How To Cure Your Sinus Infection

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KillSinus Sinus Treatment Doctor Say Buy This Treatment Summary


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Sinusitis Clinical Summary

Sinusitis is an inflammation of the mucous membranes lining the paranasal sinuses. Sinusitis can be classified as acute, subacute, or chronic purulent or sterile and allergic or nonallergic. All share an impairment of mucus clearance. Most cases of bacterial sinusitis are associated with antecedent viral upper respiratory tract infection. Maxillary sinusitis is the most common form of sinusitis and is associated with paranasal facial pain, maxillary dental pain, purulent rhinorrhea, retroocular pain, and conjunctivitis. Ethmoid sinusitis is more common in children and produces a low-grade fever and periorbital pain. Frontal sinusitis can cause a severe headache above the eyes, which is exacerbated by leaning forward a low-grade fever upper lid edema and rhinorrhea. Sphenoid sinusitis is fortunately rare and patients classically complain of a vertex headache and retroocular pain. Owing to its intracranial location, sphenoid sinusitis can involve several cranial nerves, the pituitary...


Sinusitis, or inflammation of the paranasal sinuses, is often described as rhinosinusit-is that also involves inflammation of contiguous nasal mucosa, which occurs in nearly all cases of viral respiratory infections. Acute rhinosinusitis is characterized by symptoms that resolve completely in less than 4 weeks, whereas chronic rhinosinusitis typically persists as cough, rhinorrhea, or nasal obstruction for more than 90 days. Acute bacterial rhinosinusitis (ABRS) refers to an acute bacterial infection of the sinuses that can occur independently or be superimposed on chronic sinusitis. The focus of this section will be on ABRS and appropriate treatment.

Associated Neurological Findings

Optic disk examination and documentation of increased intraocular or intracranial pressure (papilledema) should be obtained because tumors in the olfactory groove or sphenoid ridge (e.g., meningiomas) can cause the Foster Kennedy syndrome, which is composed of three clinical hallmarks--ipsilateral anosmia or hyposmia, ipsilateral optic atrophy, and contralateral papilledema. Although rare, visual disturbances are caused by some forms of sinusitis, which can also alter chemosensation. For example, optic neuropathy has been reported secondary to cocaine-induced osteolytic sinusitis. y Altered visual contrast sensitivity, color perception, and perception of the visual vertical may provide additional information about a more diffuse chemosensory disorder. Hearing problems may reflect viral or bacterial infections in the middle ear that alter taste function in the anterior tongue via chorda tympani nerve (CN VII) damage or inflammation, as well as more general nasal sinus...

Patient Encounter Part 3

Routine antibiotic use is not warranted because the primary infectious agents associated with asthma exacerbations are viruses.1 Antibiotics should be reserved for situations when bacterial infection is strongly suspected (e.g., fever and purulent sputum, pneumonia, and suspected sinusitis).

Fittings to assist with stable vices

Feeding troughs and mangers may be concrete, wooden or plastic. Whatever material is used it is important that the surface is smooth and broad enough for the size of horse. Ensure that they are placed high enough for the horse to feed comfortably and to avoid kicking the manger. Containers must be cleaned out regularly to prevent infection. Location of the manger may vary depending on the condition of the horse, e.g. a horse with sinusitis may find respite from feeding on the ground, as this allows for drainage from the sinuses.

Epidemiology and Risk Factors

Smoking is the most important risk factor for COPD and causes ongoing damage in COPD patients, as measured by an accelerated decline in FEVj compared with nonsmokers or ex-smokers. Among COPD patients who have quit smoking, exposure to secondhand smoke can also be a trigger factor for acute exacerbations. Variation in environmental air quality (ozone and small particulates) is also a factor associated with acute exacerbations of COPD. In many countries, air pollution can be a major source of smoking-equivalent damage to the respiratory tract in impoverished settings where daily cooking over indoor fires or charcoal is common. Other trigger factors for acute exacerbations include acute upper respiratory infections, sinusitis, exposure to dust or pet dander, and intercurrent illness. However, once patients reach

Inflammatory Neck Masses

Sarcoidosis is a granulomatous disease that causes cervical lymphadenopathy and may be the presenting sign in 10 to 15 of cases. This disorder typically affects the African American population. Other findings include fever, sinusitis, parotid swelling, and hilar adenopathy on chest x-ray films. Diagnosis is classically made by tissue biopsy showing non-caseating granulomas. High angiotensin-converting enzyme level is common but not diagnostic. Other studies include cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) to rule out other granulomatous diseases, purified protein derivative and acid-fast bacillus stains to rule out tuberculosis, and Venereal Disease Research Laboratory (VRDL) and RPR tests to exclude syphilis.

Radiation Therapy

A proposed alternative to surgical excision and postoperative radiation therapy has been radiation therapy alone with a curative intent. In a series of 48 patients with malignant paranasal sinus disease, Parsons and colleagues68 achieved an overall 5-year survival rate of 52 with radiation therapy alone. If the 22 patients in this series with intracranial extension are considered separately, the 5-year survival rate falls to 30 . There was a 33 (16 48) incidence of unilateral blindness in this series and an 8 (4 48) incidence of bilateral blindness. Of concern is that none of the four patients who were left totally blind had orbital invasion. Similarly, not all of the patients with treatment-induced unilateral blindness had orbital invasion. Other complications of high-dose irradiation encountered in this series were CSF leakage, oral-antral fistula, acute sinusitis requiring drainage, and meningitis. For advanced, unresectable tumors, high-dose radiation therapy alone results in...

Upon completion of the chapter the reader will be able to

List the most common bacterial pathogens that cause acute otitis media (AOM), acute bacterial rhinosinusitis (ABRS), and acute pharyngitis. 2. Explain the pathophysiologic causes of and risk factors for AOM, bacterial rhinosinusitis, and acute pharyngitis. 4. List treatment goals for AOM, bacterial rhinosinusitis, streptococcal pharyngitis, and the common cold.

