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Sinusitis: Causes, symptoms and management (2)

February 12, 2014 by Rotimi Adesanya Leave a Comment

       

| credits: File copy

Last week, I sensitised the general population to how debilitating sinus infections can be or how much we suffer as a result. Sinusitis, or a sinus infection, occurs when the sinuses and nasal passages become inflamed and swollen.

Acute sinusitis could last up to four weeks, while chronic sinusitis typically lasts more than four weeks and occurs more than four times in a year. I used a photograph to illustrate the names and locations of the sinuses on the head.

This concluding part will be on the examination, investigations, treatment and prevention of sinusitis.

Physical examination: A thorough physical examination will involve the doctor pressing the forehead and cheekbones to check for tenderness (pain) and other signs of sinusitis, including yellow to yellow-green nasal discharge. The doctor will also check the inside of the nostrils, using a device with a bright light to check the mucus and look for any structural abnormalities.

Investigations: X-Rays: X-rays are readily available though not 100 per cent Accurate.

Computed tomography: Computed tomography scan is the best method for viewing the paranasal sinuses

 Endoscopy: Nasal endoscopy, or rhinoscopy, involves the insertion of a flexible tube with a fibre-optic light on the end into the nasal passage. Endoscopy is also used for treating sinusitis.

Treatment

Fluids

-Drinking plenty of fluids and getting lots of rest when needed is still the best bit of advice to ease the discomforts of the common cold.

-Spicy or pepper soup does, indeed, help congestion and aches. The hot steam from the soup may be its chief advantage, although other ingredients in the soup may have anti-inflammatory effects.

-In fact, any hot beverage may have similar soothing effects from steam. Ginger tea, fruit juice, and hot tea with honey and lemon may all be helpful.

Steam and nasal saline sprays

-Inhaling steam two to four times a day is extremely helpful, costs nothing, and requires no expensive equipment. The patient should sit comfortably and lean over a bowl of boiling hot water while covering the head and the bowl with a towel so the steam remains under the cloth. The steam should be inhaled continuously for 10 minutes. A mentholated or other aromatic preparation may be added to the water.

-Use a humidifier.

-Nasal Wash: A nasal wash can be helpful for removing mucus from the nose and relieving sinusitis symptoms. A saline (salt water) solution can be purchased in a spray bottle at a drug store or made at home.

Drug treatment of sinusitis

Non-prescription pain relievers such as acetaminophen and ibuprofen can help mild-to-moderate pain symptoms.

Nutrition and supplements can help prevent the allergic reactions that are a major cause of allergic sinusitis. Vitamin C and Vitamin B6 help prevent inflammation and excessive histamine levels, while zinc strengthens overall immunity.

 Decongestants may help relieve congestion, but they do not cure sinusitis.

Antihistamines can dry the mucus and sometimes worsen the condition. Cough or cold medication is not recommended for children younger than age four.

Steroids are also effective both orally and intra-  nasally.

 Antibiotic drugs are used to treat bacterial, not viral, infections. Unfortunately, because of the overuse and improper use of antibiotics, many types of bacteria no longer respond to antibiotic treatment.

Allergy shots (immunotherapy) to help prevent the disease from returning

Surgery

Surgery can unblock the sinuses when drug therapy is not effective or if there are other complications, such as structural abnormalities or fungal sinusitis.

Surgery to enlarge the sinus opening and drain the sinuses may also be needed.

An ENT specialist (also known as an otolaryngologist) normally performs this surgery.

Prevention

The best way to prevent sinusitis is to avoid cold and influenza. If you are unable to avoid them, the next best way to prevent sinusitis is to effectively treat cold and influenza.

Colds and flu are spread primarily when an infected person coughs or sneezes near someone else. A very common method for transmitting a cold is by shaking hands. Everyone should always wash their hands before eating and after going outside.

Influenza Vaccine: Doctors recommend that people receive annual influenza vaccination.

-Concluded

Sinusitis: Causes, symptoms and management

February 5, 2014 by Rotimi Adesanya

 credits: File copy

A young man shared this story with me during a medical mission on an island in Epe, Lagos. He has been sent by the community health worker to our diabetes and hypertension screening. His test was within normal range and he was counselled on the need to be referred to a secondary facility for treatment. He later opened up and told me his medical history.

The man’s story: “I am 38 years old and I have suffered from chronic sinusitis my entire life. As a child, I was always going to the paediatrician, but as soon as one infection cleared up, another would start and it has been this way ever since.

