Sinusitis : A common cause of Headache

Sinusitis is an inflammation of the paranasal sinuses, which may or may not be as a result of infection, from bacterial, fungal, viral, allergic or autoimmune issues. Newer classifications of sinusitis refer to it as rhinosinusitis, taking into account the thought that inflammation of the sinuses cannot occur without some inflammation of the nose as well (rhinitis).

Types Of Sinusitis: ( BY LOCATION)

Maxillary sinusitis - can cause pain or pressure in the maxillary (cheek) area (e.g., toothache, headache) Frontal sinusitis - can cause pain or pressure in the frontal sinus cavity (located behind/above eyes), headache

Ethmoid sinusitis - can cause pain or pressure pain between/behind eyes, headache

Sphenoid sinusitis - can cause pain or pressure behind the eyes, but often refers to the vertex of the head

Acute sinusitis

Acute sinusitis is usually precipitated by an earlier upper respiratory tract infection, generally of viral origin. Virally damaged surface tissues are then colonized by bacteria, most commonly Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus.
Other bacterial pathogens include other streptococci species, anaerobic bacteria and, less commonly, gram negative bacteria. Another possible cause of sinusitis can be dental problems that affect the maxillary sinus. Acute episodes of sinusitis can also result from fungal invasion. These infections are most often seen in patients with diabetes or other immune deficiencies (such as AIDS or transplant patients on anti-rejection medications) and can be life threatening. In type I diabetes, ketoacidosis causes sinusitis by Mucormycosis.
Chronic sinusitisChronic sinusitis is a complicated spectrum of diseases that share chronic inflammation of the sinuses in common. The causes are multifactorial and may include allergy, environmental factors such as dust or pollution, bacterial infection, or fungus (either allergic, infective, or reactive). Non allergic factors such as Vasomotor rhinitis can also cause chronic sinus problems. Abnormally narrow sinus passages, which can impede drainage from the sinus cavities, can also be a factor.
Symptoms include: Nasal congestion; facial pain; headache; fever; general malaise; thick green or yellow discharge; blurred vision, feeling of facial 'fullness' worsening on bending over; aching teeth.Very rarely, chronic sinusitis can lead to Anosmia, the inability to smell or detect odors.
A more recent, and still debated, development in chronic sinusitis is the role that fungus may play.
Predisposing Factors: deviated septum or small sinus ostia; smoking; nasal polyps; carrying the cystic fibrosis gene prior bouts of sinusitis

Treatment
Acute sinusitis
nasal irrigation or jala neti using a warm saline solution, hot drinks including tea and chicken soup, over-the-counter decongestants and nasal sprays, and getting plenty of rest. Analgesics (such as aspirin, paracetamol (acetaminophen) or ibuprofen) can be used, but caution must be employed to make sure the patient does not suffer from aspirin-exacerbated respiratory disease (AERD) as this could lead to anaphylaxis.
(Amoxicillin usually being the most common) with amoxicillin/clavulanate (Augmentin/Co-Amoxiclav) being indicated for patients who fail amoxicillin alone. Fluoroquinolones may be used in patients who are allergic to penicillinsDoxycycline is also used by some, for patients who are penicillin allergic

Chronic sinusitis
Simple measuresNasal irrigation and flush promotes sinus cavity z health, andpatients with chronic sinusitis including symptoms of facial pain, headache, halitosis, cough, anterior rhinorrhea (watery discharge) and nasal congestion found nasal irrigation to be "just as effective at treating these symptoms as the drug therapies." In other studies, "daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis," and is "recommended as an effective adjunctive treatment of chronic sinonasal symptoms.
Medical approaches
FESS - functional endoscopic sinus surgery, whereby normal clearance from the sinuses is restored by removing the anatomical and pathological obstructive variations that predispose to sinusitis. This replaces prior open techniques requiring facial or oral incisions and refocuses the technique to the natural openings of the sinuses instead of promoting drainage by gravity, the idea upon which the Caldwell-Luc surgery was based
balloon sinuplasty
Endoscopic nasal Surgery allows more functional approach than by radical antrostomy. Intranasal endoscopic operations permits minimal trauma to adjacent tissues and precise removal of the diseased mucosa. intranasal inferior meatal antrostomy middle meatal antrostomy Caldwell-Luc radical antrostomy
ComplicationsIntracranial Complications -"meningitis""abscess",
Orbital Complications Orbital CellulitisOrbital Abscess
Vascular Complications -Infections aneurysms or infected blood clots in the intracranial cavity, both of which are potentially fatal.
Asthma Loss of Smell and Taste - ngs. Osteomyelitis

