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3. Hello Doctor! Medical Hand Book -9 From Er.Sulthan Chronic sinusitis

4. ஹலோ டாக்டர்! குலசை சுல்தான் வழங்கும் மருத்துவ கையேடு-9 (ENGLISH)

5. Prevention is Better than Cure

6. Health Manager Thanks to Mayo Foundation for Medical Education and Research (MFMER). Presentation From Er.Sulthan Chronic Sinusitis

7. Chronic sinusitis Definition With chronic sinusitis, the cavities around nasal passages (sinuses) become inflamed and swollen. This interferes with drainage and causes mucus to build up. This common condition is also called chronic rhinosinusitis. If you have chronic sinusitis, it may be difficult to breathe through your nose. The area around your eyes and face may feel swollen, and you may have throbbing facial pain or a headache. Chronic sinusitis may be caused by an infection but can also be caused by growths in the sinuses (nasal polyps) or a deviated nasal septum. While most people have a short-lived bout of sinusitis at some point (known as acute sinusitis), chronic sinusitis is sinusitis that lasts more than eight weeks or keeps coming back.

8. Anatomy of the Sinuses

10. Symptoms Chronic sinusitis symptoms include: Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat Nasal obstruction or congestion, causing difficulty breathing through your nose Pain, tenderness and swelling around your eyes, cheeks, nose or forehead Aching in your upper jaw and teeth Reduced sense of smell and taste Cough, which may be worse at night Other signs and symptoms can include: Ear pain Sore throat Bad breath (halitosis) Fatigue or irritability Nausea The signs and symptoms of chronic sinusitis are similar to acute sinusitis, except they last longer and often cause more significant fatigue. Chronic sinusitis is sinusitis that lasts more than eight weeks or keepscoming back. Unlike with acutesinusitis, fever isn't a common sign of chronic sinusitis.

11. When to see a doctor You may have several episodes of acute sinusitis, lasting less than four weeks, before developing chronic sinusitis. You may be referred to an allergist or an ear, nose and throat specialist for evaluation and treatment. See a doctor:  If you've had sinusitis a number of times and the condition fails to respond to treatment  If you have sinusitis that lasts more than 7 days  If your symptoms don't get better after you see your doctor See a doctor immediately if you have symptoms that may be a sign of a serious infection:  Pain or swelling around your eyes  A swollen forehead  Severe headache  Confusion  Double vision or other vision changes  Stiff neck  Shortness of breath

12. Causes • When you have sinusitis, the mucous membranes of your nose, sinuses and throat (upper respiratory tract) become swollen. This swelling blocks the sinus openings and prevents mucus from draining normally. • Blocked sinuses create a moist environment that makes it easier for infection to take hold. Sinuses that become infected and can't drain become pus-filled, leading to symptoms such as thick, yellowish or greenish discharge and other symptoms of infection. • Common causes of chronic sinusitis include: • Nasal polyps or tumors. These tissue growths may block the nasal passages or sinuses. • Allergic reactions. Allergic triggers include fungal infection of the sinuses. • Deviated nasal septum. A crooked septum — the wall between the nostrils — may restrict or block sinus passages. • Trauma to the face. A fractured or broken facial bone may cause obstruction of the sinus passages. Causes

13. Other medical conditions. The complications of cystic fibrosis, gastroesophageal reflux, or HIV and other immune system diseases may result in nasal blockage. Respiratory tract infections. Infections in your respiratory tract — most commonly, colds — can inflame and thicken your sinus membranes, blocking mucus drainage and creating conditions ripe for growth of bacteria. These infections can be viral, bacterial or fungal in nature. Allergies such as hay fever. Inflammation that occurs with allergies may block your sinuses. Immune system cells. With certain health conditions, immune cells called eosinophils can cause sinus inflammation.

14. Risk factors You're at increased risk of getting chronic or recurrent sinusitis if you have: A nasal passage abnormality, such as a deviated nasal septum, or nasal polyps Aspirin sensitivity that causes respiratory symptoms A medical condition such as cystic fibrosis or gastroesophageal reflux (GERD) An immune system disorder such as HIV/AIDS or cystic fibrosis Hay fever or another allergic condition that affects your sinuses Asthma — about one in 5 people with chronic sinusitis have asthma Regular exposure to pollutants such as cigarette smoke

15. Complications • Chronic sinusitis complications include: • Asthma flare ups. Chronic sinusitis can trigger an asthma attack. • Meningitis, an infection that causes inflammation of the membranes and fluid surrounding your brain and spinal cord. • Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent. • Aneurysms or blood clots. Infection can cause problems in the veins surrounding the sinuses, interfering with blood supply to your brain putting you at risk of a stroke.

