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Acute Sinusitis: a MEGA pain in the head. What should I do, Doc?

Dear friends, Welcome back to TGIF Dr Euan's Blog! I hope you have enjoyed the guest blog posts by my dear friend Dr PHUA Sin Yong on voice care and speech therapy issues.


Today, we are going to start a new series of BLOG POSTS which focus on the nose ๐Ÿ‘ƒ and sinuses. The post for today is about acute sinusitis. Enjoy!


Q: What is acute sinusitis?


Acute sinusitis is a short-term inflammation of the sinuses, most often including a sinus infection. (Sinusitis is also known as rhino-sinusitis because the swelling almost always includes nasal tissue as well as sinus tissue.) The sinuses are four paired cavities (spaces) in the head. They are connected by narrow channels. The sinuses make thin mucus that drains out of the channels of the nose, cleaning the nose. Typically filled with air, the sinuses can become blocked by fluid and swell from irritation. When this happens, they can become infected.


Diagram showing the different sections of the sinuses


Q: How long does acute sinusitis last?


Acute sinusitis lasts less than a month. Your symptoms may go away by themselves within about 10 days, but it may take up to three or four weeks.


Q: What are the risk factors for acute sinusitis?


Some people are more likely than others to suffer from acute sinusitis, such as:

  • People who have allergies.

  • People who have structural problems with their noses (like a deviated nasal septum) or polyps, which are growths that can hang inside noses or sinus cavities.

  • People who spend a great deal of time in places where frequent infections happen, like preschools or daycare centres.


Q: What causes acute sinusitis?


Acute sinusitis is often caused by a common cold or allergies. It can also be caused by a bacterial infection or fungus that causes the sinuses to swell and become blocked.


Q: What are the symptoms of acute sinusitis?

Sinusitis may cause symptoms such as having a blocked or stuffy nose


The main symptoms include:

  • Facial pain/pressure/tenderness.

  • Stuffy/blocked nose.

  • Thick yellow or green nasal discharge.

  • Loss of smell and taste.

  • Congestion/cough.

  • Bad breath.

You may also experience:

  • Fever.

  • Ear pain.

  • Headache.

  • Tiredness.

  • Toothache.


Q: How is Acute Sinusitis diagnosed?


Your doctor may ask about your symptoms. He or she may feel for tenderness in your nose and face and look inside your nose. Your doctor can usually make the diagnosis based on the physical examination.


Other methods that might be used to diagnose acute sinusitis and rule out other conditions include:

An ENT doctor may perform a nasoendoscopy to inspect the sinuses


  • Nasal endoscopy. A thin, flexible tube (endoscope) with a fibre-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses.

  • Imaging studies. A CT scan shows details of your sinuses and nasal area. It's not usually recommended for uncomplicated acute sinusitis, but imaging studies might help find abnormalities or suspected complications.

  • Nasal and sinus samples. Lab tests aren't generally necessary for diagnosing acute sinusitis. However, when the condition fails to respond to treatment or is worsening, tissue samples (cultures) from your nose or sinuses might help find the cause, such as a bacterial infection.

  • Allergy testing. If your doctor suspects that allergies have triggered your acute sinusitis, he or she will recommend an allergy skin test. A skin prick test is safe and quick and can help pinpoint the allergen that's causing your nasal flare-ups.

The doctor may ask you to do an allergy test if they suspect allergies are causing the sinusitis


Q: How is acute sinusitis treated?


Most cases of acute sinusitis get better on their own. Self-care techniques are usually all you need to ease symptoms.

Your doctor may recommend treatments to help relieve sinusitis symptoms, such as:

Some patients may want to use nasal sprays to clean out their sinuses

  • Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages.

  • Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase Allergy Relief, Flonase Sensimist Allergy Relief, others), budesonide (Rhinocort Allergy), mometasone (Nasonex) and beclomethasone (Beconase AQ, Qnasl, others).

  • Decongestants. These medications are available in over-the-counter (OTC) and prescription liquids, tablets and nasal sprays. Use nasal decongestants for only a few days. Otherwise, they may cause the return of more severe congestion (rebound congestion).

