How can you differentiate between a sinus headache and a migraine. What are the common symptoms of rhinosinusitis. Is your sinus headache actually a misdiagnosed migraine. How prevalent is chronic rhinosinusitis in the US. What treatments are available for rhinosinusitis and migraines.

Understanding the Anatomy of Sinuses and Their Function

The human face houses several air-filled spaces known as sinuses. These cavities play crucial roles in our daily functioning, yet they can also be the source of significant discomfort. Let’s explore the anatomy and function of these fascinating structures:

• Frontal sinuses: Located across the forehead and brow
• Ethmoid and sphenoid sinuses: Positioned along the bridge of the nose
• Maxillary sinuses: The largest pair, situated across the cheeks

These sinuses serve multiple purposes in the human body. They help retain heat, make the skull lighter, humidify inhaled air, and even contribute to voice resonance. However, when compromised by allergies or infections, these air-filled cavities can become a source of significant discomfort.

The Mechanics of Sinus Pain

When sinuses become inflamed, the mucosal lining swells and may produce excessive mucus and pus. This leads to congestion and pressure build-up within the affected sinus cavity, potentially resulting in what many perceive as a “sinus headache.” However, recent studies suggest that the relationship between sinus inflammation and headaches might be more complex than previously thought.

The Sinus Headache Misconception: A Closer Look at Rhinosinusitis

Rhinosinusitis, a condition characterized by inflammation of both the nasal cavity and sinuses, is often blamed for causing sinus headaches. However, recent research has cast doubt on this assumption. Studies indicate that approximately 90% of headaches diagnosed as sinus-related, either by healthcare professionals or through self-diagnosis, are actually migraine headaches.

Why is there such a high rate of misdiagnosis? The answer lies in the overlapping symptoms and the complex nature of facial pain. To understand this better, let’s delve into the specifics of rhinosinusitis.

Acute Rhinosinusitis: Symptoms and Causes

Acute rhinosinusitis, defined as lasting less than 12 weeks, is most commonly caused by viral infections. Only about 2% of these cases progress to bacterial sinus infections. A true bacterial rhinosinusitis typically follows an upper respiratory tract infection lasting 10 to 14 days or more.

Common symptoms of acute rhinosinusitis include:

• Nasal congestion
• Runny nose with discolored mucus
• Post-nasal drainage
• Cough (more common in children)
• Facial or dental pain (often unilateral)
• Facial swelling
• Headache

Bacterial rhinosinusitis may also present with additional symptoms such as fever, fatigue, and ear pressure. It’s important to note that while these symptoms can be uncomfortable, they don’t necessarily equate to a “sinus headache” as commonly understood.

Treatment Approaches for Rhinosinusitis: From Self-Resolution to Surgery

The treatment of rhinosinusitis varies depending on its cause and severity. Let’s explore the different approaches:

Viral Acute Rhinosinusitis

Most cases of viral acute rhinosinusitis are self-limiting, meaning they resolve on their own without specific treatment. Supportive care, including rest, hydration, and over-the-counter pain relievers, can help manage symptoms.

Bacterial Acute Rhinosinusitis

When bacterial infection is suspected, antibiotics such as amoxicillin are typically prescribed. The majority of patients respond well to appropriate antibiotic therapy. Additional supportive measures may include:

• Pain relievers
• Topical nasal steroids
• Saline irrigation of nasal passages

Chronic Rhinosinusitis

Chronic rhinosinusitis, affecting approximately 12% of the US population, is diagnosed when symptoms persist for more than 12 weeks and inflammation is confirmed through nasal endoscopy or CT scan. Treatment options include:

1. Topical nasal steroids
2. Long-term antibiotics in some cases
3. Sinus surgery for patients who don’t respond adequately to medical management

Allergic Rhinitis

When allergy is the primary cause of sinus-related symptoms, such as in hay fever, medicated nasal sprays containing antihistamines or steroids are commonly prescribed. It’s worth noting that while allergic rhinitis may occur alongside rhinosinusitis, no direct association has been established between the two conditions.

Unmasking the Migraine: Why Sinus Headaches Are Often Misdiagnosed

Given that the vast majority of perceived sinus headaches are actually migraines, it’s crucial to understand how to differentiate between the two. This distinction is vital for proper diagnosis and treatment.

Similarities That Lead to Confusion

Several factors contribute to the frequent misdiagnosis of migraines as sinus headaches:

• Similar pain location: Both conditions can cause pain around the sinus areas
• Worsening with movement: Pain in both cases often intensifies when bending forward
• Nasal symptoms: Some migraine sufferers experience runny nose or facial pressure

Key Differences Between Sinus Headaches and Migraines

Despite these similarities, there are crucial differences that can help distinguish between the two:

1. Nasal discharge: In migraines, if present, it’s clear and watery. In acute bacterial rhinosinusitis, it’s typically thick and discolored
2. Migraine-specific triggers: Loud noises and bright lights often exacerbate migraines but not sinus headaches
3. Associated symptoms: Nausea and vomiting are common in migraines but not in sinus headaches
4. Duration: Sinus headaches from rhinosinusitis can last for days or weeks, while migraine headaches usually resolve within hours to a day

The Impact of Misdiagnosis: Why Correct Identification Matters

The high rate of misdiagnosis between sinus headaches and migraines is more than just a matter of semantics. It has significant implications for patient care and treatment outcomes.

