Sinusitis

Sinus infection facts

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.

Most people do not transmit sinus infections; most clinicians agree that except for rare instances, 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 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.

Sinusitis is most often the result of a viral infection that causes the mucous membrane lining the inside of the nose and the sinuses to become inflamed.

The mucous membrane swells when it becomes inflamed, blocking the drainage of fluid from the sinuses into the nose and throat.

Mucus and fluid build up inside the sinuses, causing pressure and pain.

Bacteria are more likely to grow in sinuses that are unable to drain properly. Bacterial infection in the sinuses often causes more inflammation and pain.

Colds usually trigger this process, but any factor that causes the mucous membrane to become inflamed may lead to sinusitis. Many people with nasal allergies (allergic rhinitis), for instance, are likely to have recurring or long-term (chronic) sinus infections. Nasal polyps, foreign objects (usually in children), structural problems in the nose such as a deviated septum, and other conditions can also block the nasal passages, increasing the risk of sinusitis.

Fungal infections may also cause sinusitis. This is especially true in people with impaired immune systems. Fungal sinusitis tends to be chronic and harder to treat than bacterial sinusitis.

What are the types of sinusitis?

Sinusitis may be classified in several ways, based on the time span of the problem (acute, subacute, or chronic) and the type of inflammation (either infectious or noninfectious).

Acute sinus infection (also termed acute sinusitis caused by infection) is usually defined as being of less than 30 days duration.
Subacute sinus infection as being over 1 month but less than 3 months.
Chronic sinus infection as being greater than 3 months duration.
There is no medical consensus on the above time periods.

Infected sinusitis usually is caused by uncomplicated virus infection. Less frequently, bacterial growth causes sinus infection and fungal sinus infection is very infrequent. Subacute and chronic forms of sinus infection usually are the result of incomplete treatment of an acute sinus infection.
Noninfectious sinusitis is caused by irritants and allergic conditions and follows the same general time line for acute, subacute and chronic as infectious sinusitis.

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.

 

Are there home remedies for a sinus infection?

Sinus infections caused by viruses can use home (over-the-counter) treatments such as pain and fever medications (acetaminophen [Tylenol]), decongestants, and mucolytics. In addition, some health care providers suggest that nasal irrigation or a sinus rinse solution will help relieve symptoms of sinus infections, even chronic sinusitis symptoms. This irrigation is accomplished with a "Neti-Pot" or a sinus rinse kit (sometimes termed a nasal bidet). The last reference of this article shows a video of a sinus rinse procedure.

Bacterial and fungal sinus infections usually require antibiotic or antifungal therapy so home treatments without them are often not successful. However, some authors suggest home treatments may reduce symptoms after medical therapy has begun; some health care practitioners recommend nasal irrigation after sinus surgery.

Nasal Polyposis

What Are Nasal Polyps?

Nasal polyps are growths that result from inflamed mucus membranes in the sinuses and nasal passages. They can extend to the opening of the nostrils, or even down to the throat area. These growths can block the nasal passages.

Nasal polyps are often related to other chronic diseases and tend to last for long periods of time. They can even grow back after medical treatments or surgical removal.

What Diseases are Associated with Nasal Polyps?

Nasal polyps can occur along with many other respiratory diseases, such as allergic rhinitis, chronic sinusitis (due to bacterial and fungal infections),asthma, and aspirin allergy. It appears that nasal polyps are more common in people with non-allergic rhinitis and non-allergic asthma, rather than allergic types of these conditions.

Nasal polyps can also be a sign of immunodeficiency diseases. For example, nasal polyps in children can be a sign of cystic fibrosis. Other immunodeficiencies, such as primary ciliary dyskinesia, Churg-Strauss syndrome, selective IgA deficiency, and common variable immunodeficiency (CVID), can be associated with nasal polyps, too.

Overall, nasal polyps are relatively rare, occurring in only about 4% of the population. However, this number is significantly higher in people with other diseases, such as those listed above.

What are the Signs and Symptoms of Nasal Polyps?