Patient Care and Monitoring of ABRS

How long have the patient's symptoms been present If symptoms are mild and present for fewer than 10 days, viral sinusitis is likely. Persistent moderate or acute severe symptoms are more indicative of bacterial infection. Role of viral infections in sinusitis and how to prevent disease transmission uncomplicated acute maxillary sinusitis. Treatment success is influenced by medication adherence to the prescribed regimen, where once- or twice-daily agents are preferred over multiple daily doses.

Cambridge University and Ted Hughes

Plath spent 2 years at Newnham College of Cambridge University, where she eventually obtained her second BA. She hated the cold and rainy weather and the poor heating of the rooms. She fell ill frequently with sinusitis, colds, and the flu. She realized how much better prepared the British students were, and she abandoned plans to obtain a doctorate. She kept busy with course work, writing, and dating. Plath determined that she would be, at best, a minor writer and decided to settle down as a wife and mother who would write only in her spare time. Her depression worsened, and she saw a psychiatrist at the university. Then in February 1956, she met Ted Hughes. Hughes, an aspiring poet and writer like Plath, had graduated from Cambridge in 1954 and had worked in various odd jobs. Plath met him at a party in Cambridge and was attracted at first sight. They married in June 1956.

Bacterial Conjunctivitis

Causes of hyperacute conjunctivitis are N. gonorrhoeae and N. meningitidis. Risk factors for bacterial conjunctivitis include contact lens wear, exposure to infectious persons, compromised immune systems, nasolacrimal duct obstruction, and sinusitis. In the presence of a severe purulent discharge, culture of the conjunctiva is mandatory (see Fig. 41-3). Subcon-junctival hemorrhage may occur with bacterial conjunctivitis and is especially common with H. influenzae conjunctivitis.

Bacterial Meningitis

The host is an important determinant of susceptibility to meningitis. Obvious risk factors include a history of recent open trauma, surgery (especially neurosurgery), and burns. Closed-head trauma can cause cerebrospinal fluid (CSF) leaks, which have been associated with pneumococcal meningitis. Common predisposing factors include otitis media (most common), sinusitis, mastoiditis, alcoholism, perinatal exposure, and nonimmunized, immunocompromised, or asplenic status (Swartz, 1997).

Benign Neoplasms Osteoma

Patients with osteomas are typically 25 to 50 years of age, rarely children.32 They typically have a slow-growing, firm, and nontender mass arising from the skull. Painful sinusitis can occur when osteomas obstruct drainage from the paranasal sinuses. A plain radiograph will reveal localized, protuberant, dense cortical bone with smooth contours. The lesion is almost always homogeneously hyperdense on CT, but on rare occasions is lytic.58 During the tumor's active growth phase, it will have an intense focal increased uptake of isotope on scintigra-phy. A patient with multiple cranial osteomas may have Gardner's syndrome and require evaluation for colonic polyposis and other soft tissue tumors (see Figure 102-8).86

Migraine with Aura Classic Migraine

Ophthalmoplegic migraine is associated with acute attacks of third nerve palsy associated with a dilated pupil and migrainous unilateral eye pain. The fourth and sixth cranial nerves may be involved, but this situation is rare. The duration of ophthalmoplegia varies from hours to months. The differential diagnosis includes intracranial aneurysms and chronic sinusitis with a mucocele. However, many cases of ophthalmoplegic migraine fit the criteria for the Tolosa-Hunt syndrome of painful ophthalmoplegia (1) steady, gnawing, boring, eye pain (2) involvement of nerves of the cavernous sinus (3) symptoms lasting days or weeks (4) spontaneous remission, with recurrent attacks occurring after months or years (5) computed tomography (CT) or magnetic resonance imaging (MRI) limiting disorder to the cavernous sinus and (6) steroid responsiveness. Differential Diagnosis. Migraine-like headaches with or without aura may occur as a result of a wide variety of structural abnormalities of the...

Accreditation Commission for Acupuncture and Oriental Medicine AGAOM

228-229 sciatica, 86 shiatsu, 23-24 sinusitis, 60 stress, 203 techniques, 104 tennis elbow, 71-74 tinnitus, 230-231 uterine fibroids, 179-181 weight management, 233-234 wony, 205-206, 211 acu-pros, 4, 10-13, 18-20, 39-40, 59, 239, 244-246, 250 acupuncture, 39-40 allergies, 116-117 228-229 sciatica, 86 sinusitis, 60, 128-131 skin, 199-200 smelling, 15 stress, 203 strokes, 108-112 tennis elbow, 71-74 tinnitus, 230-231 uterine fibroids, 179-181 visits, 239-241 vomiting of milk, 144-145 weight management, 233-234 worry, 205-206 acu-woman, 25 228-229 reflexology, 24-25 safety, 17 sciatica, 86 shiatsu, 23 sinusitis, 128-131 skin, 199-200 stationary pressure, 33-34 stress, 203 strokes, 109-112 supporting pressure, 33-34 techniques, 35-36, 109-112 tennis elbow, 72, 74 tinnitus, 230-231 treatments, 18 vertical pressure, 33-34 weight management, 233 Acupressure-Acupuncture Institute, 277 shingles, 107-108 sinusitis, 60, 128-131 skin, 199-200 stress, 203 strokes, 109-112 TCM, 25

Sinus Disease Symptoms

The accuracy of the symptoms and signs of sinusitis has been evaluated. Colored nasal discharge, cough, and sneezing were the symptoms with the highest sensitivities (72 , 70 , and 70 , respectively) these symptoms, however, were not very specific. Maxillary toothache was the symptom most specific for sinusitis, with a specificity of 93 however, only 11 of patients reported this symptom. This symptom had the highest positive likelihood ratio, of 2.5. The conclusion was that the combination of maxillary toothache, poor response to decongestants, colored nasal discharge, and abnormality on sinus transillumination (discussed later in this chapter) was the strongest predictor of sinusitis in primary care populations. If all these symptoms were present in one patient, the positive likelihood ratio was 6.4, and the patient probably had sinusitis if none were present, sinusitis was ruled out.