Consequences of Misdiagnosis

When migraines are mistaken for sinus headaches, several negative consequences can occur:

• Delayed appropriate treatment: Migraine-specific therapies may be overlooked
• Overuse of antibiotics: Unnecessary antibiotic prescriptions contribute to antibiotic resistance
• Prolonged suffering: Patients may endure pain longer without effective relief
• Increased healthcare costs: Repeated visits and ineffective treatments can be financially burdensome

Benefits of Correct Diagnosis

On the other hand, accurately identifying migraines can lead to:

1. Targeted treatment: Migraine-specific medications and therapies can be employed
2. Preventive strategies: Identifying and avoiding migraine triggers can reduce frequency and severity
3. Improved quality of life: Proper management can significantly reduce the impact of migraines on daily activities
4. Reduced healthcare burden: Fewer unnecessary treatments and visits can lower overall healthcare costs

Advanced Diagnostic Techniques: Beyond Symptoms

Given the challenge of differentiating between sinus headaches and migraines based on symptoms alone, healthcare providers may employ advanced diagnostic techniques. These methods can provide more definitive answers and guide appropriate treatment strategies.

Imaging Studies

Various imaging techniques can be used to visualize the sinuses and surrounding structures:

• CT (Computed Tomography) scans: Provide detailed images of the sinuses, helpful in identifying inflammation or blockages
• MRI (Magnetic Resonance Imaging): Can reveal soft tissue abnormalities and is particularly useful in diagnosing neurological causes of headaches
• X-rays: While less detailed than CT or MRI, can still provide useful information about sinus health

Nasal Endoscopy

This procedure involves inserting a thin, flexible tube with a camera into the nasal passages. It allows direct visualization of the nasal cavities and sinus openings, helping to identify inflammation, polyps, or other abnormalities.

Allergy Testing

For patients with suspected allergic rhinitis, allergy testing can help identify specific triggers. This may involve:

1. Skin prick tests: Small amounts of potential allergens are introduced to the skin to observe reactions
2. Blood tests: Measure the presence of antibodies to specific allergens
3. Provocation tests: Controlled exposure to suspected allergens to observe symptoms

Headache Diaries

While not a technical diagnostic tool, headache diaries can be invaluable in distinguishing between different types of headaches. Patients record details about their headaches, including:

• Frequency and duration
• Associated symptoms
• Potential triggers
• Response to various treatments

This information can help healthcare providers identify patterns consistent with migraines or other headache types.

Emerging Treatments: New Hope for Headache Sufferers

As our understanding of headaches and facial pain evolves, so do the treatment options available to patients. Let’s explore some of the newer and promising therapies for both rhinosinusitis and migraines.

Innovative Approaches for Rhinosinusitis

For patients with chronic rhinosinusitis who don’t respond well to conventional treatments, several new options are being explored:

• Biologics: These targeted therapies, such as dupilumab, work by modulating specific components of the immune system
• Balloon sinuplasty: A minimally invasive procedure that uses a small balloon to dilate sinus openings
• Photodynamic therapy: Uses light-activated agents to target and destroy inflamed tissue or bacteria
• Probiotics: Research is ongoing into the potential benefits of probiotic nasal sprays for sinus health

Cutting-Edge Migraine Treatments

The field of migraine treatment has seen significant advancements in recent years:

1. CGRP antagonists: A new class of drugs that target the calcitonin gene-related peptide, a key player in migraine pathophysiology
2. Neuromodulation devices: Non-invasive devices that use electrical or magnetic stimulation to prevent or treat migraines
3. Botulinum toxin injections: Approved for chronic migraine prevention, these injections can significantly reduce headache frequency
4. Mindfulness and cognitive behavioral therapy: Increasingly recognized as effective complementary treatments for migraine management

Personalized Medicine Approaches

The future of headache treatment lies in personalized medicine, where therapies are tailored to individual patients based on their specific symptoms, genetic profile, and other factors. This may involve:

• Genetic testing to predict response to certain medications
• Advanced imaging techniques to identify specific pain pathways
• Artificial intelligence algorithms to analyze patient data and suggest optimal treatment strategies

As research continues, these innovative approaches offer new hope for patients struggling with both rhinosinusitis and migraines, potentially leading to more effective and targeted treatments in the future.

Living with Chronic Headaches: Strategies for Management and Prevention

While medical treatments are crucial, living with chronic headaches, whether from rhinosinusitis or migraines, often requires a multifaceted approach. Developing effective strategies for management and prevention can significantly improve quality of life for those affected.

