Wednesday, 27 November 2013

Sinusitis Treatments in Conventional Medicine Perspective

 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.

A. Non medical treatments
In the study of three hundred adults aged 18 to 50 years with self-report of a physician diagnosis of asthma (n = 125) or rhinosinusitis without concomitant asthma (n = 175), showed that alternative treatments, including herbal agents, ingestion of caffeinated beverages, homeopathy, acupuncture, and massage therapies. are frequent among adults with asthma or rhinosinusitis and should be taken into account by health-care providers and public health and policy analysts(67)
1. Aromatherapy
People are increasingly using complementary therapies as an adjunct or alternative to conventional treatment options as well as for general health and well being. In sinusitis, aromatherapy used volatile plant materials, known as essential oils, and other aromatic compounds to unclogs the nasal passages and sinuses and relieve pain.  The concept of aromatherapy will be explored in relation to its effects on the pain pathways, methods of administration and therapeutic effects(68)

2. Hydro Pulse Nasal Irrigation therapy
Hydro Pulse Nasal Irrigation therapy are increasingly using complementary therapies as an adjunct or alternative to conventional treatment options as well as for general health and well being and is the method of post nasal drainage & chronic sinusitis treatment for symptoms caused by sinus infections, allergies and the common cold by clearing the cavities of nasal and draining accumulated mucus of sinuses and mucous membrane

3. Acupuncture therapy
In the study of Acupuncture is commonly used to treat chronic sinusitis in traditional Chinese acupuncture, the data (presented as mean +/- SD) show a significant reduction (P < or = .05) of reduced glutathione levels (0.3 +/- 0.1 mumol/g wet weight) and uric acid levels (2.7 +/- 0.4 mumol/g wet weight) in mucosa samples obtained from patients with chronic sinusitis compared with healthy controls (0.6 +/- 0.2 and 3.4 +/- 0.6 mumol/g wet weight, respectively)(69)

4. Etc.

B. Treatments in conventional medicine perspective
B.1. Medical treatments
1. Antibiotics
a. Some studies found that in most cases sinusitis accompanies viral cold infections where antibiotics are ineffective, but the few cases that have additional bacterial infections (one or two of every 100 patients with sinus symptoms) could benefit. Six of the studies (747 participants) compared antibiotics to placebo and found that most of the participants got better within two weeks, regardless of whether they received the antibiotic or not. When antibiotics were given they somewhat speeded up recovery from sinusitis symptoms with (like skin rash and gastrointestinal problems, for example, diarrhoea, abdominal pain and vomiting), side effects include the risk of increased resistance to antibiotics among community-acquired pathogens(70)

2. In a study of Effectiveness of antibiotics for acute sinusitis, Dr. Blin P, and the team said "Most acute sinusitis cases not prescribed antibiotics resolve spontaneously. Antibiotics reduced by 3.3-fold the risk of failure within 10 days, without impact on later recurrence. The greatest benefit of antibiotics was found for patients with poor oro-dental condition or with antibiotic use within the previous 2 months(71)

2. Antihistamines  
a. Antihistamines also known as Histamine antagonist,  are commonly used for the relief sinus caused by allergies by inhibiting the action of histamine as it is blocked from attaching to histamine receptors. In the study conducted by Elblandkliniken Radebeul, HNO-Abteilung, Dr. Reiss M and Dr. Reiss G. showed that long-term therapy with oral macrolides might improve median to severe symptoms of chronic rhinosinusitis without nasal polyps. An additional therapy with antihistamines is possible in patients with an allergy(72)

b. Side effects are not limit to
b.1. Drowsiness,
b.2. Dizziness,
b.2. Headache,
b.3. Loss of appetite
b.4. Gastrointestinal discomfort
b.5. Vision changes
b.6. Irritability
b.7. Dry mouth and nose
b.8. Etc.