16. Tests and diagnosis • To look for the cause of your symptoms, your doctor will feel for tenderness in your nose or throat. Your doctor may use a tool to hold your nose open and apply medication that constricts blood vessels in your nasal passages. This makes it easier to see inside your nasal passages. Your doctor will then shine a light into your nasal passages to look for inflammation or fluid. This visual inspection will also help rule out physical conditions that trigger sinusitis, such as nasal polyps or other abnormalities. • Your doctor may use several methods to help screen for chronic sinusitis: • Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses. • Imaging studies. Images taken using computerized tomography (CT) or magnetic resonance imaging (MRI) can show details of your sinuses and nasal area. These may identify a deep inflammation or physical • obstruction that's difficult to detect using • an endoscope.

17. Nasal and sinus cultures. Laboratory tests are generally unnecessary for diagnosing chronic sinusitis. However, in cases in which the condition fails to respond to treatment or is progressing, tissue cultures may help pinpoint the cause, such as identifying a bacterial pathogen. An allergy test. If your doctor suspects that the condition may be brought on by allergies, an allergy skin test may be recommended. A skin test is safe and quick and can help pinpoint the allergen that's responsible for your nasal flare-ups.

18. Treatments and drugs • Endoscopic sinus surgery The goal of treating chronic sinusitis is to: Reduce sinus inflammation Keep your nasal passages draining Eliminate the underlying cause Reduce the number of sinusitis flare-ups you have

20. Treatments to relieve symptoms Your doctor may recommend treatments to help relieve sinusitis symptoms. These include: Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages. Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase), budesonide (Rhinocort Aqua), triamcinolone (Nasacort AQ), mometasone (Nasonex) and beclomethasone (Beconase). Oral or injected corticosteroids. These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Examples include prednisone and methylprednisolone. Oral corticosteroids can cause serious side effects when used long term, so they're only used to treat severe asthma symptoms. Decongestants. These medications are available in over-the-counter (OTC) and prescription liquids, tablets and nasal sprays. Examples of OTC oral decongestants include Sudafed and Actifed. Nasal sprays include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin). These medications are generally only taken for a few days at most; otherwise they can cause the return of more severe congestion (rebound congestion).

21. Over-the-counter pain relievers such as aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). Because of the risk of Reye's syndrome — a potentially life-threatening illness — never give aspirin to children. Aspirin desensitization treatment, if you have reactions to aspirin that cause sinusitis. However, this treatment can have serious complications such as intestinal bleeding or severe asthma attacks. AntibioticsAntibiotics are sometimes necessary for sinusitis if you have a bacterial infection. However, chronic sinusitis is usually caused by something other than bacteria and antibiotics won't help. Antibiotics used to treat chronic sinusitis caused by a bacterial infection include amoxicillin (Amoxil, Trimox, others), doxycycline (Doryx, Monodox, others) or the combination drug trimethoprim-sulfamethoxazole (Bactrim, Septra, others). If the infection doesn't subside or if the sinusitis comes back, your doctor may try a different antibiotic.

22. If your doctor does prescribe antibiotics, it's critical to take the entire course of medication. Generally, this means you'll need to take them for 10 to 14 days or even longer — even after your symptoms get better. If you stop taking them early, your symptoms may come back. ImmunotherapyIf allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat the condition. SurgeryIn cases that continue to resist treatment or medication, endoscopic sinus surgery may be an option. For this procedure, the doctor uses an endoscope, a thin, flexible tube with an attached light, to explore your sinus passages. Then, depending on the source of obstruction, the doctor may use various tools to remove tissue or shave away a polyp that's causing nasal blockage. Enlarging a narrow sinus opening also may be an option to promote drainage.