“I was scheduled for surgery by ENT surgeon but declined due to fear. I have had allergy injections thrice a week for my whole life. I’m allergic to pet, dust mite, groundnut and mould. Of course, irritants like smoke, air pollution and smells of chemical substances make life even worse.

“I’m constantly on antibiotics, steroids, nasal spray, and allergy medication. My sinus infections often turn into bronchitis (lung infection) and this last time, into viral pneumonia. I cough constantly, lose sleep, miss work, and catch any virus going around. Now, I’ve been diagnosed with migraine and cluster headaches that are triggered by the sinus headaches. All this has made me become frustrated.”

This piece is to sensitise the general population to how debilitating sinus infections can be or how much we suffer as a result.

Sinusitis, or a sinus infection, occurs when the sinuses and nasal passages become inflamed and swollen (as illustrated in the picture). Acute sinusitis can last up to four weeks, while chronic sinusitis typically lasts more than four weeks and occurs more than four times in a year.

Causes

Acute sinusitis can be caused by upper respiratory tract viral infection, such as the common cold; or bacterial/fungal infections, allergies, and environmental irritants.

Chronic sinusitis can result from recurring episodes of acute sinusitis or it can be caused by other health conditions such as asthma and allergic rhinitis, immune disorders, or structural abnormalities in the nose, such as deviated septum or nasal polyps.

 Enlarged adenoids, cleft palate and tumours can also lead to chronic sinusitis.

Risk factors

-Young children are prone to colds and may have between eight and 12 bouts every year. Smaller nasal and sinus passages make children more vulnerable; while ear infections such as otitis media are also associated with sinusitis. Nevertheless, true sinusitis is very rare in children under nine years of age.

-The elderly are at specific risk for sinusitis. Their nasal passages tend to dry out with age. In addition, the cartilage supporting the nasal passages weakens, causing airflow changes. They also have diminished cough and gag reflexes and weakened immune systems

-People with asthma or allergies are at higher risk for non-infectious inflammation in the sinuses. The risk for sinusitis is higher in patients with severe asthma.

-Some hospitalised patients are at higher risk for sinusitis, particularly those with head injuries, or those whose conditions require insertion of tubes through the nose. Again, those who breathe aided by mechanical ventilators, and those whose immune system have been weakened are all susceptible to sinusitis.

-People who experience changes in atmospheric pressure, such as while flying, climbing high altitudes, or swimming, risk sinus blockage and therefore an increased risk of developing sinusitis

-Air pollution from industrial chemicals, cigarette smoke, or other pollutants can damage the cilia responsible for moving mucus through the sinuses.

General symptoms

Sinus symptoms are very common during a cold or the flu, but in most cases, they are due to the effects of the infecting virus and resolve when the infection does. Nasal congestion or discharge, itchy nose, eyes, facial pain or pressure, cough or scratchy throat, fever, diminished or absent sense of smell, recurrent sneezing, sinus headache,  migraine and or cluster headaches, ear pain or pressure, dental pain, bad breath, fatigue, are common symptoms of sinusitis.

Symptoms indicating medical emergency

Eyes may be red, bulging, or painful if the sinus infection occurs around the eyes. Swelling and drooping eyelid, loss of eye movement (possible orbital infection, which is in the eye socket), development of severe headache, altered vision, a soft swelling over the bone (indicative of bone infection) are all signs that you should see your doctor immediately.

 

To be concluded.

