow your sinuses to drain.
Treating Allergy-Related SinusitisHave you tried irrigation with saline solution, either with a neti pot or squeeze bottle? Antihistamines could also come in handy, especially if you’re sneezing and have a runny nose.
But if you keep feeling worse, your symptoms last and are severe, or if you get a fever, it's time to see a doctor. Will You Need Sinus Surgery?An operation called FESS (functional endoscopic sinus surgery) can bring some relief, if nothing else works. But start with the simplest solution: Avoid things that irritate your sinuses, and then work with your doctor to see if medicines help. It’s not likely, but if a sinus infection passes through the bone, it can infect the lining of the brain or the brain itself. It’s also uncommon, but a sinus infection could spread into the eye socket, causing an infection that could cause blindness.
Less severe complications include asthma attacks and loss of smell or taste, which are usually temporary.



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