Cranial and Spinal Subdural Empyema

Subdural empyema is a pyogenic infection in the space between the dura mater and the arachnoid and represents 13 to 20 percent of localized intracranial infections. The arachnoid is not a very strong barrier, and subdural empyema may breach the arachnoid and cause subpial infection. y The most common predisposing condition that leads to the development of a subdural empyema is paranasal sinusitis, especially frontal sinusitis. Paranasal sinusitis is the primary cause of a subdural empyema in 50 to 80 percent of patients, and otitis media is the primary cause in 10 to 20 percent. y , y Superficial infections of the scalp and skull, craniotomy, or septic thrombophlebitis from sinusitis, otitis, or mastoiditis may extend to the subdural space causing empyema. y Subdural empyema in infants usually represents an infected subdural effusion complicating a bacterial meningitis. y , y An empyema may rarely develop in the subdural area of the spinal cord. Clinical...

Nasal Congestion Had Enough of the Stuff

Bob flies across country as part of his job and has been troubled for years with chronic sinus congestion. Sometimes he gets an infection, but most of the time he's just got a nasally voice and has intermittent headaches, especially when he flies. Due to his hectic travel schedule I was only able to treat him infrequently with acupuncture. Our successes came from a combination of a customized herbal prescription, self-care acupressure at home or in the airplane, and watching the ingestion of some mucus producing foods. Today nasal congestion, or sinusitis, rarely troubles him. Sinusitis Inflammation in a Hidden Station Your sinus cavities are open spaces located on either side of your nose. Sinuses have layers of folded-up skin (mucosa) that help regulate the pressure and keep those open spaces clean. When your immune system is low, you can get an acute attack of sinusitis (-itis at the end of any word means inflammation ). Inflammation is the immune system's response to infection and...

Headaches Riot on the Rooftop

Migraines are the most common cause of recurring headaches, but other conditions can cause your head to ache as well, including high blood pressure, glaucoma, or sinusitis. Less likely causes are cerebral tumors and meningitis. Your acu-pro can work with your conventional physician to ensure everyone fully understands from both a western and eastern perspective what's causing your head to throb before you begin treatment. With your sinuses plugged and your head and face throbbing, this Cinderella is in no shape for the ball Your sinus cavities are swollen and can't drain fluids properly you've just been diagnosed with sinusitis.

Acute Bacterial Meningitis

S. pneumoniae is the most common causative organism of community-acquired bacterial meningitis in the adult. Pneumonia and acute and chronic otitis media are important antecedent events. Chronic disease, specifically alcoholism, sickle cell anemia, diabetes, renal failure, cirrhosis, splenectomy, hypogammaglobulinemia, and organ transplantation are predisposing conditions for pneumococcal bacteremia and meningitis. The pneumococci are a common cause of recurrent meningitis in patients with head trauma and cerebrospinal fluid (CSF) rhinorrhea. In the older adult (50 years of age and older), S. pneumoniae is likely to cause meningitis in association with pneumonia or otitis media, and gram-negative bacilli are the likely organisms to cause meningitis in association with chronic lung disease, sinusitis, a neurosurgical procedure, or a

Polyarteritis Nodosa Churg Strauss and Overlap Syndromes

CSS usually begins with upper respiratory symptoms such as sinusitis and rhinitis. Symptoms of systemic vasculitis involving skin, heart, and peripheral nerves follow. In a series of 42 patients with CSS, 62 percent had nervous system involvement, almost entirely restricted to PNS. Mononeuropathy multiplex (58.6 percent), distal symmetrical polyneuropathy (24.1 percent), asymmetrical polyneuropathy (3.5 percent), and one patient with a lumbar radiculopathy (3.5 percent) were included. Three of the patients in the series (10.3 percent) had cerebral infarctions. y Inflammatory myopathy has also been described in other series.

Concepts of Addiction The US Experience

Pure cocaine proved extraordinarily popular. Within a year of its introduction in the United States in 1884, Parke, Davis & Co. offered cocaine and coca in 14 forms. Cocaine was expensive, but soon became an ingredient in the new drink Coca-Cola and was found to be a specific remedy for hay fever and sinusitis. Within a few years, reports appeared in medical journals and the popular press telling of ruined careers and bizarre behavior among some users, but eminent experts such as William A. Hammond, a professor of neurology in New York medical schools and a former surgeon-general of the U.S. army, reassured the profession and the public that cocaine was harmless and the habit no more severe than that of drinking coffee.

Cranial and Spinal Epidural Abscess

The clinical presentation of an intracranial epidural abscess is an unrelenting hemicranial headache or persistent fever that develops during or after treatment for frontal sinusitis, mastoiditis, or otitis media. Focal neurological deficits, seizures, and signs of increased ICP do not develop until the infection extends into the subdural space. y Approximately 10 percent of epidural abscesses are associated with a subdural empyema. y An epidural abscess that develops near the petrous bone and involves the fifth and sixth cranial nerves presents with ipsilateral facial pain and lateral rectus weakness (Gradenigo's syndrome). A spinal epidural abscess presents as fever and pain at the affected spinal level. Heusner y described a characteristic clinical pattern of symptom progression. Back pain is

Diagnostic Evaluation

The most common presenting symptom of sinonasal carcinoma is nasal airway obstruction, which is often unilateral, followed by chronic nasal discharge and epistaxis.90 Table 50-6 summarizes the common presenting features of paranasal sinus malignancies. Signs and symptoms of maxillary sinus tumors have been grouped by regional anatomy into nasal, oral, ocular, facial, and neurologic findings.13 Extension of the neoplasm into the nasal cavity may be seen on anterior rhinoscopy. Oral findings include unexplained pain in the maxillary teeth because of involvement of the posterior superior alveolar nerve. Further expansion may cause loosening of the teeth, malocclusion, and trismus. Fullness of the palate or alveolar ridge may manifest as ill-fitting dentures in the edentulous patient.46 Tumor bulging into the oral cavity from an adjacent sinus may be visible. Ocular symptoms occur with upward extension into the orbit, causing unilateral tearing, diplopia, exophthalmos, epiphora, and...