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PNEUMONIA IN CHILDREN

Pneumonia means an infection of the lungs. In the early 1900's pneumonia was responsible for many deaths even in children. Fortunately, with the invention of antibiotics and certain vaccines, pneumonia occurs less commonly today and can be effectively treated in most cases.
CAUSES OF PNEUMONIA
There are several types of germs that can cause an infection of the lungs; bacterial and viral. Although there are many different types of bacteria and viruses,fungi that can cause pneumonia, there tend to be related to age and other circumstances. For example the bacteria that cause pneumonia in newborns differ than those that cause the same infection in older children.
Signs and Symptoms......Symptoms of pneumonia vary, depending on the age of the child and the cause of the pneumonia. Common symptoms include:
• fever
• chills
• cough
• unusually rapid breathing
• breathing with grunting or wheezing sounds
• labored breathing that makes a child's rib muscles retract (when muscles under the rib cage or between ribs draw inward with each breath)
• vomiting
• chest pain
• abdominal pain
• decreased activity
• loss of appetite (in older kids) or poor feeding (in infants)
• in extreme cases, bluish or gray color of the lips and fingernails
When pneumonia is caused by bacteria, an infected child usually becomes sick relatively quickly and experiences the sudden onset of high fever and unusually rapid breathing. When pneumonia is caused by viruses, symptoms tend to appear more gradually and are often less severe than in bacterial pneumonia. Wheezing may be more common in viral pneumonia.
Some types of pneumonia cause symptoms that give important clues about which germ is causing the illness. For example, in older kids and adolescents, pneumonia due to Mycoplasma is notorious for causing a sore throat and headache in addition to the usual symptoms of pneumonia.N.B.....some children persistent high fever (more than 4 days) can be the only sign of pneumonia
INVESTIGATIONS
Although the doctor can sometimes hear specific noises with stethoscopes, that suggest pneumonia, the diagnosis is confirmed by a chest x-ray. After the full treatment course, children usually fully recover and there is no need to repeat the chest X-ray. However if the child was very ill, had a large or severe pneumonia, a repeat chest x ray may be recommended to make sure the pneumonia has cleared. If this is the case, a repeat X ray is performed 4- 6 weeks after treatmants.
TREATMENT OF PNEUMONIA
Viral pneumonia..........No treatment, although in most cases the doctor cannot tell if the cause is viral and will treat all pneumonias with antibiotics.
Bacterial Pneumonia .....treated by complete dose of antibiotics for 7-10 days.Children less than 3 months of age with pneumonia are admitted to hospital for intravenous antibiotics, oxygen treatment and rehydration.
Children with weakened immune systems are usually hospitalized and may need different(stronger) antibiotics than the children with normal immune systems.

After the full treatment course, children usually fully recover and there is no need to repeat the chest X-ray. However if the child was very ill, had a large or severe pneumonia, a repeat chest x ray may be recommended to make sure the pneumonia has cleared. If this is the case, a repeat X ray is performed 6-8 weeks later.
PREVENTION OF PNEUMONIA..........People who has cough should be treated,Avoid close contact with someone coughing,Those coughing should protect mouth and nose from with handkerchiefs when coughing or sneezing,Hand washing in people with cough or cold,Exclusive breastfeeeding in the first 4-6 months protects children from pneumonia,Balanced diet for older children,Avoid overcrowding,Vaccination..vaccines are available to protect pneumonia.

DIARRHOEA IN CHILDREN

Diarrhoea is the condition of having frequent loose or liquid bowel movements. It is the passing of watery stools more than three times a day. It is often a symptom of an infection or acute/long-term condition.
Diarrhoea can either be:
• acute: diarrhoea that comes on suddenly, and lasts for five to 10 days, or
• chronic: diarrhoea that lasts for more than two weeks.
Acute diarrhea is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause severe dehydration which is one cause of death in diarrhea sufferers. Along with water, sufferers also lose dangerous amounts of important salts, electrolytes, and other nutrients.
What causes diarrhoea?
Acute diarrhoea is usually caused by a viral or bacterial infection and affects almost everyone from time to time.
Rotavirus is the major cause of paediatric severe diarrhoea worldwide. Live attenuated vaccines, shown to be highly effective where they have been so far trialed, are increasingly being implemented within universal infant immunization schedules.
How common is it?
Diarrhoea and vomiting is very common, especially in children. A baby or toddler will probably have diarrhoea and vomiting two or three times a year.
How serious is it?
Diarrhoea usually clears up in a couple of days and is not serious. However, it can be serious in babies and the elderly because of the risk of dehydration.
If diarrhoea is persistent or there are other symptoms, such as bleeding, see your General Practitioner
If your child is between three months and one year old, diarrhoea should last no longer than 48 hours.
Symptomatic treatment for diarrhea involves the patient consuming adequate amounts of water to replace that loss, preferably mixed with electrolytes to provide essential salts and some amount of nutrients. For many people, further treatment is Symptomatic treatment for diarrhea involves the patient consuming adequate amounts of water to replace that loss, preferably mixed with electrolytes to provide essential salts and some amount of nutrients. For many people, further treatment is unnecessary.
The following types of diarrhea indicate medical supervision is require
• Diarrhea in institutions such as hospitals, child care centers, or geriatric and convalescent homes.
• Diarrhea in infants
• Moderate or severe diarrhea in young children;
• Diarrhea associated with blood
• Diarrhea that continues for more than two days;
• Diarrhea that is associated with more general illness such as non-cramping abdominal pain, fever, weight loss, etc;
In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth – oral rehydration therapy – or, in very severe cases, intravenouslyi.e through the vein.