There are three aspects to orthodox medical treatment. The first is to stop any Infection with an antibiotic; the second is to reduce the swelling of the lining of the nose with a decongestant, such as pseudoephedrine, thus enlarging the Opening to the sinus; and thirdly, to reduce any allergic response.
Why is the allergic response so important? Simply because it causes the cells pound the hole leading to the sinus to become inflamed, swollen and produce I Vet) more mucus. All this reduces the diameter of the hole of the antrum even further. In fact, a large number of people get sinusitis mainly because they have nasal allergies to inhaled pollen, dust, tobacco smoke, or other substances. The more allergic we are, the more the cells lining the nose are likely to swell, and the more the antrum will get blocked.
Because the allergic response is so important, often your doctor will prescribe anti-allergic medication – an antihistamine; sodium cromoglycate as drops or spray; or a steroid nasal spray. Sometimes it’s convenient to use an over-the-counter decongestive cough remedy for a short time – these typically contain a decongestant to dry up the production of mucus, and an antihistamine to reduce the local inflammation.
Some people are more prone to sinusitis than others. In some, the antrum is anatomically on the small side; in others, allergies to pollen, dust, or foods may cause the cells lining it to swell, blocking it, or reducing its size enough to cause problems whenever an infection strikes – a cold, for example. Anyone with frequent attacks of sinusitis is usually well advised to try to keep under control any allergies he has.
Food allergies may also have a part to play. Some patients find that they are sensitive to a particular food, which makes them sneeze, and gives them a blocked-up, running nose. However, the role of food allergy in sinusitis is not fully accepted by all doctors, and while all agree that pollen and dust can cause problems in sensitive individuals, many doctors are hesitant about the role that food sensitivities play.
However, all doctors agree that once an allergy has been identified the substance causing it should be avoided where possible. Often this is easier said than done; for example, although it is possible to reduce your exposure to household dust, it’s impossible to get rid of it altogether, because even the best-kept house has dust floating in the air. Nor is it easy to avoid pollen; you can stay indoors on days with a high pollen count, wear dark glasses, avoid parks, gardens, fields and the countryside in general, and walk on the shady side of the street, but all you’ll do is minimise your exposure rather than remove it altogether.
Unfortunately, minimising your exposure in this way may not be enough. Because allergies tend to work in an all-or-nothing fashion, exposure to even small quantities may trigger off almost a maximum response.
On the other hand, it is quite possible, if sometimes a little awkward, to avoid foods to which you are sensitive. And, if there are other substances you’re allergic to, like chemicals, paint, and so on, you may be able to adapt your lifestyle to avoid them.
If it’s impossible to avoid those things to which you are allergic, then you’ll need a second or third line of defence. Calming down the inflammatory reaction in the nose with antihistamines, anti-allergy drops and sprays (such as sodium cromoglycate) and local steroid preparations (such as beclomethasone) can often be very helpful. Drops of dilute salt solution can also help by liquefying mucus.
One thing the chronic sinusitis sufferer should not use for any length of time are decongestant sprays, pills or linctuses. While these are very useful in the short term – say, up to ten days – using them for a longer period lets the mucous cells lining the nose get accustomed to the medication. Then, when the spray is stopped, there is rebound extra production of mucus. So the patient starts using the spray again, What he doesn’t realise is that the spray itself is making matters worse – the more he uses his decongestant spray the more rebound secretion will occur.
The really long-term sinus sufferer may need to see an ear, nose and throat (ENT) surgeon. Doing an operation to wash out the sinuses may help clear out accumulated debris and infection. This is important because the presence of foreign material, old pus, etc, can often act as a source of further and continuing infection.
Sometimes, where the hole into the sinus is small, or there’s gross obstruction from allergy or infection, and particularly where the sinuses never drain properly and keep on re-infecting themselves, the ENT surgeon can perform an operation called an antrostomy to widen the antrum, the hole which leads from the sinus into the nose. Because the sinuses are formed inside bone, the surgeon has to drill bone away in order to enlarge this hole.
Sometimes just a small increase in the aperture of the drainage hole is sufficient to allow the infected secretions inside to get out properly. An antrostomy is often combined with a sinus washout. Operations like these are done quite frequently, and are often very successful.
I mentioned earlier that the cells lining the sinus are covered with microscopic hairs, called cilia, which waft debris out of the sinus. These cells are very important. The antrum is actually up at the top of the sinus, so gravity won’t drain away debris. The cilia must be intact and working properly in order to pull the debris up the incline to the antrum.
Unfortunately, tobacco smoke poisons the cilia and stops them working, which is one reason why sinusitis sufferers should stop smoking. Without the cilia working properly, it’s much easier for debris to remain within the sinus – a prime source for infection.
The second reason why smoking is bad for your sinuses is that both by the direct effects of the smoke particles and through (he allergic reaction of the lining of the nose to tobacco smoke, smoking inflames the cells lining the sinuses and closes off the antrum, making infection more likely.
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