Patient Encounter 2

A 36-year-old female presents to her primary care physician with purulent nasal postnasal discharge, nasal congestion, headache, and fatigue. She reports that her symptoms began 7 days ago and have worsened over the past 2 days. She states that she has severe facial pressure when she bends forward and she has noticed that her upper molars ache when eating or brushing. She has taken ibuprofen and pseudoephedrine with little to no relief. She has a history of frequent sinus infections (1-2 per year). Her last course of antibiotics was 4 months ago for sinusitis when she received amoxicillin.

Epidemiology of headache

Complaints of headache have constituted 1.5 -7 of patients visiting primary care physicians in North America (Becker et al. 1987 Hasse et al. 2002) and 4 in a UK general practice (Phizacklea and Wilkins 1978). A range of diagnoses was given most commonly tension headaches, vascular, migraine, sinusitis and upper respiratory tract infection (Becker et al. 1987 Phizacklea and Wilkins 1978).

Infectious thrombosis

Infectious CVT requires immediate broad antibiotic treatment and - often - surgical treatment of the underlying disease (e.g. otitis, sinusitis, mastoiditis). Until the results of microbiological cultures are available, third-generation cephalosporins (e.g. cefaloxim 2 g tid or ceftriaxone 2 g bid i.v.) should be given. As in aseptic CVT, anticoagulation should be initiated immediately and symptomatic therapy of septic CVT should adhere to the principles outlined for aseptic CVT, although controlled studies on the efficacy of these measures in septic CVT are lacking.

Patient Encounter 4

A 25-year-old female presents to her family physician with a sinus infection. Three days ago, she developed a sore throat, sneezing, and a watery runny nose. Today, the nasal discharge is a thicker, yellow-green color and she has a mild headache. She also has some minor nasal congestion and a dry, nonproductive cough that started yesterday. She took acetaminophen 500 mg this morning which provided some headache relief. She has no medical conditions, but she does experience colds 4 to 5 times per year. She works in a daycare center and she has a 20-month-old son who developed a fever (38.0 C 100.4 F ) and clear rhinorrhea yesterday.

Outcome evaluation

Clinical improvement should be evident within 7 days of therapy, as demonstrated by defervescence, reduction in nasal congestion and discharge, and improvements in facial pain or pressure and other symptoms. Monitor for common adverse events and refer to a specialist if clinical response is not obtained with first- or second-line therapy. Referral is also important for severe, recurrent, or chronic sinusitis or acute disease in immunocompromised patients. Surgery may be indicated in complicated cases.

General Approach to Treatment

Initial management of rhinosinusitis focuses on symptom relief for patients with mild disease lasting less than 10 days. Clinicians often inappropriately prescribe antibiotics for clinically suspected rhinosinusitis that usually is viral, self-limiting, and infrequently complicated by bacterial infection. Studies comparing antimicrobials to placebo in ABRS report only modest symptom improvements but increased adverse events in patients treated with antibiotics and a high spontaneous improvement rate of over 70 at 7 to 12 days after diagnosis of nonsevere ABRS.28,30 Therefore, watchful waiting is an option in nonsevere ABRS for up to 7 days after diagnosis if adequate

Epidemiology and etiology

Rhinosinusitis is one of the most common medical conditions in the United States, affecting about 1 billion people annually.1 It is caused mainly by respiratory viruses but also can be caused by allergies or environmental irritants. Viral rhinosinusitis is complicated by secondary bacterial infection in 0.5 to 2 of adults and 5 to 13 of children.23, 4 Upper respiratory infections of less than 7 days' duration are usually viral, whereas more prolonged disease or severe symptoms are often caused by bacteria. Risk factors for ABRS include prior viral respiratory infection, allergic rhinitis, anatomic defects, and certain medical conditions23, 5 (Table 72-3).

Eye Ear Nose and Throat Diseases

Ing rhinorrhea, hypertrophic rhinitis, and maxillary sinusitis. There are also many diseases discussed that were associated with inflammation of the throat and mouth. Symptoms in the Tongui pogam are consistent with tonsillitis, diphtheria, uvulitis, tongue cancer, ranula (sublingual cyst), and various forms of tooth disease.

Orbital And Periorbital Preseptal Cellulitis Clinical Summary

Orbital (postseptal) cellulitis is a serious bacterial infection characterized by fever, painful purple-red eyelid swelling, restriction of eye movement, proptosis, and variable decreased visual acuity. It may begin with eye pain and low-grade temperature. In general, it is caused by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. It usually arises as a complication of ethmoid or maxillary sinusitis. If not treated promptly, it can lead to blindness, cavernous sinus thrombosis, meningitis, subdural empyema, or brain abscess. Periorbital (preseptal) cellulitis usually presents with edema and typically circumferential erythema of the eyelids and periorbital skin, minimal pain, and fever. Proptosis and ophthalmoplegia are not characteristic. Preseptal cellulitis usually results from trauma, contiguous infection, or in rare instances, from primary bacteremia among young infants. Common organisms are S aureus and group A Streptococcus.