The majority of people with nasal polyps will experience nasal congestion, which may be severe, that isn't helped by typical allergy medications. Other common symptoms include:

• Runny nose with clear or colored mucus


• Loss or decreased sense of smell and taste


• Headache


• Sinus pressure

However, facial pain is much more common in people with chronic sinusitis compared to those with nasal polyps.

A person with severe nasal polyps may actually be able to see the polyps in their nostrils. These structures look like clumps of clear Jello-O. Long-standing nasal polyps can lead to widening of the nasal bridge, which can result in the eyes appearing to be farther apart.

How are Nasal Polyps Diagnosed?

In some situations, a physician can make a nasal polyp diagnosis by examining the nasal passages. This may include nasal endoscopy, which entails placing a small camera into the nose to get a better look at the nasal passages. More commonly, however, a CT ("cat scan") of the sinuses is needed to make a diagnosis.

Since other diseases are often present when a person has nasal polyps, further diagnostic tests may need to be performed.

How are Nasal Polyps Treated?

Nasal polyps may be treated by both surgical and medical therapies. In severe cases, sinus surgery is often required to remove the nasal polyps and any accompanying sinus infection. However, since nasal polyps tend to grow back in at least one-third of patients, the overuse of surgery should be avoided.

The best therapy for nasal polyps usually involves the use of surgical therapies followed by medical therapies, as this approach helps reduce the chance that the polyps will grow back.

 

• Nasal Steroid Sprays and DropsTopical nasal steroid sprays, such as Flonase (fluticasone propionate) and Nasonex(mometasone furoate), can help reduce the size of nasal polyps and prevent polyps from growing back after surgery. Some physicians, myself included, use nasal steroid drops, rather than sprays, in order to better penetrate the nasal passages and reach the nasal polyps.
  
   


• CorticosteroidsOral corticosteroids, such as prednisone, can quickly shrink the size of nasal polyps and are helpful in people with severe symptoms. After a short course of corticosteroids (about 1 to 2 weeks), however, topical nasal steroid sprays are able to control symptoms better and prevent the polyps from growing larger.
  
  In some cases, such as when fungal sinusitis is the cause of nasal polyps, low-dose oral corticosteroids may be required for weeks to months after surgery in order to prevent polyps from growing back.
  
   


• Antileukotriene MedicationsOral antileukotriene medications, such as Singulair (montelukast), are theoretically beneficial in people with nasal polyps -- especially those with aspirin allergy. People with aspirin allergy are known to have high levels of leukotrienes, so medications that block these chemicals should help to reduce symptoms of chronic sinus disease and polyp formation.
  
   


• Nasal Saline IrrigationNasal saline irrigation can be especially helpful in people with nasal polyps and chronic sinus infections. This is especially true for those who have had sinus surgery, as the saline can rinse out the sinuses and not just the nasal passages.
  
   


• Allergy ShotsMany allergists may use allergy shots in an attempt to treat or prevent nasal polyps from growing back after surgery. The best data for the use of allergy shots is in those with allergic fungal sinusitis; allergy shots may also prove to be helpful in those with nasal polyps and evidence of significant allergic triggers.

Deviated Nasal Septum

What is a deviated septum?

A deviated septum is a condition in which the nasal septum -- the bone and cartilage that divide the nasal cavity of the nose in half -- is significantly off center, or crooked, making breathing difficult. Most people have some sort of imbalance in the size of their breathing passages. In fact, estimates indicate that 80% of people, most unknowingly, have some sort of misalignment to their nasal septum. Only the more severe imbalances cause significant breathing problems and require treatment.
Deviated Septum Causes

Some people are born with a deviated septum. Other people develop a deviated septum after injury or trauma to the nose.
Deviated Septum Symptoms

The most common symptom of a deviated septum is nasal congestion, with one side of the nose being more congested than the other, along with difficulty breathing. Recurrent or repeated sinus infections can also be a sign of a deviated septum. Other symptoms include frequent:

nosebleeds
facial pain
headache
postnasal drip
loud breathing and snoring during sleep
A deviated septum may also cause sleep apnea, a serious condition in which a person stops breathing during sleep.