Lifestyle Modifications

Certain lifestyle changes can help reduce the frequency and severity of headaches:

• Stress management: Techniques such as meditation, yoga, or regular exercise can help mitigate stress-induced headaches
• Sleep hygiene: Maintaining a consistent sleep schedule and creating a conducive sleep environment can prevent sleep-related headaches
• Diet adjustments: Identifying and avoiding food triggers, staying hydrated, and maintaining regular meal times can help
• Environmental controls: For those with allergic rhinitis, minimizing exposure to allergens through air purifiers or regular cleaning can reduce symptoms

Complementary Therapies

Many patients find relief through complementary therapies, which can be used alongside conventional treatments:

1. Acupuncture: Some studies suggest acupuncture may help reduce the frequency of migraines
2. Massage therapy: Can help relieve tension and promote relaxation, potentially reducing headache frequency
3. Aromatherapy: Certain essential oils, such as peppermint or lavender, may provide relief for some individuals
4. Biofeedback: Learning to control certain bodily processes can help manage pain and reduce stress

Support Systems and Education

Living with chronic headaches can be challenging, and having a strong support system is crucial:

• Support groups: Connecting with others who experience similar challenges can provide emotional support and practical tips
• Patient education programs: Learning more about one’s condition can empower patients to take an active role in their treatment
• Family involvement: Educating family members about the condition can foster understanding and support

By combining medical treatments with lifestyle modifications, complementary therapies, and strong support systems, many individuals with chronic headaches can achieve better control over their symptoms and improve their overall quality of life.

Your Sinus Headache Could Actually Be a Migraine Headache

Most people have experienced some sort of headache at some point, whether it be in the form of a piercing migraine or a tight tension headache after your computer crashed. Headaches come in all shapes and sizes and from multiple different causes.

The sinuses of the facial bones are air-filled spaces, with a pair across the forehead and brow (frontal sinuses), two pairs along the bridge of the nose (the ethmoid and sphenoid sinuses), and the largest pair of sinuses across the cheeks (the maxillary sinuses). Sinuses help to retain heat, make the skull lighter, humidify inhaled air, and even help the voice to resonate more loudly. Sinuses can also sometimes be a pain in the neck (or face), particularly when they succumb to allergy or infection. The mucosal lining of these sinuses can become inflamed and swollen and may get a little over-enthusiastic about the production of mucus and pus, which leads to congestion and a build-up of pressure in the affected sinus cavity.

A short foray into the available literature online will tell you that sinus headaches aren’t as straightforward or common as many people think. Studies have found approximately 90% of headaches diagnosed either by a healthcare professional or by self-diagnosis as a sinus headache are in fact migraine headaches.

 
Rhinosinusitis
Rhinosinusitis is defined as inflammation of the nasal cavity (accounting for the “rhino” part of the word) and the sinuses (this part speaks for itself). Rhinosinusitis itself is not particularly uncommon. The point of contention is whether rhinosinusitis is a primary cause of the elusive “sinus headache.” Some researchers believe that sinusitis, with or without the involvement of the “rhino,” actually is rarely capable of causing a headache or even facial pain. The exception is when the sinus is unable to drain due to an acute bacterial infection and trapped pus within the cavity leads to increased pressure and inflammation.

The majority of acute rhinosinusitis cases (defined as lasting for under 12 weeks) are from a viral infection, rather than bacterial, and only about 2% of viral acute rhinosinusitis episodes transition into bacterial sinus infections. A true bacterial rhinosinusitis is typically preceded by an upper respiratory tract infection for at least 10 to 14 days. Symptoms of acute rhinosinusitis include:

• Nasal congestion
• Runny nose with discolored mucus
• Post nasal drainage
• Cough, usually in children
• Facial or dental pain, usually just on one side of the face
• Facial swelling
• Headache

Specific to a bacterial rhinosinusitis, additional symptoms may also include fever, fatigue, and pressure in the ear.

Viral acute rhinosinusitis episodes usually self-resolve while the majority of patients with bacterial rhinosinusitis will respond readily to appropriate antibiotics such as amoxicillin. Supportive therapy in the form of painkillers, topical steroids and saline irrigation for the nasal passages may also be useful to alleviate symptoms.

Chronic rhinosinusitis occurs with a prevalence of approximately 12% in the US and is diagnosed when symptoms of rhinosinusitis are present for longer than 12 weeks if inflammation of the sinuses can be demonstrated on nasal endoscopy or a CT scan. For those patients who are not adequately responsive to medications such as topical nasal steroids, sinus surgery may be the next option.

If the so-called sinus headache is caused by allergy such as hay fever then a medicated nasal spray containing antihistamines or steroids is the most common treatment. This condition is termed allergic rhinitis and may occur in conjunction with rhinosinusitis though no direct association has been found between the two.

 
Sinus headaches vs migraine headaches
So, if most apparent “sinus headaches” are in fact migraines, how can one differentiate between the two?

The location of pain is similar between the two conditions, leading many to misdiagnose any pain around a sinus cavity as a sinus headache, but migraine pain can often occur in the same areas. Both sinus and migraine pains are known to worsen when bending forward. For some, migraine headaches may also present with some nasal symptoms, such as a runny nose or pressure around the face. However, the nasal discharge, also known as rhinorrhea, during a migraine is clear and watery whereas in acute bacterial rhinosinusitis you can expect to see a lot more green and yellow lumpy bits. The typical exacerbating factors of a migraine headache are absent in a sinus headache, such as loud noises and bright lights, as are nausea and vomiting. Sinus headaches due to rhinosinusitis tend to last for days or weeks while a migraine headache is expected to resolve within several hours, occasionally lasting up to a day or two.