Emergency Department Treatment and Disposition

For acute bacterial sinusitis, amoxicillin, macrolides, and trimethoprim-sulfamethoxazole are appropriate agents. Refractory cases or immunocompromised patients require broader-spectrum antibiotics such as amoxicillin with clavulanate, clarithromycin, third-generation cephalosporins, or the newer fluoroquinolones. Treatment for up to 3 weeks may be necessary. Parenteral steroids are not used in acute or recurrent sinusitis. Intranasal steroids may have a role in allergic and chronic sinusitis. Referral or follow-up by an otolaryngologist or primary care provider should be made for all patients within 3 weeks for routine cases. Patients with comorbid illnesses or more complicated sinusitis should be admitted for parenteral antibiotic therapy and supportive care. Figure 5.56. Sinusitis. Purulent drainage from the maxillary sinus ostium in a patient with maxillary sinusitis. Drainage may not always be apparent, since the ostium may be occluded from swelling and inflammation. (Photo...

Childhood Thyroid Carcinoma

The nuclear accident at Chernobyl in 1986 refocused interest on radiation as a factor in the development of thyroid carcinoma.113 122 Prior to 1950, irradiation was frequently used to treat acne, enlarged tonsils and adenoids, chronic sinusitis, and other benign conditions.115 External radiation was commonly used to irradiate enlarged thymuses in infants and young children. The latent period, the interval from exposure to the appearance of thyroid cancer, was assumed to be 10 years and increased for at least 3 decades. Childhood thyroid cancer appeared within 4 years after the Chernobyl accident.

The risk to the individual

Physical exertion in the presence of fever means an increased hemodynamic load on the heart compared with such exertion in the healthy individual. This may lead to the manifestation, sometimes in the form of fatal dysrhythmia, of perhaps previously undiagnosed heart disease, e.g. coronary sclerosis or hypertrophic cardiomyopathy. Further, for example in respiratory tract infections, a heavy physical load may aggravate the infection, with more pronounced or prolonged symptoms, or development of complications, such as sinusitis and pneumonia. This applies even in the absence of fever. Myocarditis is the complication that has

Rehabilitation Outcome

Surgical cure rates are hard to define because of the small numbers of reported cases. Progression-free 3-year survival rates of less than 10 are reported. Local radiation therapy or focused beam irradiation have been used, resulting in a 5-year survival rate of less than 50 . In contrast, recent results with proton beam irradiation in children show a disease-free survival rate of 68 at 5 years. Of the remaining living patients from our series treated with proton beam therapy, one has had a recurrence, which may be related to inadequate surgical decompression of the nervous tissue and thus limitation of radiation dosage. To improve the results, close cooperation is necessary between the radiation therapist and the surgical team. Complications include pituitary dysfunction, sinusitis, hearing loss, radiation necrosis, and possibly, second tumors.

Two Or More Of The Following

Headache in WG is due to sinusitis, pachymeningitis, or cerebral vasculitis. Multiple forms of cranial nerve problems occur. Exophthalmos, ophthalmoplegia, and optic nerve involvement due to granulomatous involvement may be a presenting symptom of WG. y Ocular symptoms are present in 15 percent of patients at onset and 52 percent of patients during the disease course. The most helpful diagnostic finding is proptosis (2 percent at onset, 15 percent overall), since it is highly suggestive of WG when associated with upper or lower airway disease. Proptosis is usually painful and leads to visual loss owing to anterior ischemic optic neuropathy in about half of affected patients. Extraocular muscle entrapment can cause diplopia. y Recurrent serous or suppurative otitis media may cause partial (33 percent) or total unilateral (1 percent) or bilateral (1 percent) hearing loss. y Multiple cranial neuropathies rarely occur as a result of pachymeningitis. y

Directed Neurological Examination

Essential components of the directed physical examination include a neurological evaluation emphasizing the cranial nerves and orbital contents (to direct attention to lesions of the skull base) as well as a general evaluation of the ears, upper respiratory tract, and head and neck. Although much can be gained by evaluating the nose using anterior rhinoscopy, nasal endoscopy allows a more thorough assessment. With this procedure, the rhinologist can often directly visualize the olfactory neuroepithelium and establish whether airflow access to the epithelium is blocked. In the nasal examination, the nasal mucosa is evaluated for color, surface texture, swelling, inflammation, exudate, ulceration, epithelial metaplasia, erosion, and atrophy. Discovery of purulent rhinorrhea, especially its site of origin, is considered significant if it is present throughout the nasal cavity, rhinitis is suggested. If rhinorrhea is present in the middle meatus, maxillary or anterior ethmoid sinusitis is...

Other Pulmonary Diseases of the Pulmonary Vasculature

Diffuse alveolar hemorrhage may result from autoimmune collagen vascular disease or vasculitis, Goodpasture's syndrome, and other vasculitides. Goodpasture's syndrome results from the formation of anti-glomerular basement membrane antibodies, which can also attack the lung capillary membranes. Primary pulmonary vasculitides affect mostly small vessels, but systemic conditions can affect vessels of all sizes. Churg-Strauss syndrome is a small-vessel vasculitis that often manifests first as asthma. Most patients also have maxillary sinusitis, allergic rhinitis, or nasal polyposis. Gastrointestinal, neurologic, and cardiac involvement often follows. The condition responds well to systemic steroids, but patients can require long-term low-dose prednisone as maintenance therapy (Guillevin et al., 2004).

Hypertrophied Turbinates

Inferior turbinate hypertrophy is relatively common in adults and children. This usually occurs with chronic inflammation, usually resulting from allergy or rhinosinusitis. Tur-binate hypertrophy usually responds to medical treatment addressing the primary problem. If the turbinates remain significantly hypertrophied despite medical treatment, tur-binate reduction is offered, using cautery, radiofrequency treatment, fracture, excision, laser treatment, or cryotherapy. Submucosal resection of a portion of the conchal bone and stromal tissue seems to provide the greatest success.