Deviated Septum Treatments

Sometimes symptoms can be relieved with medications. If medicine alone doesn't offer adequate relief, a surgical procedure called septoplasty may be needed to repair a crooked septum and improve breathing.
Deviated Septum Surgery

During septoplasty, a surgeon, working through the inside of the nose, makes a small incision in the septum and then removes the excess bone or cartilage required to even out the breathing space of the nostrils.

Sometimes a rhinoplasty, or "nose job," is combined with septoplasty to improve the appearance of the nose. This procedure is called septorhinoplasty. Septoplasty may also be combined with sinus surgery.

Surgery to repair a deviated septum is usually performed in an outpatient setting under local or general anesthesia and takes about one to one and a half hours, depending on the amount of work being done. You should be able to go home three to four hours after surgery.

Internal splints or soft packing material may be put in the nose to stabilize the septum as it heals. If a septoplasty is the only procedure performed, there should be little to no swelling or bruising after surgery. However, if a septorhinoplasty is performed, a week or two of swelling and bruising is normal following the procedure.

If possible, it is best to wait until after the nose has stopped growing, around age 15, to have surgery.
Deviated Septum Surgery Risks

No surgery is completely risk-free and the benefits from undergoing surgery -- in this case, being able to breathe better -- must outweigh the risks. Septoplasty and septorhinoplasty are common and safe procedures and the chance of having a dangerous side effect is rare. Still, talk with your doctor about the possible risks of surgery before you make a treatment decision.

Although rare, risks of septoplasty and/or rhinoplasty may include:

infection
bleeding
hole (perforation) of the septum
loss of the ability to smell
If you are having nasal symptoms and think you may have a deviated septum, make an appointment to see an ear, nose, and throat doctor, or ENT. There are a number of reasons why you may be experiencing these symptoms, including chronic sinusitis or nasal allergies. Make sure you get the right diagnosis so that you can get the treatment you need.

Is nasal congestion a symptoms of a deviated septum?

Symptom Checker: Symptoms & Signs of Nasal Congestion

Nasal congestion, or "stuffy nose," is a term that refers to the obstruction to the flow of air in and out of the nose. In contrast, the term "runny nose" refers to a discharge (fluid) coming from the nasal passages. Nasal congestion most commonly is the result of inflammation and swelling of the lining tissues of the nasal passages and sinuses. Less commonly, anatomical obstructions (for example, a deviated nasal septum, foreign bodies) may lead to nasal congestion. Prolonged use of certain nasal decongestant sprays or drops can lead to a worsening of nasal congestion. Rarely, tumors of the nasal passages or chronic medical conditions may be the cause of nasal congestion.

Austin's classification for ossicular chain defect

Question:

Austin's classification for ossicular chain defect depends on (DPG)

Options:

(1 ) Malleus head and Stapes footplate

(2 v) Malleus handle and Stapes suprastructure

(3 ) Malleus head and Stapes suprastructure

(4 ) Malleus head and Stapes head

Syndromes Associated With Deafness

 

 

 

 

 

 

Question:

Deafness is associated with all except (MAHE)

Options:

(1 ) Cockayne's syndrome

(2 ) Alstrom's syndrome

(3 ) Alport's syndrome

(4 ) Abetalipoproteinemia

 

Learn it !

 

Syndromes commonly associated with hearing loss in children

 

It is estimated that at least 30% of congenital hearing loss is due to hereditary factors. Approximately 70% of hereditary hearing loss is non-syndromal.

 

Patterns of inheritance of non-syndromal hearing loss can be autosomal recessive, autosomal dominant, x-linked, and mitochondrial.

