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What is sinusitis?
Sinusitis is an infection of the air spaces of the head (sinus
cavities). There are numerous symptoms patients complain of when talking of
"sinus" problems, but often these generic symptoms have nothing to do
with sinusitis.
Many
patients without real infections within the sinus cavities will have
headache, nasal congestion, post-nasal drainage, cough, decreased sense of smell
and increased nasal mucous.
A diagnosis of sinusitis is made based on abnormal X-ray findings.
What is otitis?
Otitis is an infection of the middle ear space. Otitis may be either
acute or chronic. In acute otitis, there is generally pain, fever and hearing
loss. In chronic otitis, hearing loss and ear drainage are more frequent.
Chronic otitis may be associated with eardrum perforations or mastoid disease.
The diagnosis is generally made during an office examination.
What causes sinusitis and otitis?
The middle ear and sinus cavity are both air-containing spaces that
are connected to the nasal chamber by a short tube. In the sinus, the tube is
called the ostia. In the ear, the tube is called the eustachian tube.
When either of these openings is blocked, the air contained within the cavity
is absorbed by the body, resulting in a vacuum. This vacuum pulls fluid from the
surrounding tissues into the cavity. Bacteria can then settle into the fluid and
grow, resulting in an active infection. Once the infection has occurred,
symptoms follow and complications may develop. Your physician's major challenge
is concern over the complications of sinusitis and otitis.
Who is predisposed to developing sinusitis and otitis?
People who have a problem that results in the following conditions
may predispose themselves to recurrent sinusitis and/or otitis:
- Nasal mucous membrane swelling
- Blockage of the drainage ducts
- Anatomic abnormalities that narrow the drainage ducts
- Problems that result in an increased susceptibility to infection
In children, common predisposing factors include allergies, exposure to
respiratory infections from other children at day care centers, use of pacifiers
(sucking increases saliva production, which can help bacteria travel to the
middle ear), bottle drinking when lying on their backs (eustachian tubes do not
function as well when the baby is lying flat), exposure to second-hand smoke,
and adenoid enlargement.
In adults, the predisposing factors are most frequently environmental.
Smoking is also a major consideration.
What are the symptoms?
In acute, severe sinusitis, there is generally high fever and
severe pain. This presentation, however, is not very common. In the more chronic
cases, there are few symptoms that can be counted upon for a definitive clinical
diagnosis of sinusitis.
Health care providers depend, to a significant extent, upon X-ray and CAT
scan findings.
When are sinusitis or otitis suspected?
Sinusitis is suspected in patients who have upper respiratory tract
symptoms (similar to those of a cold or flu) that persist longer than 10 days.
Chronic otitis is suspected in patients who experience hearing loss associated
with upper respiratory tract infections or have ear drainage.
In either situation, it is appropriate to seek your doctor's assistance for
an evaluation of your medical history and a physical examination. X-rays,
hearing tests and other tests may be necessary for your doctor to come to a
definitive diagnostic conclusion. Evaluations to determine underlying
contributing factors may be necessary as well. In addition, neoplasms (abnormal
new tissue growth) must be
ruled out.
What is the treatment?
Generally, otitis and sinusitis can be managed medically. A high
fluid intake, active humidification, oral and nasal decongestants, topical nasal
steroids and often antibiotics are frequently recommended. Use of
over-the-counter nasal sprays (with the exception of pure saline) are
discouraged.
When medical management does not resolve the problem, surgery to drain the
infection and improve the anatomic situation that led to the obstruction may be
necessary.
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