Saturday, 18 August 2012

A COMPLETE REVIEW ON SINUS INFECTION

Sinus infection
  • Sinus infections are caused by infections from a pathogenic microorganism (virus, bacterium, or fungus), which grows within a sinus and causes intermittent blockage of the sinus ostium.  Sinus infections are not contagious but arise from mainly viruses and bacteria that, by chance, contaminate a person who sinuses support their proliferation because of minor, and rarely, major abnormalities in the person's sinus tissue (for example, swelling, inflammation, abnormal mucus production, and rarely, facial or nasal trauma).

  • Sinusitis is inflammation of the air cavities within the passages of the nose. Sinusitis can be caused by infection, but also can be caused by allergies and chemical or particulate irritation of the sinuses.

  • Sinusitis may be classified in several ways such as acute sinus infection, subacute sinus infection, chronic sinus infection, infected sinusitis, and noninfectious sinusitis.

  • Sinus infection symptoms include sinus headache, facial tenderness, pressure or pain in the sinuses, fever, cloudy discolored drainage, and feeling of nasal stuffiness, sore throat, and cough.

  • Bacterial infection of the sinuses is suspected when facial pain, pus-like nasal discharge, and symptoms that persists for longer than a week and are not responding to over-the-counter nasal medications.

  • Sinus infection is generally diagnosed based on patient history and physical examination by a health care practitioner.

  • Bacterial sinusitis is usually treated with antibiotic therapy.

  • Early treatment of allergic sinusitis may prevent secondary bacterial sinus infections.
  • Home remedies for sinus infections include OTC medications such as Tylenol, decongestants, and mucolytics. Nasal irrigation can be accomplished with a Neti-pot(Himalayan Institute Ceramic Neti Pot ) or rinse kit (nasal bidet-).

  • Rare fungal infections of the sinuses (for example, zygomycosis) constitute a medical emergency.

  • Complications of a sinus infection that may develop are meningitis, brain abscess, osteomyelitis, and orbital cellulitis.

  • There are no fungal vaccines available to prevent fungal sinus infections.

What causes sinus infections?

Sinus infection may be caused by anything that interferes with airflow into the sinuses and the drainage of mucus out of the sinuses. The sinus openings (ostea) may be blocked by swelling of the tissue lining and adjacent nasal passage tissue, for example with common colds, allergies, and tissue irritants such as OTC nasal sprays, cocaine, and cigarette smoke. Sinuses can also become blocked by tumors or growths that are near the sinus openings.
The drainage of mucous from the sinuses can also be impaired by thickening of the mucous secretions, by decrease in hydration (water content) of the mucous brought on by disease (cystic fibrosis), drying medications (antihistamines), and lack of sufficient humidity in the air. The epithelial cells have small hairlike fibers, called cilia, which move back and forth to help the mucus move out of the sinuses. These small cilia may be damaged by many irritants, especially smoke. This can prevent them from assisting the mucus in draining from the sinuses.
Stagnated mucus provides an environment for bacteria, viruses and in some circumstances (for example, AIDS or immunodepressed persons) fungus to grow within the sinus cavities. In addition, the microbes themselves can initiate and exacerbate sinus blockage. The most commonly infected sinuses are the maxillary and ethmoid sinuses.
Rarely, immunodepressed or victims of multiple traumas in disasters such as tsunamis, hurricanes, earthquakes, or tornadoes may breathe in fungi from the soil or water. Eventually, in a few days to over a week, the fungi can grow and cut off blood supply to almost any type of tissue, especially in the nose and eyes. These infections, although rare, are serious and can be deadly and require immediate medical and surgical care. Although the fungal infection may resemble common bacterial sinusitis initially, it is a disease termed zygomycosis or mucormycosis.


What are the signs and symptoms of sinus infection?
Commonly the symptoms of sinus infection are headache, facial tenderness, pressure or pain, and fever. However, as few as 25% of patients may have fever associated with acute sinus infection. Other common symptoms include:
  • cloudy, discolored nasal drainage,
  • a feeling of nasal stuffiness,
  • sore throat, and
  • cough.
Some people notice an increased sensitivity or headache when they lean forward because of the additional pressure placed on the sinuses. Others may experience tooth or ear pain, fatigue, or bad breath. In noninfectious sinusitis, other associated allergy symptoms of itching eyes and sneezing may be common, but may include some of the symptoms listed above for infectious sinusitis. Nasal drainage is usually clear or whitish-colored in people with noninfectious sinusitis.
With rare fulminant fungal infections, there may be ulceration, with sharply defined edges and a black, necrotic center in the nasal area. Some fungal infections cause a dark, black-appearing exudates. This requires immediate medical evaluation.


How is sinus infection treated?

For sinusitis caused by virus infection, no antibiotic treatment is required. Frequently recommended treatments include pain and fever medications (such as acetaminophen [Tylenol]), decongestants and mucolytics.
Bacterial infection of the sinuses is suspected when facial pain, nasal discharge resembling pus, and symptoms persist for longer than a week and are not responding to OTC nasal medications. Acute sinus infection from bacteria is usually treated with antibiotic therapy aimed at treating the most common bacteria known to cause sinus infection, since it is unusual to be able to get a reliable culture without aspirating the sinuses.
The five most common bacteria causing sinus infections are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Streptococcus pyogenes. The antibiotics that are effective treatment for sinus infection must be able to kill these bacterial types. Although amoxicillin (Amoxil) is an acceptable first antibiotic for an uncomplicated acute sinus infection, many physicians choose amoxicillin-clavulanate (Augmentin) as the first-line drug for treatment of a suspected bacterial sinus infection because it is usually effective against most of the species and strains of bacteria that cause the disease.
In the penicillin allergic individual, cefaclor (Ceclor), loracarbef (Lorabid), clarithromycin (Biaxin), azithromycin (Zithromax), sulfamethoxazole (Gantanol), trimethoprim (Bactrim, Septra) and other antibiotics may be used as first choices. If a patient is not improving after five days of treatment with amoxicillin, the patient may be switched to one of the above drugs or amoxicillin-clavulanate (Augmentin. Generally, an effective antibiotic needs to be continued for a minimum of 10-14 days. It is however not unusual to need to treat sinus infection for 14-21 days.
Taking decongestants (pseudoephedrine) and mucolytics (guaifenesin) orally may be helpful in assisting drainage of sinus infection.
The treatment of chronic forms of sinus infection requires longer courses of medications, such as Augmentin, and may require a sinus drainage procedure. This drainage typically requires a surgical operation to open the blocked sinus under general anesthesia. In general, antihistamines should be avoided unless it is felt that the sinusitis sinus infection is due to allergy, such as from pollens, dander, or other environmental causes.
It is likely that the use of a topical nasal steroid spray will help reduce swelling in the allergic individual without the drying that is caused by using antihistamines although both are occasionally used.
In many people, allergic sinusitis develops first, and later, bacterial infection occurs. For these individuals, early treatment of allergic sinusitis may prevent development of secondary bacterial sinusitis.
In rare instances or in natural disasters, fungal infections (termed zygomycosis or mucormycosis) may develop in debilitated patients. Death rates of 50%-85% have been reported for patients with these sinus infections. Treatment relies on early diagnosis followed by immediate surgical debridement, antifungal drugs, (mainly Amphotericin B) and stabilizing any underlying health problem such as diabetes.

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