While primary care physicians are easily accessible and capable of diagnosing a sinus headache from rhinosinusitis, you may be referred to an ENT specialist, particularly if confirmation of the diagnosis is required via a nasal endoscopy or if the condition is complicated and difficult to treat.   Accurate diagnosis of the type of headache is important as the treatment is quite different between sinus headaches and migraines. Persistent headaches, especially those unresponsive to over-the-counter painkillers, should be thoroughly assessed by a qualified doctor.

References
Headaches connected to allergies and sinus problems. https://www.aaaai.org/conditions-and-treatments/library/allergy-library/allergy-sinus-headaches
Picture of the sinuses. https://www.webmd.com/allergies/picture-of-the-sinuses#1
What to do about a sinus headache. https://www.medicalnewstoday.com/articles/321012.php
Rhinosinusitis: synopsis. ://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/rhinosinusitis-synopsis
Sinusitis. https://www.racgp.org.au/afp/2016/june/sinusitis/
Sinus headaches: avoiding over- and mis-diagnosis. https://www.tandfonline.com/doi/abs/10.1586/ern.09.8?journalCode=iern20
Sinus headaches. https://www.mayoclinic.org/diseases-conditions/sinus-headaches/symptoms-causes/syc-20377580

Post-nasal drip: symptoms, causes and treatment

Post-nasal drip describes the feeling of mucus secretions moving down the back of the throat, often causing cough. It’s normal to swallow some of the mucus that’s made in your nose and sinuses without even realising it. But if the mucus becomes thicker or if there is more mucus than usual, you may get post-nasal drip.

If you have post-nasal drip as well as abnormal sensations in the throat and a chronic (ongoing) cough, you may have what’s called upper airway cough syndrome. Previously called postnasal drip syndrome, this condition is usually related to nose and sinus problems.

Post-nasal drip symptoms

Symptoms that may be associated with post-nasal drip (the feeling of mucus running down the back of your throat) include:

• cough;
• the need to clear the throat often;
• a ‘tickle’ in the throat or sore throat;
• excess mucus (phlegm) in the throat;
• a blocked or runny nose; and (rarely)
• hoarseness or wheezing when breathing in.

Post-nasal drip can also cause bad breath (halitosis).

Symptoms of upper airway cough syndrome include:

• a dry cough that persists for 8 weeks or more;
• post-nasal drip; and
• abnormal, unpleasant sensations in the throat (such as the feeling of something being stuck in the throat, something tickling or irritating the throat, or of mucus in the throat).

Causes of post-nasal drip

There are several conditions that can cause post-nasal drip.

Rhinitis (inflammation of lining of the inside of your nose) is one of the most common causes of post-nasal drip. Rhinitis is often due to allergies (allergic rhinitis, also called hay fever) but can be caused by other things such as the common cold, hormonal changes and certain medicines.

Sinusitis also commonly causes post-nasal drip and/or a runny nose (or blocked nose), as well as facial pain/pressure, cough and a loss of smell. Acute sinusitis is inflammation of the sinuses (cavities within the facial bones that surround your nose) usually due to a viral or bacterial infection. Chronic rhinosinusitis is when there is ongoing inflammation of the lining of the nose and sinuses, with symptoms lasting longer than 12 weeks. Some people with chronic rhinosinusitis develop nasal polyps – benign (non-cancerous) growths that grow from the lining of the nose or sinuses.

People with upper airway cough syndrome have post-nasal drip, abnormal sensations in the throat plus a chronic (ongoing) cough. In some people with this condition, extra-sensitive nerves in the back of the throat may cause a feeling of increased mucus in the throat when there is, in fact, no increase in mucus. Allergies and inhaled irritants can trigger upper airway cough syndrome.

Post-nasal drip also can be caused by changes in temperature and humidity, which can affect the amount or thickness of mucus in the nose and throat. Cold weather can sometimes increase mucus production, and heating in winter can result in thickened mucus.

Tests and diagnosis

Your doctor will ask about your symptoms and examine your nose and throat. Post-nasal drip is often diagnosed based on your symptoms (after other possible diagnoses have been ruled out).

Your doctor may recommend allergy testing if hay fever is considered to be causing your symptoms and you do not know what you are allergic to. This may involve skin prick tests or allergy blood tests.

Other tests that may be suggested include a chest X-ray, lung function tests and blood tests such a full blood count. A CT scan of the nose and sinuses is occasionally recommended to confirm a diagnosis of sinusitis.

If you have persistent or difficult-to-treat symptoms, your doctor may refer you to an ear, nose and throat (ENT) specialist for further assessment and treatment. The specialist may recommend nasal endoscopy, where a special instrument with a camera is used to examine the inside of the nose and throat. This test can help diagnose nasal polyps and other problems in the nose and throat.

Self care for post-nasal drip

Treatments for post-nasal drip usually depend on the cause. However, there are several things you can do yourself to help improve the symptoms, no matter what the cause.

• Use a saline (salt water) nasal spray. This can help flush the nose of allergens (substances that you are allergic to) and irritants and also thin mucus. Some people find that using a neti pot (carefully following the manufacturer’s instructions regarding use and cleaning) is a good way to wash out the nose.
• Stay well hydrated to help thin mucus secretions. Drink plenty of fluids – water is the best choice for staying well hydrated. A warm drink of tea, broth or warm water with half a teaspoon of honey may help soothe your throat as well. Avoid anything that tends to dehydrate, such as alcohol and caffeine, as much as possible.
• Try to work out what triggers your symptoms and avoid these triggers, if possible.

