Sinusitis

Overview of Sinusitis

It defined as acute sinusitis if it lasts less than 4 weeks, and as chronic sinusitis if it lasts for more than 12 weeks. Sinusitis can cause by infection, allergies, air pollution, or structural problems in the nose. Most cases cause by a viral infection. Recurrent episodes are more likely in persons with asthma, cystic fibrosis, and poor immune function.

The sinus most commonly involved the maxillary follow in turn by ethmoid, frontal and sphenoid. Very often more than one sinus infect (Multi-sinusitis). Sometimes, all the sinuses of one or both sides are involved simultaneously

(Pansinusitis unilateral or bilateral). Sinusitis may “open” or “closed” type depending upon whether the inflammatory products of sinus cavity can drain freely in to the nasal cavity through the nasal ostia or not. A “closed” sinusitis causes more severe symptoms and is also likely to cause complication [1].

Epidemiology of Sinusitis

Causes of Sinusitis

Acute sinusitis

(A) Exciting cause i.e.:

• Nasal infections; Sinus mucosa is a continuation of nasal mucosa and infections from nose can travel directly by continuity or by way of submucosal lymphatics. Most common cause of acute sinusitis is viral rhinitis followed by bacterial invasion.
• Swimming and diving; Infected water can enter the sinuses through their ostia. High content of chlorine gas in swimming pools can also set up chemical inflammation.
• Trauma; Compound fractures or penetrating injuries of sinuses—frontal, maxillary and ethmoid—may permit direct infection of sinus mucosa. Similarly, barotrauma may be followed by infection.
• Dental infections; This applies to maxillary sinus. Infection from the molar or premolar teeth or their extraction may be followed by acute sinusitis [2].

(B) Predisposing causes i.e.;

• LOCAL

1.Obstruction to sinus ventilation and drainage. Normally, sinuses are well-ventilated. They also secrete small amount of mucus, which by ciliary movement, is directed towards the sinus ostia from where it drains into the nasal cavity. Any factor(s) which interfere with this function can cause sinusitis due to stasis of secretions in the sinus. They are i.e.:

1. Nasal packing
2. Deviated septum
3. Hypertrophic turbinate
4. Oedema of sinus ostia due to allergy or vasomotor Rhinitis
5. Nasal polyp
6. Structural abnormality of ethmoidal air cells
7. Either Benign or malignant neoplasm.

2.Stasis of secretions in the nasal cavity.

Normal secretions of nose may not drain into the nasopharynx because of their viscosity (cystic fibrosis) or obstruction (enlarged adenoids, choanal atresia) and get infected.

3.Previous attacks of sinusitis.

 Local defences of sinus mucosa are already damaged.

GENERAL

Environment i.e.

Sinusitis is common in cold and wet climate. Atmospheric pollution, smoke, dust and overcrowding also predispose to sinus infection.

Poor general health i.e.

 Recent attack of exanthematous fever (measles, chickenpox, whooping cough), nutritional deficiencies and systemic disorders (diabetes, immune deficiency syndromes) [2].

Types 

[1] According to duration

• Acute sinusitis
• Chronic sinusitis

[2] According to sinuses

The four paired paranasal sinuses are the frontal, ethmoidal, maxillary, and sinuses. The ethmoidal sinuses are further subdivided into anterior and posterior ethmoid sinuses, the division of which is defined as the basal lamella of the middle nasal concha. In addition to the severity of disease, discussed below, sinusitis can be classified by the sinus cavity it affects:

• Maxillary– can cause pain or pressure in the maxillary (cheek) area (g., toothache, or headache).
• Frontal– can cause pain or pressure in the frontal sinus cavity (located above the eyes), headache, particularly in the forehead
• Ethmoidal– can cause pain or pressure pain between/behind the eyes, the sides of the upper part of the nose (the medial canthi), and headaches.
• Sphenoidal – can cause pain or pressure behind the eyes, but is often felt in the top of the head, over the mastoid processes, or the back of the head[1].

Risk factors 

Pathogenesis

Pathophysiology 

[A] In Acute sinusitis:

Acute inflammation of sinus mucosa causes hyperaemia, exudation of fluid, outpouring of polymorphonuclear cells and increased activity of serous and mucous glands. Depending on the virulence of organisms, defences of the host and capability of the sinus ostium to drain the exudates, the disease may be mild (nonsuppurative) Or severe (suppurative). Initially, The exudate is serous; later it may become mucopurulent or purulent. Severe infections cause destruction of mucosal lining. Failure of ostium to drain results in empyema of the sinus and destruction of its bony walls leading to complications. Dental infections are Very fulminating and soon result in suppurative sinusitis.

[B] In Chronic sinusitis:

Acute infection destroys normal ciliated epithelium impairing drainage from the sinus. Pooling and stagnation of secretions in the sinus invites infection. Persistence of infection causes mucosal changes, such as loss of cilia, oedema and polyp formation, thus continuing the vicious cycle. In chronic infections, process of destruction and attempts at healing proceed simultaneously. Sinus mucosa becomes thick and polypoidal (i.e. hypertrophic sinusitis) or undergoes atrophy (i.e. atrophic sinusitis). Surface epithelium may show desquamation, regeneration or metaplasia. Submucosa is infiltrated with lymphocytes and plasma cells and may show micro abscess, granulations, fibrosis or polyp formation[2].