23. Picture of the anatomy of the sinuses

24. Lifestyle and home remedies • These self-help steps can help relieve sinusitis symptoms: • Get plenty of rest. This will help your body fight infection and speed recovery. • Drink plenty of fluids, such as water or juice. This will help dilute mucous secretions and promote drainage. Avoid beverages that contain caffeine or alcohol, as they can be dehydrating. Drinking alcohol can also worsen the swelling of the lining of the sinuses and nose. • Steam your sinus cavities. Drape a towel over your head as you breathe in the steam from a bowl of hot water. Keep the steam directed toward your face. Or take a hot shower, breathing in the warm, moist air. This will help ease pain and help mucus drain. • Apply warm compresses to your face. Place warm, damp towels around your nose, cheeks and eyes to ease facial pain. • Rinse out your nasal passages. Use a specially designed squeeze bottle (Sinus Rinse, others), bulb syringe or neti pot to rinse your nasal passages. This home remedy, called nasal lavage, can help clear your sinuses. • Sleep with your head elevated. This will help your sinuses drain, reducing congestion.

25. Prevention • Take these steps to reduce your risk of getting chronic sinusitis: • Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before your meals. • Carefully manage your allergies. Work with your doctor to keep symptoms under control. • Avoid cigarette smoke and polluted air. Tobacco smoke and air contaminants can irritate and inflame your lungs and nasal passages. • Use a humidifier. If the air in your home is dry, such as it is if you have forced hot air heat, adding moisture to the air may help prevent sinusitis. Be sure the humidifier stays clean and free of mold with regular, thorough cleaning.

27. Antibiotics: Use them wisely Antibiotics are the first line of defense against many infections. But overusing or misusing antibiotics can cause more harm than good. Your head throbs, your nose is stuffy, and you're too tired to do anything but flop into bed at the end of the day. You're probably coming down with a cold or the flu. But if you think that antibiotics will help you feel better, think again. Antibiotics won't do a thing for viral illnesses such as colds, flu and most sore throats. What's more, taking antibiotics when you don't need them actually can be harmful. Here's more information on what antibiotics are, when they should and shouldn't be used, and what you can do to combat antibiotic resistance. What are antibiotics? Antibiotics are powerful drugs used for treating many serious and life-threatening infectious diseases, but taking them when you don't need to can lead to antibiotic-resistant germs. Antibiotics are only effective against bacterial infections, certain fungal infections and some kinds of parasites. Most infections result from either bacteria or viruses. Antibiotics can't help you if a virus is responsible for your illness.

29. Superbugs: How antibiotic resistance develops Since penicillin was introduced in the 1940s, scientists have developed more than 150 antibiotics to help stop the spread of infectious disease. But although these drugs have saved millions of lives, the misuse of antibiotics has caused problems. Their frequent use, often for conditions or infections that aren't caused by bacteria, has given rise to bacteria that are resistant to many commonly used antibiotics. Superbugs emerge when an antibiotic fails to kill all of the bacteria it targets, and the surviving bacteria become resistant to that particular drug and frequently other antibiotics as well. Doctors then prescribe a stronger antibiotic, but the bacteria quickly learn to withstand the more potent drug as well, perpetuating a cycle in which increasingly powerful drugs are required to treat infections. Antibiotic-resistant strains of bacteria began to appear soon after penicillin was introduced. Today, antibiotic-resistant strains have become common, and bacteria resistant to a number of antibiotics have developed. Once only seen in hospitals, outbreaks of some resistant strains — such as methicillin-resistant Staphylococcus aureus (MRSA) — are appearing in the wider community.

30. For years, the potent antibiotic vancomycin (Vancocin) was a reliable last defense against certain severe infections, notably those caused by staphylococcus bacteria. But in recent years, some superbugs have become able to resist vancomycin. While experts are working to develop new antibiotics and other treatments to keep pace with antibiotic-resistant strains of bacteria, infectious organisms adapt quickly. Antibiotic-resistant bacteria will continue to be a global health concern — and using antibiotics wisely is an important part of preventing their spread. While experts are working to develop new antibiotics and other treatments to keep pace with antibiotic-resistant strains of bacteria, infectious organisms adapt quickly. Antibiotic-resistant bacteria will continue to be a global health concern — and using antibiotics wisely is an important part of preventing their spread.

