How do you get sinusitis?Typically sinusitis presents like a

cold that does not clear after a

week. There is usually a history of a viral

upper respiratory tract infection. The patient

remembers having a sore throat occasionally

with fever and muscle aches or tiredness

about 1 week to 10 days, previously. This is

usually followed by persistent nasal blockage,

colored nasal discharge & phlegm in the throat

and cough. Some patients will ignore these

symptoms as they see them just as an irritation

and not something serious. These symptoms

then persist for months and progressively

develop into chronic sinusitis.

What are the sinuses?The nasal sinuses are pockets that

develop from the nose cavity proper

into the facial bones. The lining of the sinuses

consists of pseudo stratified columellar

epithelium that produces mucus and have

cilia. The mucus coats the cilia at the surface

lining and the cilia is continuously moving

the layer of mucus from within the sinus to

outside where it opens into the nasal cavity.

This mucociliary conveyor belt mechanism

is so efficient that normally the contents

of our sinuses are sterile in health. Because

of that, there is no chance of finding any

environmental pollutant like soot, bacteria or

even viral particles within the sinuses.

Sinusitis –

ColdThe

that never goes away

What sort of mucolytics is best?You would need one that regulates

the excess mucus production seen & that

normalizes the mucous viscosity. It should

restore the ventilation & drainage of the sinuses

& eliminate stagnation of mucus in the sinus by

restoring the mucociliary clearance.

You would also need one that has no

interaction with other drugs & without any

gastric irritation. It should work in synergy with

the common antibiotics used. Finally it should

be safe in children and in pregnancy, and

suitable for long term treatment.

What is the common cause of delayed response or failure to respond to medical therapy?

• Inappropriate antibiotics use with antibiotic

bacterial resistance.

• Inappropriate antihistamine use with

secretions getting more viscous and drainage

of the sinuses affected with stagnation of

secretions within.

• Failure to take adequate rest & hydration.

• Secondary Smoke & Other Environmental

Irritants/Allergens.

• Failure to use adjuvant treatment like

mucolytics.

In a diseased and unhealthy state, the sinuses

conveyer belt mechanism fails from damage

to the cilia, quality change of the mucus or

swelling of the sinonasal lining cells due to

inflammation. This causes accumulation of

mucus and pus from secondary infections and

builds up pressure within the sinus, resulting in

acute discomfort and pain. When this infection

and inflammation prolongs and if treatment

is not sought early, it will lead to chronic

persistent blockage and ache.

How do you treat & get well from sinusitis?The goal of medical therapy is to

restore mucociliary clearance, drainage and

aeration of the sinuses. For acute & chronic

sinusitis, medical therapy using antibiotics is the

mainstay of treatment.Adjuvant therapy with

nasal saline rinse, topical & oral decongestant,

anti-histamines, topical & oral steroids, &

mucolytics is considered.

Exactly what adjuvant therapy is dependent

on the patient’s symptoms.

If there is a lot of nasal itch and sneezing

then an antihistamine is considered. However

this is rare in sinusitis and anti-histamines are

rarely used. If there is nasal congestion and

blockage with post nasal drip & cough, then

topical steroids & mucolytics are used. Most

cases of infective sinusitis present as the latter

symptom complex. Dr A B JohnConsultant Ear Nose & Throat SurgeonMBBS, FRCS, FAMS.

A. B. John Ear Nose & Throat (ENT) Clinic & Surgery3 Mount Elizabeth #15-10 Mount Elizabeth Medical Centre Tel: 6735 9654 www.sinonasal.com

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January 2011 | ezyhealth&beauty 23

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