Sinusitis

A 24 years old female complains “my head feels heavy, can’t bend down, something tight feeling around the head, my nose is stuffed, and I cannot breath. I got very ill one winter, dizzy, fever, congestion, and ear infection, fatigue. My sinuses were constantly draining, green, thick mucus. Because I let it go so long thinking it was just a cold, it turned into Bronchitis and I was out of work for 2 weeks on a strong course of antibiotics.” this is what we hear most of them complaining. If we try to enquire about the past they give a history of recurrent cold or coryza. That is how a case of sinusitis presents.

So what is this sinusitis?

It’s nothing but the inflammation of the Paranasal sinuses.
What are these Paranasal sinuses then? These are the four paired structures surrounding the nasal cavities which make the skull bone feel light, provides insulation to the skull and provide Resonance for the voice.

Depending upon the location they are named as,

  • Frontal (forehead, eyebrows),
  • Maxillary (cheek bone),
  • Sphenoid (behind the eyes to vertex) and
  • Ethmoid (in between the eyes or root of nose).

Pathophysiology of Sinusitis:-

The paranasal sinuses are lined with mucus membrane that has ciliated epithelium which produces mucus. Normally, mucus does not accumulate in the sinuses, as it is cleared by the cilia. These discharges remain sterile despite their adjacency to the bacterium-filled nasal passages. But, when the sinus ostia are obstructed, however, or when ciliary clearance is impaired or absent, the secretions can be retained. This is when it can get infected with bacteria, virus or fungus producing the typical signs and symptoms of sinusitis.

Other causes are: Noninfectious causes include Allergic Rhinitis (mucosal oedema or polyp), Barotrauma (deep sea diving, air travel), chemical irritants, squamous cell carcinoma or deviated nasal septum.

These infectious agents or the irritants cause the mucus membrane to swell up and prevent draining of fluid from sinuses. Collected fluid dries up and becomes viscid and turns yellowish to green.

How does it presents?

Most of them present it after a viral infection or any upper respiratory tract infection.
Common presenting symptoms of sinusitis include,

  • Nasal drainage
  • Congestion
  • Facial pain or pressure
  • Headache

Start on one side and progress to both. Thick, purulent or discolored nasal discharge is often thought to indicate bacterial sinusitis, but it also occurs early in viral infections such as the common cold and is not specific to bacterial infection alone.

Other nonspecific symptoms include,

  • Cough,
  • Sneezing,
  • Fever.
  • Tooth pain, most often involving the upper molars, is associated with bacterial sinusitis,
  • Halitosis (offensive breath).

Headaches or heaviness of the head is localized to the involved sinus like frontal sinus, pain in the forehead, maxillary, pain in cheek bones etc. it can be worse when the person bends over or lying down. Sphenoid or Ethmoid sinus infection can present as severe frontal or retro-orbital pain radiating to the occiput. Presence of nasal discharge can differentiate it from toothache, tension headaches or migraine.

Complications

If these symptoms are not treated on time it will lead to chronic sinusitis. That is if it is persistent for more than 3 months or acute is recurring.
The symptoms are similar to acute but of longer duration and may lead to loss of sense of smell and taste. Due to the stuffed nose there may be difficulty in sleeping and tiredness.
Rarely may end up in severe complications like Lower Respiratory Tract infections (Bronchitis), swelling around the face, meningitis, cerebral abscess.

How will the physician diagnose??

A detailed case history can identify the cases. Depending on the symptoms or presentation it’s difficult to differentiate it as bacterial or viral.

Duration of the disease can be of help to differentiate it, less than 7 days for viral and more than 7 days for bacterial.

Tenderness: In acute cases no much investigations is required. The doctor may press on your face to check for any tender points to locate the infection. In chronic or seemingly complicated cases may require CT -Scan to be done.

A routine blood investigation will help to know the severity of infection. Few cases may require endoscopy or culture and sensitivity if the case is not clear.

Mode of Treatment

General management:

  • Quit smoking
  • 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. Water is the best fluid and helps lubricate the mucus membranes.
  • Ginger tea, fruit juice, and hot tea with honey and lemon may all be helpful.
  • Spicy foods that contain hot peppers or horseradish may help clear sinuses.
  • Inhaling steam 2 – 4 times a day is extremely helpful

What is the treatment available??

Most of the Sinusitis headaches are neglected in the beginning stage, that too when intensity of pain is less, even if taken care also, it will be in the form of following measures.

Antibiotics: – but it is not required in all cases. Only if the infection is serious it may be required. Taking more antibiotics may suppress the mucus discharge per nose and may lead to collection of more mucus in sinuses. Adaptation of Antibiotics may lead to higher/strong range of Antibiotics every time.
Nasal steroid spray (adverse reaction are seen), decongestant nasal drops, nasal irrigation or inhalation, steam inhalation – reduce the swelling of mucus membrane and can be soothing but later affects are worse than previous by reducing the sensitivity.

Other treatment includes
Surgery: – functional endoscopic sinus surgery (even after surgery you will need to use steroid nasal sprays, or other medication)
Balloon dilatation of the sinuses (not enough research is available)
Why Homoeopathy is safer…?
As I mentioned Common infections like common cold, repeated attack of Allergic Rhinitis are the main causes for the Sinusitis, which shows that the particular person’s immunity or body’s resistance power is poor and are much prone to diseases like this. Through Homeopathic medicines we can boost up the immunity and even it’ll reduce the recurrence (which is very common) with permanent relief & without any side effect.
Why Positive homeopathy…?
“Homoeopathy is same but Homeopath’s approach differs”
Yes, we have very wonderful Homeopathic remedies (Like ,Allium Cepa,Hydrastis,Kali Bich ,Kali Iod, Lemna minor,Lyco, Pulsatilla, Sanguinaria, Sil, Spigelia, ,Sticta p ,Viola odarata, , etc etc.) that can open and hydrate sinuses may help in getting better in an acute conditions with severe headache.
But to get complete relief without recurrence one has to follow the Classical homeopathy which is found by our Master Samuel Hahnemann and taught by Dr.Prafull Vijaykar. Where through Theory of Suppression we can access the exact stage of disease and can decide the prognosis after giving a very well selected Constitutional remedy. By treating the root causes only one can make get rid of recurrence and from further complications.

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