Bacterial Sinusitis

Diagnostic Summary

History of acute viral respiratory infection, dental infection, or nasal allergy; nasal congestion and purulent discharge; fever, chills, and frontal headache; pain, tenderness, redness, and swelling over involved sinus; transillumination shows opaque sinus; chronic infection may produce no symptoms other than mild postnasal discharge, musty odour, or non-productive cough.

General Considerations

Predisposing factor is viral upper respiratory infection (common cold); allergic rhinitis and other factors interfering with normal protective mechanisms may precede viral infection and are predisposing factors; any factor inducing mucous membrane oedema may obstruct meatal drainage; transudate serves as medium for bacteria – streptococci, pneumocci, staphylococci, and Haemophilus influenza are the most common; allergy is common in chronic sinusitis; 25% of chronic maxillary sinusitis involves underlying dental infection; vasoconstrictors and antihistamines give transient relief, but prolonged use contraindicated – reflex reaction following continual administration.

Therapeutic considerations

• Antibiotics: limited value; efficacy controversial; recent analysis; antibiotic treatment in acute maxillary sinusitis in general practice population is not based sufficiently on evidence; warranted in severe or unresponsive cases; newer; more potent antibiotics (lactam antibiotics) are more effective than penicillin, amoxicillin, and other less potent antibiotics; even less evidence of significant benefit in children; overuse of antibiotics in children with sinusitis or otitis media can generate antibiotic resistant bacterial pathogens; chronic sinusitis – antibiotics of little or no benefit; addressing underlying cause (respiratory or food allergens) plus supportive therapy (saline nasal sprays, immune-enhancing herbs, and natural decongestants) is the most rational approach.

• Allergy: 25-70% of cases of allergic associated with sinusitis; chronic sinusitis unresponsive to immune support and antibiotics warrants aggressive work-up for environment and food allergies; eliminate dust mites –warm water washing at temperature of at least 58 degrees C, air-filtering vacuum cleaners, air cleaner with HEPA filter, and humidity < 50%; remove all pets, carpeting and feather bedding, if necessary.

• Sick building syndrome: environmental chemicals within buildings can induce lethargy, headaches, and blocked or runny nose – symptoms of chronic sinusitis.

• Helicobacter pylori: in atopic patients with symptoms of peptic ulcer, urticaria, sinusitis and exercise-induced anaphylaxis increased when patients were positive for H. pylori; H. pylori-specific IgE and IgG reactivity and IgG reactivity identified with endoscopy confirming H. pylori in stomachs or sinuses of those with H. pylori antibodies; antibiotic therapy for H. pylori-induced ulcers resolved allergy symptoms in a significant number of such patients.

Therapeutic approach

• Therapeutic goals: re-establish drainage and clear acute infection.

• Methods: local heat application, local use of volatile oils, antibacterial botanicals, and immune system support.

• - isolate and eliminate food or air-borne allergens and correct underlying problem allowing allergy to develop.
• - Acute phase: eliminate common food allergens (milk, wheat, eggs, citrus, corn, and peanut butter) until more definitive diagnosis made.
• - Local applications of heat may alleviate short- and long-term symptoms of allergic rhinitis.

• Supplements:

• - vitamin C
• - bioflavanoids
• - vitamin A
• - zinc
• - thymus extract

• Botanicals:

• - Echinacea
• - Hydrastis

• Local treatment:

• - intranasal douche with hydrastis tea
• - swab passages with oil of bitter orange, Menthol or eucalyptus packs over sinuses (care should be taken to avoid irritation)
• - hot packs
• - diathermy: 30 min (discontinue if pain increases without drainage).

For more information on this topic please call ICIM Medics on +353 45 844 819 or email us at info@icim.ie

Tags: Allergies, Headache, Infection