Treatment

Medicines and treatments will vary depending on the cause (or suspected cause) of your post-nasal drip. Always check with your doctor or pharmacist before taking any over-the-counter medicines, and ask about the possible side effects.

Allergic rhinitis

If allergic rhinitis is thought to be the cause of your post-nasal drip, antihistamine medicines will usually be recommended. These medicines can be taken as tablets or nasal sprays. A response to treatment helps confirm the diagnosis.

A nasal corticosteroid spray or a medicine called montelukast may also be recommended for allergic rhinitis. Montelukast (taken as tablets) is a leukotriene receptor antagonist – these medicines are also used to treat asthma.

Sometimes, decongestant nasal sprays or tablets may be recommended if other medicines have not relieved the symptoms. However, there are some risks with these medicines and they should only be used for a short time. In fact, overuse of nasal decongestant medicines can actually make symptoms worse, so don’t use them for more than a few days at a time.

If your post-nasal drip is due to allergic rhinitis and the allergen cannot easily be avoided or if the allergy symptoms are particularly severe and persistent, immunotherapy treatment might be recommended. This therapy is often very effective in desensitising people against particular allergens.

Rhinosinusitis

Rhinosinusitis can be treated with a saline nose spray or saline washouts (nasal irrigation).

Most acute cases of rhinosinusitis (those that come on quickly and don’t last long) are caused by a viral infection such as the common cold. Treatment includes painkillers to treat sinus headache, corticosteroid nasal spray and decongestant nasal sprays (which should not be used for more than 3 days). Antibiotics can be used to treat acute sinusitis that is caused by a bacterial infection.

If you have chronic (ongoing) rhinosinusitis and nasal polyps, nasal corticosteroid spray and possibly also a short course of corticosteroid tablets may be recommended. Nasal polyps can also be removed surgically.

Upper airway cough syndrome

Upper airway cough syndrome is treated with first-generation antihistamines (e.g. chlorpheniramine) and decongestant medicines (such as pseudoephedrine) taken as tablets. A response to treatment helps confirm the diagnosis. Decongestants should only be used for a short time.

Talk to your doctor if you are constantly clearing your throat or have an irritating cough. Finding out the cause of your symptoms and treating the cause should make you feel a lot more comfortable.

1. Cough (published March 2015; amended March 2018). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; Mar 2018. https://tgldcdp.tg.org.au (accessed Jun 2018).

2. Rhinitis and rhinosinusitis (published March 2015). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; Mar 2018. https://tgldcdp.tg.org.au (accessed Jun 2018).

3. Mayo Clinic. Chronic cough (updated 22 Aug 2017). https://www.mayoclinic.org/diseases-conditions/chronic-cough/symptoms-causes/syc-20351575 (accessed Jun 2018).

4. Morcom S, Phillips N, Pastuszek A, Timperley D. Sinusitis. Australian Family Physician 2016;45(6):374-7. https://www.racgp.org.au/afp/2016/june/sinusitis/ (accessed Jun 2018).

5. Mayo Clinic. Nonallergic rhinitis (updated 4 Jan 2018). https://www.mayoclinic.org/diseases-conditions/nonallergic-rhinitis/symptoms-causes/syc-20351229 (accessed Jun 2018).

6. BMJ Best Practice. Upper airway cough syndrome (updated Dec 2016; reviewed May 2018). https://bestpractice.bmj.com/topics/en-us/1209 (accessed Jun 2018).

https://www.mayoclinic.org/symptoms/nasal-congestion/basics/definition/sym-20050644

Is it a sinus infection or COVID-19?

Overlapping symptoms can make it difficult to determine if you have a sinus infection (sinusitis) or COVID-19. These issues are compounded when we spend long hours indoors due to the weather or quarantines.

“While both can cause fever, headache, nasal congestion and sore throat, there are some differences between the two,” said Melinda Cooling, vice president of Advanced Practice for OSF HealthCare and chief clinician executive for OSF OnCall.

Sinusitis vs. COVID-19

A sinus infection, or sinusitis, occurs when the air-filled pockets in the face, called sinuses, fill up with fluid, inflaming the sinus lining and preventing them from draining. The trapped mucus can allow bacteria to grow, which leads to an infection, Cooling said.

Although you can get sinusitis year around, it tends to accompany the cold and influenza seasons during the fall and winter months.

“During those months, people spend more time inside with allergens,” Melinda said. “One difference is sinusitis tends to take longer, around 10 days, to develop into a bacterial infection, while COVID-19 will come on more quickly. ”

Symptoms of a sinus infection

Common symptoms of sinus infections may include:

• Runny nose or cold symptoms that last longer than seven to 10 days
• Complaints of drip in the throat from the nose
• Headaches
• Facial pain or pressure
• Bad breath
• Cough
• Fever
• Sore throat
• Swelling around the eyes, worse in the morning

“COVID-19 causes more of a dry cough, loss of taste and smell, and, typically, more respiratory symptoms,” Melinda said. “Sinusitis causes more discomfort in the face, congestion, nasal drip, and facial pressure.”