31. Consequences of antibiotic resistance When more and more bacteria become resistant to first line treatments, the consequences are severe. Illnesses last longer, and the risk of complications and death increases. In the United States alone, thousands of people die each year of infections they contract in the hospital from antibiotic-resistant bacteria. The inability to treat a particular infection leads to longer periods in which a person is contagious and able to spread the resistant strains to others. The failure of first line treatments also means that doctors have to resort to less-conventional medications, many of which are much more costly and more toxic than common drugs are. For instance, the drugs needed to treat multidrug-resistant forms of tuberculosis (TB) are much more expensive than are the drugs used to treat nonresistant TB. The course of treatment is long — up to two years — and the side effects can be severe. Other consequences are the increased costs associated with prolonged illnesses, including the direct expense for additional laboratory tests, treatments and hospitalization, and the indirect costs from loss of income or time away from family.

32. Safeguard effective antibiotics: What you can do Using antibiotics too often or incorrectly is a major cause of the increase in resistant bacteria. Here are some things you can do to promote proper use of antibiotics: Understand when antibiotics should be used. Don't expect to take antibiotics every time you're sick. Antibiotics are effective in treating most bacterial infections, but they're not useful against viral infections, such as colds, acute bronchitis, or the flu. And even some common bacterial ailments, such as mild ear infections, don't benefit much from antibiotics. Don't pressure your doctor for antibiotics if you have a viral illness. Instead, talk with your doctor about ways to relieve the symptoms of your viral illness — a saline nasal spray to clear a stuffy nose, for instance, or a mixture of warm water, lemon and honey to temporarily soothe a sore throat. Take antibiotics exactly as prescribed. Follow your doctor's instructions when taking prescribed medication, including how many times a day and for how long. Never stop treatment a few days early if you start feeling better — a complete course of antibiotics is needed to kill all of the harmful bacteria. A shortened course of antibiotics, on the other hand, often wipes out only the most vulnerable bacteria, while allowing relatively resistant bacteria to survive.

33. Never take antibiotics without a prescription. If you didn't complete a full course of antibiotics, you might be tempted to use the leftover medication the next time you get sick or to pass it along to someone else. But this isn't a good idea. For one thing, the antibiotic might not be appropriate for a future illness. And even if it is, you're not likely to have enough pills to combat the germs making you sick, which can lead to more resistant bacteria. Protect yourself from infection in the first place. Good hygiene can go a long way in preventing infection. Wash your hands thoroughly with soap and water, especially after using the toilet, changing a diaper or handling raw meat or poultry. Keep food preparation areas clean. Although antibacterial cleaners and soap are widely available, they aren't necessary. Plain soap and water works fine to kill germs in most settings.

34. The scope of your responsibility Antibiotic resistance is a pressing, global health problem. Nearly all significant bacterial infections in the world are becoming resistant to commonly used antibiotics. When you abuse antibiotics, the resistant microorganisms that you help create can become widely established, causing new and hard-to-treat infections. That's why the decisions you make about antibiotic use — unlike almost any other medicine you take — extend far beyond your reach. Responsible antibiotic use protects the health of your family, neighbors and ultimately the global community.

35. Aspirin allergy: What are the symptoms? • I think I may have an aspirin allergy. What are the symptoms? • Answer • from James T. Li, M.D. • It's possible to have a sensitivity to aspirin. In fact, aspirin can cause a severe asthma attack — especially in people who have asthma or sinus problems. Reactions to aspirin are often related to the drug itself, however, rather than to an allergic or immunological response to the drug. • Signs and symptoms of aspirin sensitivity — which usually occur within a few hours of taking the medication — range from mild to serious and may include: • Hives • Itchy skin • Runny nose • Swelling of the lips, tongue or face • Coughing, wheezing or shortness of breath

36. If you've had a reaction to aspirin, avoid all forms of aspirin. It's also best to avoid other nonsteroidal anti-inflammatory drugs (NSAIDs) as well, including ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Keep in mind that aspirin and other NSAIDs are found in many over-the-counter medications — so check labels carefully. • If you think you might have an aspirin sensitivity, consult your doctor or allergist for advice. Rarely, aspirin can cause a life-threatening reaction.

37. We Pray For Your Good Health Action is the proper fruit of knowledge. The best of all medicines is resting and fasting Health is a blessing that money cannot buy. From Er.Sulthan

38. Chest infection • Medical Hand Book-10 • From • Health Manager