Plain radiographs of the sinuses are still useful in certain circumstances. Plain sinus radiographs are reasonably accurate in assessing the maxillary and frontal sinuses in cases of acute sinusitis. Complete opacification or an air-fluid level in one of these sinuses usually indicates acute sinusitis. However, the relatively low sensitivity and specificity of plain films, especially in evaluating the ethmoid sinuses, have limited their usefulness. Computed tomography has become an invaluable diagnostic tool for evaluating chronic nasal and sinus problems and has essentially supplanted the use of plain sinus films. CT of the sinuses allows unparalleled imaging of the complicated anatomy of the nose and paranasal sinuses. It has also increased understanding of the pathophysiology of sinusitis. CT scanning can show areas of mild mucosal thickening in the sinuses (indicating chronic sinusitis), complete opacification (seen in acute sinusitis, polyps, or sinus tumors), bone erosion, or...

Clinical Problems

Complaints related to the nose and sinuses are among the most common seen in a family medicine practice. Acute rhinitis (the common cold), allergic rhinitis, and sinusitis compose the vast majority of these complaints and, taken together, result in an enormous socioeconomic impact in terms of missed workdays and schooldays and pharmaceutical costs. Nasal complaints are usually related to nasal congestion, rhinorrhea, bleeding, facial pressure or pain, headache, cough, otalgia, facial or periorbital swelling, altered (diminished, absent, or distorted) sense of smell, or postnasal drainage.

Nasal Polyps

Nasal polyps are the result of nasal mucosal inflammation and edema. On examination, nasal polyps are usually silver-gray in color and may be translucent. If there is associated infection, polyps can appear erythematous or may be obscured by mucus. Polyps cause significant and sometimes complete nasal obstruction but are painless and insensate. Nasal polyps predispose the patient to sinusitis and often cause anosmia. Medical treatment is initially offered but is often inadequate. Initial treatment includes topical steroids, allergy treatment, and treatment of sinusitis. In many patients, endoscopic sinus surgery is an important adjunct to medical treatment and results in significant improvement in symptoms. Unfortunately, polyps often recur after surgery, requiring repeated removal.

Harm Alarm

About 25 percent of chronic maxillary sinusitis (near your cheekbones) is caused by a dental infection. If your immune system is compromised, sinusitis can be caused from fungal infections. Check with your physician to make sure you know the root of your snout problem. The goal is to get your sinuses to drain (remember the soggy, folded garments ). This will stop the swelling and pain, encouraging normal circulation to return, and end the thick, gunky mucus discharge. Oriental medicine does a great job at relieving both acute and chronic sinusitis. Patients are amazed at the rapid release of pressure in the sinuses that acupuncture can bring. Herbal medicine, improved diet, and attention to potential environmental irritants can help keep your sinuses healthy once they've been cleared. Your acu-pro will determine the kind of sinusitis you have, such as wind heat or dampness heat, based on your symptoms. Acupuncture and acupressure create circulation of...


Asia and Africa have a relatively high incidence of paranasal sinus tumors. The Bantu of South Africa have the highest incidence in the world of carcinoma of the upper jaw, likely related to the carcinogenic effects of their homemade snuff.33 In Japan rates are between 2 and 3.6 cases per 100,000 annually, approximately four times that of the U.S. population.77 This is mostly due to an increased rate of squamous carcinoma of the maxillary sinus, thought to be the result of the high prevalence of chronic sinusitis and cigarette smoking among the Japanese.27,58 Fortunately, the incidence of paranasal sinus tumors in Japan seems to be decreasing.28 Adenocarci-noma of the paranasal sinuses is quite rare in Japan, possibly because of the extensive use of softwood rather than hardwood in the Japanese furniture industry.27

Maxillary Sinus

V Maxillary sinusitis results from inflammation of the mucous membrane lining the maxillary sinus and is a common infection because of its pattern of drainage. The maxillary sinus drains into the nasal cavity through the hiatus semilunaris, which is located superiorly in the sinus (Figure 23-2C). As a result, infection has to move against gravity to drain. Infection from the frontal sinus and the ethmoidal air cells potentially can pass into the maxillary sinus, compounding the problem. In addition, the maxillary molars are separated from the maxillary sinus only by a thin layer of bone. Therefore, if an infecting organism erodes the bone, infection from an infected tooth can potentially spread into the sinus. The infraorbital nerve (CN V-2) innervates the maxillary teeth and sinus therefore, pain originating from a tooth or the sinus may be difficult to differentiate.


There is at present no specific cure effective against this viral disease. In mild cases, symptoms disappear in 7-10 days, although physical or mental depression may occasionally persist. Influenzal pneumonia is rare but often fatal. Bronchitis, sinusitis, and bacterial pneumonia are among the more common complications, and the last can be fatal if untreated. Influenza is generally benign, and even in pandemic years, mortality is usually low - 1 percent or less - the disease being truly life-threatening for only the very young, the immunosuppressed, and the elderly. However, this infection is so contagious that in most years multitudes contract it, and thus the number of deaths in absolute terms is usually quite high. The sequelae of influenza are often difficult to define, but evidence indicates that the 1920s global pandemic of

Paranasal sinuses

Sinusitis Sinusitis may be acute or chronic, inflammatory or infective. Acute inflammatory sinusitis is seen in patients with acute seasonal allergic rhinitis, commonly known as hay fever. As such, this condition is seldom diagnosed and the treatment relies on treating the inflammatory rhinitis with topical antihistamines and decongestants. It is only once inflammatory rhinitis becomes chronic and sinus outflow tracts become blocked with oedematous, swollen mucosa that chronic inflammatory sinusitis sets in. Chronic inflammatory sinusitis occurs in people with allergic nasal conditions (asthma, allergic rhinitis, aspirin sensitivity). It is usually associated with an allergic or inflammatory rhinitis, which is characterised by boggy swelling of the nasal mucosa. Patients present with nasal obstruction, a feeling of congestion, pressure between the eyes and over the nasal bridge and postnasal discharge of mucus. Treatment includes long-term low-dose topical nasal corticosteroids....

