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S i n u s I s s u e s by Ihor Magun, M.D., F.A.C.P. During the winter months, upper respiratory tract infections account for a great number of visits to physicians. Sinus infections notoriously fall into this category and form a good percentage of those cases. A brief lesson in the anatomy of sinuses will help you understand why this happens. The paranasal sinuses are aerated cavities in the bones of the skull. There are four pairs of si nuses: frontal, maxillary, ethmoid and sphenoid. These sinuses moisten and warm the air that is fil tered by the nose and ultimately protect the lungs. They are also involved in voice resolution. Air passes in and out of the sinuses permit ting fluid (such as mucus) to drain into the nose through an opening called the ostium. When ob struction of sinus openings occurs due to inflamma tion or increased secretions, sinusitis develops. Not all obstructions indicate infection is present, how ever, even though they may cause pain or discom fort. Acute sinusitis is characterized by nasal symptoms, such as congestion, postnasal discharge and sinus pain or pressure depending on the location of the sinus. Lying down or bending over can make the pain worse. Approximately half of patients af fected by acute sinusitis also develop fever. Two percent develop headaches. Pain is most frequently experienced in the cheek, between the eyes, or above the eyebrow. Sinusitis can be caused by bac terial or viral infections, which are virtually indis tinguishable and therefore make treatment decisions difficult. The most common treatment is antibiotics. Chronic sinusitis is defined by symptoms present for more than three weeks. This is usually the result of repeated past infections or from an un derlying structural problem like a deviated septum, nasal polyps, or tooth abscess. Symptoms are less severe than with acute sinusitis, but are continuous and seem to last forever. Fever is rare. People who suffer from acute or chronic sinusitis can alleviate the discomfort by trying the following recommendations. Drink plenty of fluids (sounds familiar?) to help hydrate the body and thin out secretions. If you blow your nose, blow gently; harsh blowing actually spreads the secretions and the viruses or bacteria. Drying out mucus com pletely is not a good idea. Use caution with antihis tamines and know when to stop or cut down on the dose. Buy antihistamines in a liquid form and cut down on the dosage recommended on the label by using less. Breathe in hot, moist air (like in a shower). Be aware that being around children or smokers increases the risk of infection. So does handling things touched by others, so it is a good idea to wash hands often and thoroughly (sounds familiar?). If the condition persists and symptoms are painful and uncomfortable, consult a physician. CAT scan imaging is the diagnostic gold standard for sinusitis. A consultation with an otolaryngologist is appropriate. Treatment depends upon the diagno sis. It is more likely that people with allergies de velop sinusitis. Have this checked out as an option because the treatment for allergies is completely different. If your physician prescribes antibiotics and you do not begin to feel better, you may be tak ing an incorrect antibiotic or the diagnosis is incor rect. To help sinus congestion at night, specialists recommend two sprays of oxymethazolene to help open the passages (available without a prescription under the name brand of Vicks Sinex), to be used only briefly. This does not produce the swelling problems often caused by nasal spray medications containing neosynephrine. Also get plenty of rest (sounds familiar?) at night. 'НАШЕ ЖИТТЯ”, ГРУДЕНЬ 2005 15
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