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Saturday, 11 February 2017

SINUSITIS

Tanvir MedicalCare
     
                                        SINUSITIS

In most medical literatures, Sinusitis is defined as inflammation of the lining of the sinuses (mucous membrane + epithelium+ connective tissue layer).

 In most cases, the sinuses, which are affected, are the maxillary sinuses, present below the eye sockets, frontal sinuses present in your forehead on either side, ethmoid sinuses present between the bony part of roof of nose and orbits.
These sinuses are hollow cavities in the skull. Their function is to lighten the weight of the skull and also act as resonators to impart special quality to the voice of the person.    

  Also all sinuses are connected to the nasal cavity either directly or indirectly. But this also means that various allergens and infections of the nose and mouth can make their way into the sinuses through these connections. But this connectivity of the nose and mouth with the sinuses also imparts a very important modus operandi to the etiology of sinusitis.

     Most medical literature describes sinusitis as infective with some cases described as allergic or autoimmune. Most also describe sinusitis as either acute when inflammation lasts for less than 3 months and chronic when it lasts for more than 3 months. Also viral sinusitis is described as healing within 10 days and bacterial sinusitis lasting more than 10 days.

     But when I started my research on sinusitis, I came to mixed conclusions, which I am presenting in front of the readers.

      In my study I found that almost all cases of sinusitis have an underlying allergic etiology. This means that in most cases of sinusitis, one or the other allergen induces an allergic reaction in the lining of the sinuses. This causes from mild to moderate (sometimes severe) inflammation in the lining of the sinuses.

     We must also understand that mouth, including teeth, is harboring all sorts of bacteria and viruses. Normally they are kept in check by the immunity of the person. But due to exposure to particular allergens, an allergic reaction against the allergen or allergens ensues and the body’s immune cells and antibodies are diverted to fight these allergens. This decreases the person’s fighting capacity against and to control microorganisms present in the mouth and nose.

     Now an inflamed mucus is very good for anchoring, harboring and for growth of microorganisms present in the mouth and environment.
    So when allergens (like dust, cold, food, drugs, bacterial toxins etc.) has decreased the immunity of the person, particularly in the mouth, these microorganisms multiply to greater number and migrate upwards from mouth into the nose and from there into the sinuses. Also microorganisms from the nose can directly migrate to these inflamed sinuses through sinus openings in the nose.

      Thus depending on the microorganisms in excess in the mouth and nose or in the environment, the microorganisms invading the sinuses can be either bacterial, viral or both.
Also a sinus with more inflammation or immune response is more likely to be the home for these invading microorganisms.

   Thus almost all cases of sinusitis have an allergic reaction as the underlying cause, which helps in inflammation of the sinuses and proliferation of microorganisms in the mouth, nose and invasion from the environment. This is the real etiology of sinusitis.
  
Once we have understood that the basic underlying cause of sinusitis is an allergic reaction to an allergen to which a person is exposed, the treatment of sinusitis becomes easier.

   The first step to curb sinusitis and stop its recurrence is to stop the exposure of the patients to allergens to which they are sensitive. For this, a study by rotational and sequential exposure to common, and than uncommon allergens to the persons are tested. The allergen sensitivity is found out and
the patient advised means to stop being exposed to such allergens. This is the most important step. Steps like wearing a face mask, avoiding sensitive foods, environment and situations can all be helpful once the culprit allergen or allergens are found out by the above investigation.

    In already existing sinusitis, apart from above study, proper antibiotics need to be prescribed for a minimum of 5 days. Amoxycillin+ clavaulinic acid, ciprofloxacin, levofloxacin etc. along with Metronidazole can all be effective.

      In addition I prescribe Tetanus Toxoid 0.5 ml stat, followed by a minimum 5-day antibiotic course as described above. Also prescribe antihistamines like Pheniramine 25 mg, chlorpheniramine 4 mg, cetrizine 10 mg, or levocetrizine in appropriate doses twice daily in accordance with the weight of the patient (including children).

    In cases where allergens cannot be identified or cannot be completely avoided and the patient continues to be exposed to allergens, low dose steroids should be prescribed like prednisolone .03 mg/kg or its equivalent of other steroids.

     To prevent resistance to steroids, such low dose steroids should be prescribed intermittently, say for one week, than a gap of 3 to 5 days, than one week, than gap and so on.

   Also certain anatomical anomalies of face like DNS(deflected nasal septum) predisposes a person to allergic reaction much more and in such cases also, such anomalies should be corrected by appropriate surgical means to better the outcome for such patients.

    Other anatomical anomalies may   include polyps, which should be removed by appropriate surgical means.

     To relieve stuffiness and congestion, normal saline (either market one or prepared at home) drops should be instilled in the nasal cavity at least twice a day.

    Another way to relieve symptoms in sinusitis is to boil Eucalyptus leaves and inhale the vapors. It contains natural decongestants and steroids in small amounts, appropriate for most cases of sinusitis. Such an inhalation can be done at a time when the symptoms of sinusitis are at its worst. Extract can also be prepared and commercial sprays prepared.

In addition, I have found that boiling Pine cones which have fallen down and inhaling its vapours has a very good decongestant effect and which is long lasting as well. Pine cone does seem to have its own anti-microbial properties, which are very beneficial in Sinusitis. Thus cases which have become resistant to Eucalyptus inhalation can try Pine cone inhalation as a replacement or even as primary inhalation.

     Also since Trigeminal cranial nerve gives sensory supply to sinuses and duramater (outer brain covering), so sinusitis leads to headaches. Such headaches should be relieved by appropriate analgesics like diclofenac, ibuprofen in appropriate doses SOS or when the headache occurs.

    Another useful preventive and curative method is to undergo immunization against all common sinusitis causing bacteria and viruses like haemophilus influenza, Streptococcus pneumonia, and appropriate viruses where available.  My research indicates that vaccination even in adults is advantageous and must be done in all cases of sinusitis.


Copyright Tanvir Nebuchadnezar

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