3. Pain relievers 
a. Ibuprofen (Advil)
a.1. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used as as an analgesic for relief of symptoms pain as aresult of inflammation of certain diseases. In adult, researchers found that ibuprofen 200 and 400 mg are effective in reducing headache intensity and rendering patients pain-free at 2 hours. Photophobia and phonophobia improved with 400 mg dosing(73)
a.2. Side Effects are not limit to
a.2.1. Common side effects include nausea, dyspepsia, gastrointestinal ulceration/bleeding, headache, dizziness, rash, etc.
a.2.2. Less common side effects include esophageal ulceration, heart failure, renal impairment, confusion, etc.
a.2.3. Etc.

b. Acetaminophen
b.1. Acetaminophen is a pain reliever to treat moderate to moderately-severe pain. Some researchers suggested that Tramadol/acetaminophen reduces the severity of pain, photophobia, and phonophobia associated with migraine headache, but does not reduce migraine-associated nausea. Tramadol/APAP might be an appropriate option for the management of moderate-to-severe migraine headache(74)

4. Topical corticosteroids
a. In the assessment of the effects of topical steroid in patients with CRS without nasal polyps and perform a meta-analysis of symptom improvement data, including subgroup analysis by sinus surgery status and topical delivery methods conducted by Macquarie University, researchers found that Topical steroid is a beneficial treatment for CRS without polyps and the adverse effects are minor. It may be included in a comprehensive treatment of CRS without polyps. Direct delivery of steroid to the sinuses may bring more beneficial effect. Further studies comparing different topical drug delivery methods to the sinuses, with appropriate treatment duration (longer than 12 weeks), are required(75)

b. Side effects
b.1. Skin wrinkled, and shiny
b.2. Stretch Marks are permanent and irreversible.
b.3. Alternation of the immune system functions, causing skin rash
b.4. It may cause allergic effects
b.5. Etc.

5.  Oral and nasal decongestants
a. Oral and nasal decongestants medications is often used to relieve headaches associated with sinus infections as they constrict blood vessels that cause headache pain. In the study of assess the efficacy of dexpanthenol nasal spray compared with normal saline spray in the postoperative treatment of patients with chronic rhinosinusitis (CRS) conducted by Med Assoc Thai. The majority of the postoperative symptom scores and all of the endoscopic scores of the dexpanthenol group were not statistically different from those of the normal saline group. However, dexpanthenol nasal spray has superior efficacy compared with normal saline nasal spray on improvement of mucociliary clearance and nasal discharge in the postoperative care of CRS patients after ESS(76)

b. Side effects are not limit to
1. Fever,
2. Rash, or a
3. Persistent headache
4. Etc. 

5.  Triptan
a. Triptan are a family of tryptamine-based drugs used in the treatment of migraine headache and cluster headache. In the comparison of subcutaneous sumatriptan and oral administration formulation, subcutaneous formulation has a faster time of onset and high rate of efficacy when compared with the oral formulation, but the oral formulation appears to be better tolerated.(77). In the article by Ed Susman, posted in ENT Today, June 2008, researchers recommended that otolaryngologists might empirically treat selected patients with sinus headaches as if these patients actually had migraines, following study results illustrating that the use of triptans brought relief to more than 80% of these individuals(78)

b. Side effects of Triptan are not limit to
b.1. Nausea
b.2. Dry mouth
b.3. Tingling
b.4. Burning,
b.5. Dizziness
b.6. Drowsiness
b.7. Warm or cold sensations
b.8. Feelings of heaviness, pressure, or tightness
b. Other severe symptoms include coronary spasm, heart disease, shortness of breath, changes in vision, etc.

6. Etc.

B.2. Surgical treatment 
If the diagnosis found the sinus headache are caused by abnormalities of strusture or failed to respond to conservative medical therapy, then Endoscopic sinus surgery may be necessary.  Endoscopic sinus surgery with the removal of pressure points with reestablishment of a competent airway, and revision of sinus passageways to facilitate mucociliary drainage and ventilation of the obstructed cavity can benefit patients with chronic headaches(79). but for some patient,  endoscopic sinus surgery provides significant symptom relief for the nasal and facial symptoms associated with CRS. Patients will often still require topical nasal corticosteroids for the management of their CRS, but can expect decreases in antibiotic requirements after ESS (80)

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