Wednesday, 27 November 2013

Sinusitis – Headache/Sinus headache Complications and Diseases associated

Sinusitis is defined as a condition of inflammation of the paranasal sinuses of which can develop headache as a result of exposure to a cold or flu virus, or an allergic reaction to pollen, mold, dust or smoke, etc..Sinusitis affects 37 million people each year.
II. Complications and Diseases associated with Sinus headache
A. Complications
As a result of inflammation and infection of several paired paranasal sinuses, including the frontal, ethmoid, maxillary and sphenoid sinuses that make Sinus headache as one of most dangerous complication if infection of the brain by the invasion of anaerobic bacteria went through the bones or blood vessels.
1. Abscesses
Abscesses is defined as a collection of dead neutrophils that has accumulated in a cavity formed by the tissue as a result of an infectious process. In the study of Microbiology of Intracranial Abscesses
and Their Associated Sinusitis, Intracranial Abscesses is a rare but serious complication of paranasal sinusitis, Because of its life-threatening nature, IA must be managed as a medical and surgical emergency(24)
2. Meningitis
In a national survey associated with sinusitis or otitis media, among 372 cases of bacterial meningitis within our nationwide 17 years survey, 201 cases were community acquired (CBM) and in 40 (20%) otitis media or sinusitis acuta/chronica were reported 1-5 weeks before onset of CBM(25). Other study suggested that almost one fifth of all bacterial meningitis appear in patients with acute or after treated chronic otitis media or sinusitis. A main causative agent is Str. pneumoniae in about half of all cases and those cases appear significant more among diabetic, alcoholic and traumatic patients(26)
3. Orbital cellulitis
Orbital cellutitis is defined as medical condition of an acute infection that cause acute onset of periorbital pain and swelling of the tissues surrounded the eye, including the eyelids, eyebrow, and cheek as a result of accumulation of debris in both frontal sinuses, causing increased intracranial pressure due to a space-occupying lesion with potential long-term disabilities and death(27)
4. Cranioencephalic complications
In the investigation of 58 children were hospitalized with sinusitis, and eight (13.8%) had cranioencephalic complications for an annual incidence of 1.6% and a sex ratio of 5 boys to 3 girls by Hôpital d’instruction des armées Omar Bongo Ondimba Service, disorders of consciousness were found in five cases, with a mean Glasgow score of 9 (range: 7-13). Seven children had multifocal sinusitis and one frontal sinusitis. Five children had a subdural empyema, two associated with thrombophlebitis of the sagittal sinus, one with a brain abscess with thrombophlebitis of the sagittal sinus, and another with meningitis and thrombophlebitis of the sagittal sinus. Two children had osteomyelitis of the frontal sinus table, including a frontal lobe abscess for one. Another had multiple cerebral abscesses. Five children had sinus and neurosurgical drainage, two sinus drainage only, and one neurosurgical drainage only. Microbiology was positive for microbes in four cases: Streptococcus eqinus (one case), Staphylococcus aureus (one case), both S. pneumoniae and Haemophilus influenzae (one case), and Aerococcus viridans (one case). Outcome was favourable in seven cases, including four without sequelae. Two children had recurrences, and one died(28)
5. Etc.
B. Diseases associated with Sinus headache
1. Humoral immunodeficiency and granulomatous disease
Although there are many similarities of allergic rhinitis and Sinus headache, Patients with allergic rhinitis do not necessarily have more severe chronic rhinosinusitis as assessed by symptom scores, nasal endoscopy, or computed tomography staging. However, at least in pediatric patients with chronic rhinosinusitis who undergo surgery, consideration of allergy and allergy treatment appears to improve surgical results. . Rhinosinusitis is among the most common infectious complications of humoral immunodeficiency, and humoral immunodeficiency is not uncommon in patients with refractory chronic rhinosinusitis. Patients with granulomatous disease causing rhinosinusitis, such as Wegener’s granulomatosis, appear to suffer from a symptom burden that is equivalent to the broader population of chronic rhinosinusitis patients(20)
2. Nasal polyps and asthma
Chronic rhinosinusitis (CRS) with and without nasal polyps represent different stages of one chronic inflammatory disease of the mucosa of the nasal cavity and paranasal sinuses. In a study conducted by Kaunas University of Medicine, Dr. Staikūniene J, and the team indicated that patients with chronic rhinosinusitis compose clinically heterogeneous group and when associated with nasal polyps and asthma constitutes the most severe form of unified respiratory tract disease, which is characterized by older age of the patients, greater duration of nasal symptoms, extent of sinus radiological changes, more prominent systemic inflammation markers, greater bronchial obstruction, incidence of perennial allergic rhinitis.(21)
3. Allergy and sinus
A retrospective review of 200 consecutive patients conducted by University of California was carried out on patients who had chronic rhinosinusitis refractory to medical therapy and who subsequently underwent functional endoscopic sinus surgery. Allergy testing for common perennial and seasonal inhalant allergens showed that each patient had sinus CT imaging before undergoing the surgery. Allergy testing indicated that 84% of all patients tested positive for allergies. Moreover, 60% of all patients had significant allergic sensitivity; 52% of all patients had multiple allergen sensitivities(22)
4. Perennial or seasonal allergic rhinitis
There are universally accepted, allergic rhinitis (AR) may play an important role in the occurrence of rhinosinusitis. As in the investigation of the frequency and severity of rhinosinusitis among patients with seasonal or perennial AR, conducted by Süleyman Demirel University, fifty-two of the 73 patients (71.2%) were shown to have findings of rhinosinusitis. Of these 52, twenty-four patients (77.4%) had perennial AR and 28 (66.7%) patients had seasonal AR.(23).
5. Etc.
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