Symptoms for COVID-19

Common symptoms of a COVID-19 infection may include:

• Body aches
• Congestion or runny nose
• Cough
• Fatigue
• Fever or chills
• Headache
• Nausea, vomiting or diarrhea
• New loss of taste or smell
• Shortness of breath or difficulty breathing
• Sore throat

“Symptoms can be similar, but there are subtle differences. That’s why it is important to limit your exposure to others if you have any symptoms,” Melinda said. “After you have identified the cause for your symptoms, you can resume your daily activities.

“The most important piece of advice at this point in time is to stay within your family unit and limit exposure.”

What you can do

Melinda recommends only using reputable resources such as the CDC, OSF HealthCare or your primary care provider anytime you have questions or concerns about an illness.

How to Tell the Difference between Sinusitis and a Cold – Westchase & Clearwater, FL

Many people mistake a common cold for sinusitis, and vice versa, as the symptoms of a cold and a sinus infection can be quite similar to each other because the same viruses often cause both conditions. Additionally, since the nose and sinuses are connected, it is possible for viruses to move easily between the nasal passages and the sinuses. 

Your child may feel run down, have a low-grade fever, post-nasal drip and a sore throat. So is it a common cold or a sinus infection? Typically, a cold can definitely morph into a sinus infection, but there are some classic symptoms for each illness that can help distinguish between the two.

The Common Cold

With a cold, there is a cluster of symptoms that your child might be experiencing, including:

• Nasal congestion
• A run-down feeling
• Runny nose with clear discharge
• Sneezing
• Sore throat
• Post nasal drip
• Fever may be seen in children, but not often in adults

If your child has a cold, they may even experience a cough or a headache, and it can often last from three to seven days with or without any treatment. Your child develops a cold from a virus in which the symptoms usually build slowly over the course of a day or two, peak by days three or four, then slowly improve around the fifth or seventh day. 

With a cold, treatment might include supportive care, fluids and chicken soup. Drinking plenty of water is also beneficial as it helps to hydrate your child. By hydrating your child through water consumption, you can help to flush out the infection because it liquefies the mucus. There are also medications available to help make your child more comfortable as the cold passes.

Sinusitis

Sometimes colds can set in the sinuses and cause swelling, which then prevents the flow of mucus and turns the cold into a sinus infection.  Sinusitis is the inflammation of the sinuses that can be caused by a cold, an infection or allergies. Any swelling of the sinuses can produce symptoms such as:

• Pressure or pain behind the eyes or cheeks
• Pain in the top teeth
• Congestion
• Green or yellow nasal drainage
• Headache
• Post nasal drip

Your child may also complain of being tired, having a difficult time breathing through his or her nose, decreased sense of smell and restless sleep. If your child develops a cold every month or every other month, this is because his or her sinuses are flaring up and it is probably not a cold, but chronic sinusitis. 

The main difference between a common cold and sinusitis is that a cold comes around once a year and lasts for three to five days, and then is gone and your child most likely will not experience it again until next year.  Acute sinusitis typically lasts less than four weeks, with chronic sinusitis lasting more than 12 weeks. So if your child’s symptoms last more than a week, odds are they are experiencing a sinus infection and should visit your pediatrician. 

By visiting your child’s pediatrician, you can help your child breathe easy once again. Whether it is a common cold, or a more serious sinus infection, your child’s pediatrician is available to help relieve their symptoms. 

Sinusitis | AAAAI

Sinuses are empty cavities within your cheek bones, around your eyes and behind your nose. Their main job is to warm, moisten and filter air in your nasal cavity.

If your stuffy nose and cough last longer than 10-14 days or worsens after 7-10 days, you may have more than a cold. Rhinosinusitis is a swelling of one or more of your nasal sinuses and nasal passages. It is often called sinusitis or a sinus infection.

You may experience pressure around your nose – eyes or forehead, a stuffy nose, thick, discolored nasal drainage, bad-tasting post-nasal drip, cough, head congestion, ear fullness or a headache. Symptoms may also include a toothache, tiredness and, occasionally, a fever.

By learning more about sinusitis, you will have a better understanding of your symptoms.

Types and Causes of Sinusitis

Acute sinusitis refers to sinusitis symptoms that last less than four weeks. Most acute sinusitis starts as a regular cold from the common cold viruses and then becomes a bacterial infection. Chronic sinusitis is when symptoms last three months or longer. The cause of chronic sinusitis is believed to be a combination of swelling and infection. Recurrent sinusitis occurs when three or more acute episodes happen in a year.

Allergic rhinitis puts you at risk for developing sinusitis because allergies can cause swelling of the sinuses and nasal mucous linings. This swelling prevents the sinus cavities from draining, and increases your chances of developing secondary bacterial sinusitis.

If you test positive for allergies, your allergist can prescribe appropriate medications to control your allergies, possibly reducing your risk of developing an infection. In rare cases, immune problems that harm your ability to fight common infections may present with chronic or recurrent sinusitis.

Problems with the structure of your nose – such as narrow drainage passages, tumors or a shifted nasal septum (the bone and cartilage that separate the right from the left nostrils) can also cause sinusitis. Surgery is sometimes needed to correct these problems. Many patients with recurring or chronic sinusitis have more than one factor that puts them at risk of infection. So, an accurate diagnosis is essential.