Clinical Features

Sign & Symptoms 

[1] Acute sinusitis

1. Headache or facial pain or pressure of a dull, constant, or aching sort over the affected sinuses is common with both acute and chronic stages of  sinusitis. This pain is usually localized to the involved sinus and may worsen when the affected person bends over or when lying down. Pain often starts  on one side of the head and progresses to both sides.
2. Acute sinusitis may be accompanied by thick nasal discharge that is usually green in color and may contain pus or blood.
3. Often, a localized headache or toothache is present, and these symptoms distinguish a sinus-related headache from other types of headaches, such as tension and migraine headaches. Another way to distinguish between toothache and sinusitis is that the pain in sinusitis is usually worsened by tilting the head forward.

4. Other symptoms associated with acute rhinosinusitis include cough, fatigue, hyposmia, anosmia and ear fullness or pressure.

A 2005 review suggested that most "sinus headaches" are migraines. The confusion occurs in part because migraine involves activation of the trigeminal nerves, which innervate both the sinus region and the meninges surrounding the brain. As a result, accurately determining the site from which the pain originates is difficult. People with migraines do not typically have the thick nasal discharge that is a common symptom of a sinus infection [2].

[2] Chronic sinusitis:

Symptoms may include any combination of:

1.Nasal congestion

2.Facial pain

3.Headache

4.Night-time coughing

5.An increase in previously minor or controlled asthma symptoms

6.General malaise

7.Thick green or yellow discharge

8.Feeling of facial fullness or tightness that may worsen when bending over

9.Dizziness, aching teeth, and/or bad breath.

10.Often, chronic sinusitis can lead to anosmia, the inability to smell objects.

Diagnosis

Differential Diagnosis

Complications 

Investigations 

1. X-ray of the involved sinus may show mucosal thickening or opacity.
2. X-rays after injection of contrast material may show soft tissue changes in the sinus mucosa.
3. Computed tomography (CT) scan is particularly useful in ethmoid and sphenoid sinus infections and has replaced studies with contrast materials.
4. Dental examination and appropriate radiography aid in ruling out pain arise from a tooth[2].

Treatment 

Antimicrobial drugs:

Ampicillin and amoxicillin are quite effective and cover a wide range of organisms. Erythromycin or doxycycline or cotrimoxazole are equally effective and can be given to those who are sensitive to penicillin. β-lactamase-producing strains of H. influenzae and M.Catarrhalis may necessitate the use of amoxicillin/ clavulanic acid or cefuroxime axetil. ciprofloxacin is also effective, and has the advantage of single daily dose.

Nasal decongestant drops.

One per cent ephedrine or 0.1% xylo- or oxymetazoline are used as nasal drops or sprays to decongest sinus ostium and encourage drainage.

Steam inhalation.

Steam alone or medicated with menthol or Tr.Benzoin Co. provides symptomatic relief and encourages sinus drainage. Inhalation should be given 15–20 Min after nasal decongestion for better penetration.

Analgesics.

Paracetamol or any other suitable analgesic should be given for relief of pain and headache.

Hot fomentation.

Local heat to the affected sinus is often soothing and helps in the resolution of inflammation.

Surgery [2].

Prevention

Homoeopathic Treatment 

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Homeopathic treatment is based on individualization in which a doctor selects a medicine according to your/ patients constitution rather then matching only symptoms similarity, so before taking any homeopathic medicine you have to firstly consult a homeopathic physician for your concern problem’s, there are so many remedies work in this case but some of the few therapeutic indications of homeopathic remedies in the cases of sinusitis are as follows.

Arsenicum Album

These children feel throbbing and burning pains in the sinuses. Their pains are aggravated by light, noise, movement, after midnight, and may be triggered by anxiety, exertion, and excitability. They may feel relief by lying quietly in a dark room with the head raised on pillows and exposed to cool air. Their teeth may feel long and painful. They may feel nausea and experience vomiting concurrent with their sinusitis.

Belladonna

Throbbing pains in the front part of the head that come on suddenly and tend to leave suddenly only to return are characteristic of children who need this medicine. (see Headache)

Hepar Sulphur

Rarely indicated at the beginning of a sinusitis condition, Hepar sulphur children begin sneezing and then develop sinusitis from the least exposure to cold air. Their nasal discharge is thick and yellow. The nostrils become very sore from the acrid discharge, and their nasal passages become sensitive to cold air. Concurrently, they may have a headache with a sense of a nail or a plug that is thrust into the head along with a boring or bursting pain. Their headache above the nose is worse from shaking the head, motion, riding in a car, stooping, moving the eyes, or simply from the weight of a hat, but is relieved by the firm pressure of a tight bandage. The scalp is so sensitive that simply combing the hair may be painful.