 

Here is a list of syndromes commonly associated with hearing loss:

 

ð  Alport syndrome: collagen synthesis disease chracterized by renal disease

ð  Alström syndrome: pigmentary retinopathy, diabetes mellitus, and obesity

ð  Apert Syndrome: craniosynostosis, syndactyly of hands and feet, mental retardation

ð  Branchio-Oto-Renal syndrome: kidney, ears, and neck abnormalities

ð  Charcot-Marie-Tooth: motor and sensory neuropathy, nephritis

ð  CHARGE syndrome: acronym for the set of congenital features: Coloboma of the eye, Heart defects, Atresia of the nasal choanae, Retardation of growth and/or development, Genital and/or urinary abnormalities, and Ear abnormalities and deafness.

ð  Chondrodysplasias, e.g. achondroplasia

ð  Crouzon Syndrome: craniosynostosis, maxillary hypoplasia, shallow orbits

ð  DiGeorge sequence: cardiac defects, Thymus hypoplasia and/or T call-mediated immunodeficiency, and hypocalcemia and/or absence of parathyroids– (part of deletion

22q11 spectrum)

ð  Down Syndrome

ð  Ehlers-Danlos syndrome: synthesis of collagen defects, characterized by hypotonia, ocular abnormalities, joint hypermobility

ð  Friedreich ataxia: spinocerebellar, resulting in progressive gait ataxia

ð  Goldenhar syndrome: incomplete development of the ear, nose, soft palate, lip, and mandible (part of the oculo-auriculo-vertebral spectrum)

ð  Hemifacial microsomia: abnormal development of the lower half of the face, most commonly the ears, the mouth and the mandible (part of the oculo-auriculo-vertebral spectrum)

ð  Hunter syndrome (mucopolysaccharidosis II): a lysosomal storage disease characterized by progressive intellectual impairment, death between 10 and 15 years

 

ð  Hurler syndrome (mucopolysaccharidosis I): a lysosomal storage disease characterized by coarse facial features, skeletal malformations, recurrent otitis media, hepatosplenomegaly, and macroglossia, developmental delay, death by 10 years

ð  Jervell and Lange-Nielsen syndrome: variant of long QT syndrome (see below)

ð  Klinefelter syndrome (XXY): hypogonadism, infertility

ð  Large Vestibular Aqueduct Syndrome: enlargement of vestibular aqueduct in the inner ear

ð  Long QT syndrome: prolongation of QT on ECG, syncope, and sudden death

ð  Neurofibromatosis II (NF2): tumours of the central and peripheral nervous system, including non-malignant vestibuloschwannomas

ð  Noonan syndrome: short stature, characteristic facial features, hypotonia, cardiac abnormalities

ð  Norrie syndrome: retinal detachment, possible mental retardation

ð  Ohdo syndrome: mental retardation, congenital heart disease, blepharophimosis/ptosis, hypoplastic teeth

ð  Osteogenesis imperfecta: disorder of type I collagen metabolism characterized by bone fragility

ð  Osteopetrosis: increased osseous density due to defects in osteoclastic resorption

ð  Pendred syndrome: goitre and hypothyroidism

ð  Pfeiffer syndrome: craniosynostosis

ð  Pierre Robin sequence: craniofacial abnormalities

ð  Refsum syndrome: phytanic acid storage disease characterized by microcephaly, severe developmental delay, hypotonia, hepatomegaly, retinitis pigmentosa and dysmorphic facial features

ð  Saethre-Chotzen Syndrome: craniofacial anomalies including variable craniosynostosis

ð  Stickler syndrome: flat midface, cleft palate, myopia with retinal detachment and cataracts, musculo-skeletal findings

ð  Treacher Collins syndrome: craniofacial abnormalities

ð  Turner syndrome: XO genotype characterized by short stature, infertility, renal abnormalities, chronic otitis media

ð  Usher syndrome: retinits pigmentosa and vitiligo

ð  Velocardiofacial Syndrome: (part of 22q11 deletion spectrum) typical characteristics include cardiac abnormality (especially Fallot's Tetralogy), abnormal facies, t hymic aplasia, cleft palate, hypocalcemia

ð  Waardenburg Syndrome: white forelock, heterochromia of irises