Brain Abscess

Brain abscess is a rare disease in immunocompetent individuals. In adults, otitis media and paranasal sinusitis (frontal, ethmoidal, or sphenoidal sinuses) are the most common predisposing conditions for brain abscess formation. In children, otitis media and cyanotic congenital heart disease are the most common predisposing conditions for brain abscess formation. Individuals with the acquired immunodeficiency syndrome (AIDS) are at increased risk for focal intracranial infections caused by Toxoplasma gondii. Organ transplant recipients are at risk for brain abscesses caused by Aspergillus fumigatus. Patients receiving chronic corticosteroid therapy and those who are immunosuppressed from bone marrow transplantation are at a particular risk for CNS candidiasis manifested as multiple intraparenchymal microabscesses mainly in the territory of the middle cerebral artery. Brain abscesses may develop as a result of cranial trauma, either penetrating brain...

Biological Dentistry

Examples of illnesses and problems that biological dentists aim to cure, in addition to cancer, include tinnitus (a ringing noise in the ear), vertigo, epilepsy, hearing loss, eye problems, sinusitis, joint pain, kidney problems, digestive disorders and heart disease. Oral Acupuncture. This procedure involves the injection of salt water, weakened local anesthetics, or homeopathic remedies into acupuncture points in the mouth (see Chapter 1). Oral acupuncture injections are used to relieve pain during dental procedures and treat sinusitis, allergies, digestive problems, and neuralgia (pain from damaged nerves).

Adjunctive Therapy

Supportive medications that target symptoms of viral URIs are used widely in patients with rhinosinusitis, particularly in the early stage of infection. There is a lack of evidence supporting their use in ABRS, but they may provide temporary relief in cer- tain patients. ' Analgesics can be used to treat fever and pain from sinus pressure. Oral decongestants relieve congested nasal passages but should be avoided in children younger than 4 years of age and patients with ischemic heart disease or uncontrolled hypertension. Intranasal decongestants can be used for severe congestion in most patients 6 years of age or older, but use should be limited to 3 days or less to avoid rebound nasal congestion. Guaifenesin is often used as a mucolytic with no evidence to support its use in rhinosinusitis. Antihistamines should be avoided because they thicken mucus and impair its clearance, but they may be useful in patients with predisposing allergic rhinitis or chronic sinusitis. Similarly,...

The History

Congenital Heart Disease Cxr

In 1933, Kartagener called attention to the association of sinusitis, bronchiectasis and situs inversus,72 a combination subsequently called Kartagener syndrome or triad.16'51'73'80'92'132 In the first English language publication of the syndrome (1937), as many as one fifth of patients with situs inversus had bronchiectasis, underscoring that the association was not fortuitous.5 In 1986, a blinded controlled study of cilia ultrastructure in Kartagener syndrome found a widespread inherited ciliary disorder40,95,98,133 that included the upper and lower respiratory tracts54,73,133 (bronchitis, bronchiectasis, sinusitis) and the testis4,6,7,49,103 (immobile sperm, male infertility). Situs inversus is common in infertile men, an observation that contributed to the identification of a generalized disorder of ciliary motil-ity6,49 Respiratory symptoms are a significant part of the history and may lead to the discovery of situs inversus. The connection between abnormal cilia and laterality...

Cluster Headache

The differential diagnosis of cluster headache includes chronic paroxysmal hemicrania, migraine, trigeminal neuralgia (TN), temporal arteritis, pheochromocytoma, Raeder's paratrigeminal syndrome, Tolosa-Hunt syndrome, sinusitis, and glaucoma. y Raeder's syndrome has characteristics similar to cluster headaches. It may be associated with severe pain, unilateral and supraorbital distribution, and an associated partial Horner's syndrome. It is distinct from cluster headache in that there are no distinct attacks and the pain is constant.

Sinonasal Tumors

Intranasal and sinus tumors often manifest with symptoms identical to those of more benign sinonasal conditions. Nasal obstruction, facial pressure or pain, and bloody rhi-norrhea are common symptoms of a neoplastic process within the nasal cavity or sinuses. Because these symptoms are also common with sinusitis, a high index of suspicion is required, and diagnosis is often delayed. A much more aggressive papillary lesion is an inverted papilloma. These tumors often manifest as unilateral polyps and can cause symptoms of nasal obstruction, bleeding, and sinusitis. These lesions require excision because they can be locally destructive, and malignant degeneration can occur. Endoscopic excision is usually possible, although external approaches are sometimes required. Malignant tumors of the nose and sinuses include squa-mous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, hemangiopericytoma, osteosarcoma, and malignant melanoma. Again, early symptoms are similar to those of...


Rhinitis is not self-limiting and often coexists with more serious conditions such as asthma, sleep apnea, nasal polyps, sinusitis, and OME. The treatment is the same for perennial rhinitis and for seasonal allergic rhinitis. The link among seasonal allergic rhinitis, asthma, and sinusitis is based on the one-airway theory. Because the mucosa in each of those areas consists of basement membrane, a capillary system, mucous glands, goblet cells, and nervous innervation, each area reacts similarly to allergens and responds to like treatments.

