West Michigan Ear Nose & Throat

Sinusitis

Sinusitis is a very common disease entity, which affects millions of patients per year. Sinusitis can be classified either into acute, subacute, or chronic sinusitis.

Acute sinusitis occurs when the sinus ostia become obstructed. This can be from blood, trauma, irritations, allergies, or manifestations of the sinusitis itself. After the inciting phase, the obstructive phase occurs. Blockage of the sinus openings leads to the pain and pressure associated with a relative vacuum or pressure inside the sinuses. This leads to an internal increase in the drainage, and the decreasing of the oxygen content within the sinus. All of these are very favorable for bacterial colonization. Once bacteria colonize a sinus, this can lead to the infective phase. Now, increasing production occurs due to the bacterial infection. This causes pain and pressure of the forehead, teeth, gums, and even back and top of the head. At this point, sinusitis usually manifests with an elevated temperature as well. Under severe circumstances, this infection may migrate to the eyes and the brain causing vision and life-threatening complications. Reversal this, the third stage, or the infective phase, revolves around the use of topical decongestants, anti-inflammatories including steroids and antibiotics. Once the acute phase resolves, the sinus ostia open, they are allowed to drain, the purulent infectious material is released, and air can now enter the sinuses, equalizing the pressure.

Should this occur greater than 6 weeks, this is known as subacute and manifestations of this disease that never completely resolve are called chronic sinusitis.

Chronic sinusitis may manifest merely as headache and face ache when the weather changes outside. Trapped air is either causing a relative pain, pressure, or vacuum associated with the rise and fall of the atmospheric pressure. There can also be an increased amount of drainage, congestion, fatigue, and malaise. Chronic sinusitis by definition is not reversible by medical treatment.

Surgical intervention includes a continuum of procedures some as mild as office sinuplasty using a balloon to dilate the sinuses. This can be done under a topical anesthetic with light oral sedation if requested in a similar fashion to filling a cavity.

More severe chronic sinusitis may require the use of an anesthetic and a brief outpatient surgical stay. A variety of tools including debriders or lasers are used and, unlike the past, no bruising or swelling or packing is required.

Should you have any further questions about acute, subacute, or chronic sinusitis, feel free to contact us.

Epistaxis (Nosebleeds)

Epistaxes, also known as nosebleeds, are a very frequent and annoying problem. The most common cause of epistaxes is trauma. This can be external, or self-induced (nose picking). The location most commonly affected is the front part of the nose known as the anterior septum. This is a confluence of blood vessels intermingle creating what is called Keisselbach's plexus. Small veins and arteries are very close to the surface of the mucosal membrane. Digital trauma, decreased humidity, external trauma and infection are all possible causes and triggers for epistaxes.

Treatment

Treatment is usually in the form of local pressure. Pressing the nostrils together with your finger and thumb for 10 minutes by the clock will usually resolve any uncomplicated epistaxis. If you are on blood thinners, increased the duration to 15 to 20 minutes. An ice cube on the upper lip will help as it constricts blood flow through the incisive foramina into this Keisselbach's plexus. Internal pressure such as gauze or facial tissue will also help this area to clot. However be aware that the removal of these products can we open the wound. Topical decongestants such as Afrin, Neosynephrine and 24-hour are all helpful at shrinking the blood vessels inside of the nose either by directly spraying on the on the vessels or applying to cotton ball which is then inserted into the nostril. If these simple remedies are not successful, a trip to an urgent care or emergency room may be necessary. Significant nosebleeds or epistaxis can occur from much larger blood vessels deeper in the nose which would require professional assistance.

Prevention

Prevention can be as simple as improving humidification in the atmosphere during dry winter months, applying a antibiotic or vitamin ointment to the nose will also help and avoidance digital manipulation and Extertal trauma is also helpful. Some infections in the nostril can be quite resistant and require prescription strength antibiotic ointment.

Should you have any further questions about epistaxes or any other your nose and throat problems, contact us today!