Kali Carb

The distinguishing feature of children with sinusitis who need this medicine is that they have a thick, stringy nasal discharge. They have extreme pain at the root of the nose that is better by applying pressure there. The bones and scalp feel sore. Dizziness and nausea when rising from sitting and the severe pain may lead to dimmed vision. The pains are worse by cold, light, noise, walking, stooping, and in the morning (especially on waking or at 9 am) or at night. They prefer to lie down in a darkened room and feel better by warmth, warm drinks, or overeating.

Mercurius

These children feel as though their head was in a vise. The pains are worse in open air, from sleeping, and after eating and drinking. The pains also aggravated by extremes of hot and cold temperature. The scalp and the nose become very sensitive to the touch. Their teeth feel long and painful, and they may salivate excessively. The nasal discharge is usually green and too thick to run. It is offensive smelling and acrid.

Pulsatilla

The head pain is worse when lying down and in a warm room also is better in cool air for children who need this medicine. The sinusitis may after overheated. Stooping, sitting, rising from lying down, and eating can aggravate the head pain, which is often in the front part of the head and accompanied with digestive problems. Besides this, They get some relief from slow walking in the open air or by wrapping the head tightly in a bandage. This condition commonly experience when the child is in school. The nasal discharge is often thick and yellow or green.

Silicea

These children usually have a chronically stuffed nose. They have a sense as though their head would burst. Additionally, The head pain tends to worse in one eye, usually the right. It aggravated by mental exertion (students tend to get sinusitis while studying for an exam). Cold air, moving the head, light or noise can also aggravate the head pain. It relieve specifically by wrapping the head warmly and tightly or by applying heat.

Spigella

Children who develop sinusitis with a sharp pain that is worse on the left side may need this medicine. In detail, They tend to get sinusitis after exposure to cold or cold, wet weather. They feel pain from warmth or when they stoop or bend the head forward, and they feel some relief especially by cold applications or from washing with cold water [3].

Diet & Regimen 

Warm water:

Start your morning with a glass of warm water, added with a pinch of turmeric and black pepper. Warm water will help calm your throat whereas turmeric is beneficial in killing bacteria and black pepper reduces inflammation. This is a quick fix, which will provide an instant relief to your body and will also help in reducing sinus

Warm milk with turmeric:

This is the most common home remedy which is used in all Indian households. Turmeric and milk are the best combination to cure any kind of inflammation, ache or flu. Milk has immunity-boosting enzymes whereas turmeric has anti-bacterial properties.

Cold drinks or foods:

Cold drinks or foods directly from the refrigerator is a strict no during sinus. You should avoid foods with added sugar, it hampers the immune system and doesn’t do any good to the body. Chilled water will cause inflammation and eventually will increase your allergic reaction [4].

Consult physicians first whenever you fall ill avoid self-medication

Do’s and Don’ts 

Sinusitis do’s and don’ts 

Do’s:

• Do stay hydrated: Drink plenty of fluids to thin mucus and promote drainage
• Do use saline irrigation or nasal sprays: These help to moisten and cleanse the nasal passages
• Do apply warm compresses: This can help to relieve facial pain and pressure
• Do use over-the-counter pain relievers: These can help to manage discomfort
• Do seek medical attention if symptoms worsen or persist: Early diagnosis and treatment can prevent complications
• Do get plenty of rest: This allows your body to focus on healing

Don’ts:

• Don’t smoke or be around secondhand smoke: This irritates the sinuses and worsens inflammation
• Don’t blow your nose too forcefully: This can increase pressure in the sinuses and lead to complications
• Don’t overuse decongestant nasal sprays: These can cause rebound congestion and worsen symptoms
• Don’t fly or dive while experiencing sinusitis: Changes in air pressure can exacerbate pain and discomfort
• Don’t ignore persistent or severe symptoms: Seek medical evaluation for proper diagnosis and treatment [7]

Terminology

Reference

1. https://en.wikipedia.org/wiki/Sinusitis
2. Disease of EAR, NOSE, AND THROAT&HEAD AND NECK SURGERY 6^TH EDITIONS BY P.L Dhingra, Shruti Dhingra.
3. https://homeopathic.com/homeopathic-medicines-for-sinusitis/
4. https://timesofindia.indiatimes.com/life-style/food-news/what-to-eat-and-what-to-avoid-if-you-have-sinus/articleshow/68684677.cms
5. Sharma, S., Gupta, A., & Verma, R. (2022). Epidemiology of sinusitis in India: A comprehensive review. Indian Journal of Otolaryngology and Head & Neck Surgery, 74(Suppl 1), S15-S22.
6. Ear, Nose & Throat Diseases: A Pocket Reference Guide" (2nd Edition), written by Ratna Sagar and published in 2019 by Jaypee Brothers Medical Publishers
7. Cummings Otolaryngology Head and Neck Surgery 7th Edition, Flint PW, Haughey BH, Lund V, Niparko JK, Robbins KT, Thomas JR, Lesperance MM (Eds), Elsevier 2021

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