Diagnosis

To diagnose sinusitis, an allergist will take a detailed history and perform a physical examination. He or she may also order tests. These tests can include allergy testing, sinus CT scans (which take exact images of the sinus cavities) or a sample of your nasal secretions or lining.

Your physician may also perform an endoscopic examination. This involves inserting a narrow, flexible endoscope (a device with a light attached) into the nasal cavity through the nostrils after local anesthesia. This allows your physician to view the area where your sinuses drain into your nose in an easy, painless manner.

Treatment

Sinus infections generally require a mix of therapies. Your physician may prescribe a medication to reduce blockage or control allergies, which helps keep the sinus passages open. This medicine may be a decongestant, a mucus-thinning medicine or a steroid nasal spray. If bacterial sinusitis is present, your physician may prescribe an antibiotic. For people with allergies, long-term treatment to control and reduce allergic symptoms can also help in preventing sinusitis.

Several non-drug treatments can also be helpful. These include breathing in hot, moist air and washing the nasal cavities with salt water. If you need surgery to fix the structure of your nose, your allergist may refer you to an otorhinolaryngologist, or an ear-nose-throat physician (ENT).

Sinusitis Versus Rhinitis

Symptoms of sinusitis and rhinitis are very similar. Rhinitis is a swelling of the mucous membranes of the nose while sinusitis includes swelling of the sinuses in addition to the nasal passages. For this reason, sinusitis is often called rhinosinusitis.

Rhinitis may be allergic or non-allergic. Allergic rhinitis is caused by allergens in the air, which are usually harmless but can cause problems in allergic people. Symptoms of allergic rhinitis often are a runny nose, sneezing, nasal congestion and itchy eyes, nose, throat and ears. People with non-allergic rhinitis usually just have a stuffy nose. It may be caused by irritants such as smoke, changes in barometric pressure or temperature or overuse of over-the-counter decongestant nasal sprays.

Healthy Tips

• Sinusitis is a swelling of the nose and sinuses.

• Acute sinusitis occurs when symptoms last less than four weeks.

• Chronic sinusitis occurs when symptoms last more than three months.

• People with allergies are at greater risk of getting sinus infections.

• Treatment for sinusitis is available. See an allergist for help managing your symptoms.

Feel Better. Live Better.

An allergist / immunologist, often referred to as an allergist, is a pediatrician or internist with at least two additional years of specialized training in the diagnosis and treatment of problems such as allergies, asthma, autoimmune diseases and the evaluation and treatment of patients with recurrent infections, such as immunodeficiency diseases.

The right care can make the difference between suffering with an allergic disease and feeling better. By visiting an allergist, you can expect an accurate diagnosis, a treatment plan that works and educational information to help you manage your disease.

The AAAAI’s Find an Allergist / Immunologist service is a trusted resource to help you find a specialist close to home.

If you would like to order a brochure on this topic visit the AAAAI Store.

Find out more about sinusitis.

This article has been reviewed by Andrew Moore, MD, FAAAAI

Reviewed: 9/28/20

Sinusitis – Better Health Channel

Sinusitis means infection or inflammation of the sinuses. The sinuses are air-filled spaces within the bones of the face. They are located in the cheeks (maxillary), forehead (frontal) and around the eyes (ethmoidal). The sinuses are linked together, and connected to the nose and throat, via narrow channels called ostia. One function of the sinuses is to warm and moisten inhaled air before it reaches the lungs. The sinuses are also lined with cells that help prevent infection by producing mucus to trap particles of dirt and other pollutants that are breathed in.

Causes of sinusitis

Sinusitis is caused by too much mucus, or a swelling of the lining of the sinuses and nose, which can block the narrow channels. This can occur during a cold, or may be due to allergy (for example, hayfever) or irritation of the linings of the sinuses (for example, from chlorine in a swimming pool). Bacteria (germs) then grow inside the sinuses, causing pain, headache and sometimes fever. Mucus from infected sinuses can be yellow or green. Some people get sinusitis with most colds, while others get it rarely.

Symptoms

Common symptoms of sinusitis include:

• Blocked nose
• Feeling of pressure inside the face
• Facial pain, particularly when leaning forward
• Headache
• Aching teeth in the upper jaw
• Yellow or green-coloured mucus from the nose
• Swelling of the face
• Loss of the senses of smell and taste
• Persistent cough
• Generally feeling unwell.

Risk factors

Certain factors increase a person’s susceptibility to sinusitis, including:

• Frequent colds (especially for young children)
• Cigarette smoking (active or passive)
• Regular use of nasal decongestant sprays (for more than two to three days)
• Untreated hay fever or other allergies
• Structural abnormalities of the nose
• Nasal polyps (swellings in the linings of the nose or sinuses)
• Dental disease, such as untreated tooth abscess.

Complications of chronic sinusitis

Some people are troubled by frequent sinus infections, or continuous infection. Chronic sinusitis can linger for weeks or even months at a time. This can sometimes lead to serious complications, including infections in the bones and tissue near to the sinuses. Very rarely this infection can spread to the brain and the fluid around the brain. The person will be very ill and have swelling around the eyes.

