QUESTION: I would like to ask for your advice regarding sinusitis as I’ve been on antibiotics many times and I don’t seem to be winning.
When I go outside, my cheeks become puffy and one cheek gets quite swollen. I also tend to get a swollen gland on the left side of my face when the season changes.
I’ve been using a hot pack and a saline spray, but what can I do about the puffiness? I can’t afford to see an ear, nose and throat specialist and would truly appreciate your advice.
ANSWER: Sinusitis usually refers to inflammation of the paranasal sinuses due to infections, allergies and certain complex auto-immune responses. This differs from simple hayfever, which triggers an immune response that is self-limiting.
The sneeze is where sinusitis starts, and in complex cases it can end with meningitis.
Most cases are caused by viral infection and resolve spontaneously within 10 days.
People who suffer from acute sinusitis can suffer for up to four weeks, while chronic sinusitis is defined as lasting at least three months.
We should all remember that in immunocompromised patients – those with illnesses such as diabetes and HIV – fungal infections of the sinuses are not uncommon. Chemical irritants are often forgotten as a cause of sinusitis, which can be triggered by smoking and inhaled chlorine.
The mechanisms that lead to inflammation of the sinuses are generally problems of anatomy, environmental and genetics. The size, shape and drainage of the sinuses all play a role.
Sufficient oxygenation, blood supply and temperature control are all important factors that facilitate control of illness.
For most people, the frontal sinuses are associated with intense headache and congestion, with the complications of sinusitis always being a danger.
Complications to watch for
l Abscess – intracranial or orbital.
l Meningitis
l Thromboses
l Periorbital cellulitis – inflammation and infection of the eyelid and portions of skin around the eye.
l Cavernous sinus thrombosis – the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood.
l Polyps – an abnormal growth of the tissue projecting from a mucous membrane.
l Mucoceles – chronic, cystic lesions in the paranasl sinuses.
l Osteomyelitis – infection of the bone caused by bacteria.
Treatment needs a holistic approach
The key to treating sinusitis is to remove the triggers. When treating blindly, we create a dependency on pain killers and encourage antibiotic resistance.
The cornerstones of good treatment are:
l A detailed history of onset, duration and course of the condition.
l Find and treat allergies, whether food or environmental.
l If recurrent infection occurs, consider specialist review with imaging of the airways and sinuses.
l Patient education regarding the importance of compliance.
l Understanding the chronicity of allergies and the immune response.
l Be aware of the warning signs of complications (see bullet box above).
Approach to treatment:
Treating sinusitis is difficult for many doctors and patients. The triggers and causes vary from one individual to the next. I always advise that you understand why you are taking medication or doing certain practices to minimise and control the condition.
Acute sinusitis can be very painful and fever is often documented.
Secondary swelling of the glands or lymph nodes indicates an active immune response. Patients complain of neck pain, which sends parents down anxiety road for meningitis. Often the grossly enlarged nodes contribute to pain.
Remember that the ear, nose and throat system is interwoven and post-nasal drip is often accompanied by a sore throat and ear pain.
Treatment for acute episodes does include antibiotics. Antihistamines also form part of chronic treatment, but one is confronted with the sedative versus non-sedative choice.
To those parents who love the sedative syrups for kids to facilitate the odd early night or two, be warned: some children have the adverse reaction of being hypervigilant after antihistamines. - Cape Argus
Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues.
He features on 567CapeTalk, and is a regular guest on SABC3 and the Expresso show. Dr Green works as an emergency medical practitioner at a leading Cape Town hospital and completed four years of training as a registrar in the specialisation of neurology.
If you’ve got medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen. Catch him in Cape Town on 567 CapeTalk, most Fridays at 1.30pm.
The advice in this column does not replace a consultation and clinical evaluation with a doctor.