Tag Archives: Sinus

Balloon sinuplasty; A non-surgical treatment of sinusitis

Sinusitis is inflammation of sinuses. Mucus collects and blocks the sinus openings.

Symptoms are headache, facial pain,nasal discharge, nasal blockage and post nasal drip.

Aim of treatment is to open up blocked sinus passageways.

balloon-sinuplasty

Balloon sinuplasty is true advance in the field of sinus care. It works on same concept as balloon angioplasty for the treatment of clogged coronary arteries.

A wire catheter (approved by FDA) is introduced through the nostril and moved towards blocked passageways. Catheter has a balloon in the front.Then balloon gradually inflated to open up blocked passageways, then it is deflated and removed. Sinus drainage is restored.

Balloon sinuplasty alone may eliminate the need for surgery in some patients and others may require concurrent endoscopic sinus surgery.

Balloon sinuplasty is safe, effective , minimally invasive, cost effective, takes less recovery time, has less patient discomfort, and has no side effects.

Studies confirm it’s safety and efficacy and high patient satisfaction. But still it is under evaluation for long term success and further studies are needed to see it’s effectiveness in presence of nasal polyp or when ethmoid sinus is involved.

Home care for sinus problem

Infection of sinuses is called sinusitis. Sinusitis may be caused by anything that interfere with airflow into the sinuses and mucus drainage out of the sinuses, usually follow a viral infection, allergy, or irritants. Thus treatment is aimed at thinning of secretions for easy drainage or reducing inflammation to open up blocked sinus passageways.

Home remedies effectively reduce symptoms of sinusitis and reduce visits to doctor’s clinic.

Proper rest and nutrition.

Vitamin c, vitamin A and zinc

Sleep with head elevated.

Maintain adequate hydration.

Drink hot drinks like hot soups and tea.

Steam inhalation– Plain water or medicated steam with menthol has soothing effect and helps in improving sinus drainage. hot shower also helps.

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 available saline nasal sprays can be used.

Avoidance of allergen if any.

Avoidance of irritants/smoke.

Use of humidifier.

If symptoms persist visit your clinician or otolaryngologist.

Sinus, Acute sinusitis and treatment

Management of sinusitis has witnessed fundamental change 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 cavities connected to the space between nostril and nasal passage; these are called Sinuses (or Para Nasal Sinuses). Sinuses help insulate the skull, reduce its weight and add resonance to voice.

There is 4 major pair of sinuses–
1.Frontal (in the forehead), 2. Maxillary (behind the cheek bones) 3.Ethmoid (between the eyes), 4. Sphenoid (behind the eyes).

sinusitis

 

 

 

Sinuses are lined by respiratory epithelium with Goblet cells to secretes mucus (forming mucus blanket) and cilia (fine hair like structure) to help trap and propel pollutant and bacteria outward to nose through osteum (opening) of sinuses.

 

Most of the sinuses drain into a key area (Osteo-Meatal complex). Thus treatment of sinusitis is focused on this area.

Acute sinusitis


Infection of sinuses is called sinusitis–acute or chronic based on the time span.
Sinusitis may be caused by anything that interfere with airflow into the sinuses and mucous drainage out of the sinuses, usually follow a viral infection, allergy, or irritants.

Most common bacteria involved are streptococcus pneumonae, Haemophilus influenzae, and moraxella catarhalis.

 

 

 

Signs and symptoms of sinusitis depend on which sinus is involved–usually present with:
-nasal congestion and discharge or post nasal drip
-headache, or facial pain, or pain under or around the eyes
-fever

 

 

 

Treatment of acute sinusitis:-

Maxillary sinus is most commonly involved followed by ethmoid, frontal and sphenoid.

 

 

Aims of management are:-

1. To achieve normal healthy sinuses

2. To decrease duration of the symptom

3. To prevent complications

4. To prevent development of acute sinusitis.

 

 

 

 

Most patients of acute sinusitis can be benefitted without many investigations as diagnosis is mainly clinical. Nasal endoscopy for proper visualization of nose and sinuses is important for appropriate management. Endoscopic assessment of nose guide therapy and at the same time accurate pus-swab can be obtained for bacteriological examination.

Sometimes if symptoms persist for longer duration further investigation may be required like examination of mucocilliary mechanism, allergic and immune status of patient and computerized tomography (CT scan) of sinuses.

 

 

 

Medical management:-

Analgesics, antibiotics and decongestants are given to reduce swelling and thus increase clearance and drainage from the sinuses.

Antibiotics–studies have confirmed that acute bacterial sinusitis treated with antibiotics have more rapid resolution of symptoms.

Antibiotics should be effective and should cover wide range of organisms.

In general antibiotics are required for 10 days but in some cases especially recurrent cases up to 2 weeks course may be given.

Usually amoxicillin, ampicillin, co-amoxyclav and cephalosporins are primary drugs of choice. If first line drugs fail then second line treatment is based on culture and sensitivity report of pus aspirated from sinuses by antral lavage.

 

 

 

Nasal decongestant drops–Nasal decongestant or steroid drops or sprays are used to decongest sinus osteum and thus encourage drainage.

Clinicians prefer long acting preparation because of less rebound phenomena. Topical decongestant drops should not be used for long duration as it back fires and person develops “rhinitis medicamentosa.”

 

 

 

Oral decongestant or mucolytics–may be used to reduce mucosal inflammation. In general antihistamines are to be avoided in acute bacterial sinusitis because it will thicken and dry the secretion.

 

 

 

Analgesics–any suitable and safe pain killer medicine acetaminophen or ibugesic are prescribed to relieve pain.

 

 

 

Home care–

Steam inhalation— plain water or medicated steam with menthol provides relief from symptoms 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, Nasal wash or “jala neti” –-nose and sinuses should be washed by ¼ tsf salt in 1 cup water using bulb syringe or alternatively commercially available saline nasal sprays can be used.

 

Avoidance of allergy if any

Use of humidifier
Avoidance of irritants

 

Baloon Sinuplasty it’s new nonsurgical technique which is cost effective.

A balon is placed in the affected nasal cavity, inflated for short duratin to open up sinus passageways.  

Surgical management-

 

Usually acute sinusitis is treated by medicines. Most cases of acute maxillary sinusitis resolve with effective and proper medical management. Very rarely when medical treatment fails surgical approach is required.

 

Surgical treatment is reserved for-

Failure of medical management

Severe pain

Impending complications.

 

Antral lavage-

This is opd procedure under local anaesthesia where medial wall of maxillary sinus is punctured in the region of inferior meatus, sinus is drained and irrigated. Now this technique is rarely employed and endoscopic enlargement of middle meatus is preferred.

Frontal sinuses wash outs-

This is done in general anaesthesia. Small incision is given below eyebrow medially.

 

 

 

Functional Endoscopic sinus surgery-

Recurrent acute bacterial sinusitis or sinusitis of long duration unresponsive to medicine is major indication for endoscopic sinus surgery.

Endoscopic surgery is minimally invasive surgery. It does not require skin incisions and done by endoscope inserted through nose.

CT scanning is must before surgery.

One thing to be remembered-meticulous postoperative cleaning is equally important for success as is the expertise of surgeon.

 

 

 

 

Treatment plan for acute sinusitis may vary according to experience of treating physician, but it is crucial to understand the importance of “osteomeatal region”.

 

Effective medical management requires good doctor-patient understanding. Medical professional 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 create resistant bacteria leading to failure of medical treatment.

 

From my article at helium.com- http://www.helium.com/items/1269826-treatment-of-acute-sinusitis