Tension Type Headache

Migraine is the primary headache disorder that may be confused with TTH. Both can be bilateral, nonthrobbing, and associated with anorexia. Migraine is more severe, often unilateral, and frequently associated with nausea. IIH, brain tumor headache, chronic sphenoid sinusitis, and cervical, ocular, and temporomandibular disorders need to be considered. '291 , '301


CVT may be due to infectious and non-infectious causes. Septic CVT is observed as a complication of bacterial infections of the visceral cranium, namely otitis, sinusitis, mastoiditis and bacterial meningitis. The infectious agents reach the cerebral sinuses ascending Otitis, mastoiditis, sinusitis Septic CVT may be caused by bacterial infections of the visceral cranium, e.g. otitis, sinusitis, mastoiditis and bacterial meningitis. Aseptic CVT may be caused by the same causes as extracranial thrombosis (see Table 11.1).

Pulmonary System

Chronic lung disease is a hallmark of CF, leading to death in 90 of patients.3 Pulmonary disease is characterized by thick mucus secretions, impaired mucus clearance, chronic airway infection and colonization, obstruction, and an exaggerated neutrophil-dominatedinflammatory response.4 Over time, chronic obstruction and inflammations lead to air trapping, atelectasis, mucus plugging, bronchiectasis, cystic lesions, pulmonary hypertension, and eventual respiratory failure. In the U.S.-CF population, pulmonary function declines at an average yearly rate of 2 , as measured by forced expiratory volume in 1 second (FEV1). The rate in an individual patient may be higher or lower depending on severity of CFTR dysfunction and comorbidit-ies. Patients may show a slow steady decline over time, or they may have stable lung function with intermittent periods of sharp decline.1 In the upper airways, sinusitis

Vni73 Influenza

There is at present no specific cure that is effective against this viral disease. In mild cases the acute symptoms disappear in 7 to 10 days, although general physical and mental depression may occasionally persist. Influenzal pneumonia is rare, but often fatal. Bronchitis, sinusitis, and bacterial pneumonia are among the more common complications, and the last can be fatal, but seldom is if properly treated. Influenza is generally benign, and even in pandemic years, the mortality rate is usually low 1 percent or less-the disease being a real threat to life for only the very young, the immunosuppressed, and the elderly. However, this infection is so contagious that in most years multitudes contract it, and thus the number of deaths in absolute terms is usually quite high. Influenza, combined with pneumonia, is one of the 10 leading causes of death in the United States in the 1980s. The sequelae of influenza are often hard to discern and define - prolonged mental depression, for...


Elevate the tip of the nose and inspect the nasal mucosa. Are secretions present Purulent secretions from above and below the middle turbinate may be suggestive of sinusitis. Watery discharge may be indicative of allergy or viral upper respiratory infection. Epistaxis is usually caused by local trauma and is quite common in preschool- and school-aged children. In children with head trauma, the presence of a clear discharge from the nose is suggestive of cere-brospinal fluid leakage.

Diagnosis Symptoms

Mass Hard Palate

Nasal cavity and paranasal sinus malignancies often do not cause symptoms until they have expanded to a significant size or have extended through the bony confines of the sinus cavity. These tumors therefore tend to present at a more advanced stage. Symptoms may initially include nasal obstruction, epistaxis, pain, and episodes of sinusitis. Tumor expansion inferiorly towards the oral cavity may be associated with swelling of the gingiva or palate with loose teeth, while orbital invasion may lead to ocular symptoms such as proptosis, diplopia, decreased acuity, and restriction of ocular motion. Extension laterally into the pterygoid musculature may cause trismus and deeper invasion into the infratemporal fossa. Anterior extension through the anterior maxillary wall may cause visible cheek swelling and numbness from involvement of the infraorbital nerve. In rare cases, posterior and superior extension into the skull base, dura and brain may lead to headache, cerebrospinal fluid leak,...

Clinical Features

STS have a biphasic age distribution 80 to 90 percent affect adults while 10 to 20 percent are seen in the pediatric age group. The median age of presentation of STSHN at the Memorial Sloan-Kettering Cancer Center (MSKCC) was 49 years and there was a slight male preponderance.6 Most patients present with a painless mass, but some tumors such as clear cell sarcoma, cutaneous leiomyosarcoma, and calcified synovial sarcoma can present as painful masses. Other symptoms depend upon the site of origin and local extent of the tumor, and can include visual disturbances, epistaxis, chronic sinusitis, otalgia, etc. Tumors of the paranasal sinuses or base of the skull may present with no other symptoms except sensory or motor cranial nerve deficits (see Table 17-1). A detailed physical and head and neck examination is vital, and particular attention must be directed toward determining the relation of the mass to important

Nasal Obstruction

Successful treatment of nasal obstruction depends on making a correct diagnosis. Once the diagnosis has been established, a treatment plan should be developed. If the nasal obstruction is secondary to one of the various types of rhinitis, it is treated medically. This includes nasal steroids, antihistamines, leukotriene inhibitors, mucolytics, oral decongestants, topical decongestants, and nasal saline. These medications may be used alone or in various combinations. The choice of medications is determined by the severity of symptoms and the patient's medical history, response to treatment, and wishes. Oral steroids can be used in select severe cases but are associated with potential significant side effects. Nasal decongestant sprays are very effective for treating severe nasal congestion but should be used sparingly and never for longer than 3 days, to prevent rebound nasal obstruction (rhinitis medicamentosa). Allergy testing is done when allergies are suspected and the standard...


Tympanic membrane, impaired mobility, or a fluid level. In patients with intact tympanic membranes, tympanometry to measure middle ear pressures provides an indirect measure of eustachian tube function (Lazo-Saenz et al., 2005). The edematous nasal mucosa can obstruct the ostia, resulting in congestion or sinusitis with pressure symptoms or headache that is particularly notable with bending forward. Up to one third of patients have a lower respiratory tract component, including exercise-induced and mild persistent asthma.

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