  • Allergy medications. If your sinusitis is due to allergies, using allergy medications may help lessen allergy symptoms.

  • OTC pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or aspirin. Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children.


Antibiotics

Antibiotics are not usually needed to treat acute sinusitis, because it's usually caused by a virus and not by bacteria. Even if your acute sinusitis is bacterial, it may clear up without treatment. Your doctor might wait and watch to see if your acute sinusitis worsens before prescribing antibiotics.

However, severe, progressive or persistent symptoms might require antibiotics. If your doctor prescribes an antibiotic, be sure to take the whole course, even after your symptoms get better. If you stop taking them early, your symptoms may recur.

Immunotherapy


If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat your symptoms. These self-help steps can help relieve sinusitis symptoms:

  • Rest. This will help your body fight infection and speed recovery.

  • Drink fluids. Continue to drink plenty of fluids.

  • Use a warm compress. A warm compress on your nose and forehead may help relieve the pressure in your sinuses.

  • Moisten your sinus cavities. Drape a towel over your head as you breathe in the vapour from a bowl of hot water. Keep the vapour directed toward your face. Or take a hot shower, breathing in the warm, moist air. This will help ease pain and help mucus drain.

  • Rinse your nasal passages. Use a specially designed squeeze bottle (Sinus Rinse, others) or neti pot. This home remedy, called nasal lavage, can help clear your sinuses.


Alternative medicine

No alternative therapies have been proven to ease the symptoms of acute sinusitis. It's been suggested that products containing certain combinations of herbs may be of some help. These combination therapies contain cowslip, gentian root, elderflower, verbena and sorrel.

Possible side effects from these herbal products include stomach upset, diarrhoea and allergic skin reactions. Check with your doctor before taking herbal or dietary supplements to be sure they're safe and that they won't interact with any medications you're taking.


Conclusion:


Dear friends, if you need a consultation at Euan's ENT, please contact us here.

Till then, have a restful weekend! TGIF!



Here are some useful references if you are keen to read more on Acute Sinusitis: References: 1. Aring AM, Chan MM. Current Concepts in Adult Acute Rhinosinusitis. Am Fam Physician. 2016 Jul 15;94(2):97-105. [PubMed]

2. DeMuri G, Wald ER. Acute bacterial sinusitis in children. Pediatr Rev. 2013 Oct;34(10):429-37; quiz 437. [PubMed]

3. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1-S39. [PubMed]

4. Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM., Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012 Apr;54(8):e72-e112. [PubMed]

5. Berger G, Kattan A, Bernheim J, Ophir D, Finkelstein Y. Acute sinusitis: a histopathological and immunohistochemical study. Laryngoscope. 2000 Dec;110(12):2089-94. [PubMed]

6. Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, Nelson CE, Rosenfeld RM, Shaikh N, Smith MJ, Williams PV, Weinberg ST., American Academy of Pediatrics. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013 Jul;132(1):e262-80. [PubMed]

7. Rosenfeld RM. CLINICAL PRACTICE. Acute Sinusitis in Adults. N Engl J Med. 2016 Sep 08;375(10):962-70. [PubMed]

8. Brook I. Acute sinusitis in children. Pediatr Clin North Am. 2013 Apr;60(2):409-24. [PubMed]

9. Boisselle C, Rowland K. PURLs: Rethinking antibiotics for sinusitis: again. J Fam Pract. 2012 Oct;61(10):610-2. [PMC free article] [PubMed]

10. Zalmanovici Trestioreanu A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev. 2013 Dec 02;(12):CD005149. [PMC free article] [PubMed]

11. Dwyhalo KM, Donald C, Mendez A, Hoxworth J. Managing acute invasive fungal sinusitis. JAAPA. 2016 Jan;29(1):48-53. [PubMed]

12. Knipping S, Hirt J, Hirt R. [Management of Orbital Complications]. Laryngorhinootologie. 2015 Dec;94(12):819-26. [PubMed]

13. Schubert MS. Allergic fungal sinusitis: pathophysiology, diagnosis and management. Med Mycol. 2009;47 Suppl 1:S324-30. [PubMed]



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