Preventable Blindness

Causes:

Cataract

Corneal diseases

retinal pathology

glaucoma

trachoma

Injuries

Tonsillitis and Its Complications

Tonsillitis

is a disorder involving inflammation of the tonsils. There are two tonsils, situated on either side of the back of the throat and they form part of the body's immune system. They, like the rest of the immune system, contain special cells to trap and kill bacteria and viruses travelling through the body. When the main site of infection is within the tonsils they swell, become red and inflamed and may show a surface coating of white spots. Tonsillitis is extremely common in children and young people but it can occur at any age. The characteristics of the disease are pain in the throat and trouble swallowing.Tonsillitis is usually a self-limiting condition, ie it gets better without treatment, and generally there are no complications.

Cause

Whether due to viruses or bacteria, the infection is spread from person to person by airborne droplets, hand contact or kissing.There are many different individual viruses and bacteria that can potentially cause tonsillitis. For example the Epstein-Barr virus, which is the cause of glandular fever (infectious mononucleosis), is a common cause. It is typically seen in young people, particularly in situations such as university halls of residence when person-to-person spread is made easier by numerous close contacts. Among the bacteria that cause sore throats, the streptococcus group A is the most common - often known as 'strep throat'. The incubation period between picking up the infection and the disease breaking out is two to four days - sometimes it can be less.

signs and symptoms

Pain in the throat (sometimes severe) that may last more than 48 hours and be associated with difficulty in swallowing. The pain may spread to the ears.
The throat is reddened, the tonsils are swollen and may be coated or have white spots on them.
Possibly a high temperature.
Swollen lymph glands under the jaw and in the neck.
Headache.
Loss of voice or changes in the voice. If the sore throat is due to a viral infection the symptoms are usually milder and often related to the common cold. If due to Coxsackie virus infection, small blisters develop on the tonsils and roof of the mouth. The blisters erupt in a few days and are followed by a scab, which may be very painful.If the sore throat is due to a streptococcal infection, the tonsils often swell and become coated and the throat is sore. The patient has a temperature, foul-smelling breath and may feel quite ill.These different appearances are however very variable, and it is impossible to tell by looking at someone's throat whether the infection is due to a virus (which cannot be helped by antibiotics) or a bacterial infection (which might be helped by antibiotics). Good advice
If signs of a sore throat persist for more than a few days or are severe with marked difficulty in swallowing, high fever or vomiting, then you should consult your GP.
Warm drinks, soft food and the use of throat lozenges and/or a mouthwash may ease swallowing problems. Your pharmacist can advise on the most appropriate over-the-counter remedies.
Drink plenty of fluids. Understandably a sore throat can discourage swallowing but in tonsillitis it is common to lose a lot of body fluid through fever and mouth breathing. Dehydration adds considerably to feeling unwell.
It is important to ensure you have adequate rest and stay in a warm environment. How does the doctor make a diagnosis?The doctor usually makes the diagnosis from the symptoms and signs of the disease, but occasionally a swab of the secretions of the throat and maybe a blood sample are required to identify the cause. What complications may arise?Usually a throat infection such as tonsillitis causes no trouble and only lasts about a week, but the following complications can arise.

COPMPLICATIONS

A secondary infection may occur in the middle ear or sinuses.
If the sore throat is due to a streptococcus infection, there may be a rash (scarlet fever).
An uncommon complication is a throat abscess which occurs usually only on one side. If sufficiently large this can need surgical drainage (Quinsy throat).
In very rare cases, diseases like rheumatic fever or a particular kidney disease (glomerulonephritis) can occur. This is much less commonly observed now than it was several decades ago.

Treatment:

the vast majority of people, infection caused by a virus infection need only be treated with paracetamol (eg Calpol, Panadol) to bring the temperature down.

Aspirin (eg Disprin) is also useful, but should not be given to children under 16 years of age, unless on the advise of a doctor.

In a small minority of patients, tonsillitis caused by bacteria is treated with penicillin or erythromycin (eg Erythroped) if the person is allergic to penicillin.

If antibiotics are prescribed, it is important to complete the full course, or the infection may not be cured.

Surgery to remove the tonsils (tonsillectomy) may be necessary for those patients suffering from repeated, severe infections that refuse to respond to treatment and significantly interfere with their school or work schedule but it is now a relatively uncommon operation compared to previous practice.

Source : British Medical Journal 2007