Sunday, July 24, 2016

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Chronic sinusitis - Steam inhalation not effective, nasal irrigation may help

 DEFINITION 
Chronic sinusitis refers to inflammation the paranasal sinuses for a period of at least 12 weeks. The most important cause of chronic sinusitis is failure of acute infections to resolve.

 PATHOPHYSIOLOGY 
Acute infection destroys the normal ciliated epithelium, thus impairing drainage from the sinuses. There is pooling and stagnation of secretions in the sinuses which favours infections. Persistence of infection causes mucosal changes, such as loss of cilia, edema and polyp formation. We eventually have a vicious cycle.


 CLINICAL FEATURES 
Patients may complain of blocked nose, runny nose, headache and a reduced sense of smell (hyposmia). Foul-smelling discharge suggests anaerobic infection. Some people will also have nasal polyps.

 TREATMENT 
1) We should always search for underlying aetiological factors which obstruct sinus drainage and ventilation.
2) A work-up for nasal allergy may be required.
3) Culture and sensitivity of sinus discharge helps in the proper selection of an antibiotic.

Initial treatment of chronic sinusitis is conservative, including antibiotics, decongestants, antihistaminics and sinus/nasal irrigations.

Nasal irrigation is a procedure that rinses the nasal cavity with isotonic or hypertonic saline solutions. The patient instils saline into one nostril and allows it to drain out of the other nostril, bathing the nasal cavity.

In this Cochrane review, even though the level of evidence was low, the authors concluded that:

There is some benefit of daily, large-volume (150 ml) saline irrigation with a hypertonic solution when compared with placebo. 

A recent article published in the Canadian Medical Association Journal, concluded that steam inhalation was not effective but nasal irrigation may provide some symptomatic relief especially with regard to headaches.

First published on: 24 July 2016

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