How do you get sinusitis? Typically sinusitis presents like a cold that does not clear after a week. There is usually a history of a viral upper respiratory tract infection. The patient remembers having a sore throat occasionally with fever and muscle aches or tiredness about 1 week to 10 days, previously. This is usually followed by persistent nasal blockage, colored nasal discharge & phlegm in the throat and cough. Some patients will ignore these symptoms as they see them just as an irritation and not something serious. These symptoms then persist for months and progressively develop into chronic sinusitis. What are the sinuses? The nasal sinuses are pockets that develop from the nose cavity proper into the facial bones. The lining of the sinuses consists of pseudo stratified columellar epithelium that produces mucus and have cilia. The mucus coats the cilia at the surface lining and the cilia is continuously moving the layer of mucus from within the sinus to outside where it opens into the nasal cavity. This mucociliary conveyor belt mechanism is so efficient that normally the contents of our sinuses are sterile in health. Because of that, there is no chance of finding any environmental pollutant like soot, bacteria or even viral particles within the sinuses. Sinusitis – Cold The that never goes away What sort of mucolytics is best? You would need one that regulates the excess mucus production seen & that normalizes the mucous viscosity. It should restore the ventilation & drainage of the sinuses & eliminate stagnation of mucus in the sinus by restoring the mucociliary clearance. You would also need one that has no interaction with other drugs & without any gastric irritation. It should work in synergy with the common antibiotics used. Finally it should be safe in children and in pregnancy, and suitable for long term treatment. What is the common cause of delayed response or failure to respond to medical therapy? • Inappropriate antibiotics use with antibiotic bacterial resistance. • Inappropriate antihistamine use with secretions getting more viscous and drainage of the sinuses affected with stagnation of secretions within. • Failure to take adequate rest & hydration. • Secondary Smoke & Other Environmental Irritants/Allergens. • Failure to use adjuvant treatment like mucolytics. In a diseased and unhealthy state, the sinuses conveyer belt mechanism fails from damage to the cilia, quality change of the mucus or swelling of the sinonasal lining cells due to inflammation. This causes accumulation of mucus and pus from secondary infections and builds up pressure within the sinus, resulting in acute discomfort and pain. When this infection and inflammation prolongs and if treatment is not sought early, it will lead to chronic persistent blockage and ache. How do you treat & get well from sinusitis? The goal of medical therapy is to restore mucociliary clearance, drainage and aeration of the sinuses. For acute & chronic sinusitis, medical therapy using antibiotics is the mainstay of treatment.Adjuvant therapy with nasal saline rinse, topical & oral decongestant, anti-histamines, topical & oral steroids, & mucolytics is considered. Exactly what adjuvant therapy is dependent on the patient’s symptoms. If there is a lot of nasal itch and sneezing then an antihistamine is considered. However this is rare in sinusitis and anti-histamines are rarely used. If there is nasal congestion and blockage with post nasal drip & cough, then topical steroids & mucolytics are used. Most cases of infective sinusitis present as the latter symptom complex. Dr A B John Consultant Ear Nose & Throat Surgeon MBBS, FRCS, FAMS. A. B. John Ear Nose & Throat (ENT) Clinic & Surgery 3 Mount Elizabeth #15-10 Mount Elizabeth Medical Centre Tel: 6735 9654 www.sinonasal.com OUR EXPERT: ADVERTORIAL Sinupret ® is available in Guardian, Watsons, NTUC Unity, Nishino and other leading pharmacies. For more information on the Sinupret ® , please contact us at MBD MARKETING (S) PTE LTD Tel: 6391 5915 MBD MARKETING SDN. BHD. Tel: +603-6156 9877 January 2011 | ezyhealth&beauty 23 medical