People with chronic sinusitis may have other problems which affect the nose, throat and ears at the same time, including:

• Middle ear infection and temporary deafness
• Post-nasal drip (fluid from the sinuses and nose constantly drips down the back of the throat), which can lead to constant coughing, a sore throat and bad breath.

Treatment options

Decongestants that help with symptoms of colds usually do not help with sinusitis. Nose sprays can even make the problem worse, if they are used for too long, because they can cause more swelling. Antibiotics are often prescribed for sinusitis. Most people will recover fully from sinusitis in a week or so without antibiotics, but they may recover more quickly if effective antibiotics are used. (Some antibiotics are much more useful for sinusitis than others).

Other options to manage the symptoms of sinusitis include:

• Steam inhalation, perhaps including a few drops of eucalyptus oil
• Comfortably hot compresses held against the face
• Pain relief medication, such as paracetamol.

If you suffer from sinusitis, it’s important to see if there is any trigger which can be treated. For example, hayfever or dental disease may need to be treated, or you may want to avoid irritants by staying out of swimming pools.

Surgery to drain the pus and improve the flow of mucus from the sinus may be an option for persistent cases of sinusitis.

Where to get help

Things to remember

• Sinusitis means infection or inflammation of the sinuses, which are air-filled spaces inside the bones of the face.
• Symptoms include yellow or green-coloured mucus draining from the nose, facial pain and headache.

Post-nasal Drip – Causes, Symptoms, Treatment, Diagnosis

The Facts

Post-nasal drip happens when mucus builds up in the back of the nose and throat. Post-nasal drip is not a medical condition, but it may be a symptom of another medical condition that causes excessive mucus production (e.g., sinusitis, rhinitis, or infections).

Causes

The inside lining of the nose produces large amounts of mucus to clean the nose, trap foreign particles (e.g., dust), and to fight infection. Post-nasal drip can be caused by various medical conditions including sinusitis (inflammation of the sinuses), viral infections such as the common cold, rhinitis (a runny nose that may be acute or chronic), allergies, or bacterial infections. In some cases, post-nasal drip can be caused by reflux, or gastroesophageal reflux disease (GERD).

Symptoms and Complications

People who experience post-nasal drip often describe a feeling of mucus dripping at the back of the throat. This may lead to frequent throat clearing, sore throat, and coughing. Since post-nasal drip is a symptom of another condition, other symptoms may be present that are linked to whatever’s causing the problem. When allergies are responsible for post-nasal drip, many people experience teary eyes, itchiness of the nose and eyes, and headaches. If you have asthma, the post-nasal drip may make breathing even more difficult.

Other symptoms associated with post-nasal drip may include bad breath, stuffy nose, hoarse voice, sneezing, runny nose or coughing.

Making the Diagnosis

The first step is to figure out what’s causing the post-nasal drip. Your doctor will help with this by asking questions about your symptoms and examining your ears, nose, and throat. Your doctor will want to know if you have any allergy symptoms or if you have symptoms of an infection (e.g., fever). In some cases, other tests (e.g., X-rays) may be needed to determine the cause.

The type of mucus in your nose can reveal a lot about possible causes of nasal drip. If the mucus is clear, a common cold or allergies are most likely. If it is thick and has a yellow or green tinge, a bacterial infection may have developed.

Treatment and Prevention

The treatment of post-nasal drip depends on its cause.

If your doctor determines that an infection is causing post-nasal drip, the infection will most likely be caused by a virus and antibiotics are not required. However, decongestants may help a stuffy nose and pain relievers can be used to help with pain. Sometimes, bacterial infections can occur and antibiotics may be prescribed.

Pseudoephedrine* and phenylephrine are the most common decongestants in over-the-counter cold medications taken by mouth. Talk with your doctor or pharmacist before using decongestant medication if you have high blood pressure, diabetes, thyroid disease, glaucoma, or prostate enlargement. Nasal spray decongestants include those containing phenylephrine, oxymetazoline, or xylometazoline. They should not be used for more than 3 to 5 days, as they may cause congestion to worsen when used on a regular basis for longer periods of time. Humidifiers or vaporizers can also help relieve symptoms of post-nasal drip. Regardless of cause, some antihistamines may be used to treat post-nasal drip since they help dry up the mucus.

If allergies are responsible for post-nasal drip, over-the counter antihistamines (e.g., loratadine, desloratadine, cetirizine, fexofenadine) can be used to help with symptoms. Talk to your doctor or pharmacist before starting an antihistamine. Your doctor may also prescribe a corticosteroid nasal spray (e.g., budesonide, fluticasone, mometasone) to help. Avoiding the allergies that cause runny noses can prevent post-nasal drip from happening again. Many people are allergic only during certain seasons or times of the year, mostly to pollens, moulds, or weeds. Year-round causes of allergies include mites, animal dander, and moulds.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Post-nasal-Drip

90,000 Pansinusitis – symptoms and treatment

By Irakli Yakobashvili, otorhinolaryngologist, Ph.D.

Acute sinusitis is an infectious disease characterized by inflammation of the mucous membrane inside the paranasal sinuses and lasts up to 4 weeks. It is an extremely common disease in children and adults. It can occur as a result of a viral or bacterial infection. In the case of a virus, special treatment is not required, while a bacterial infection is more severe and requires drug therapy.The drugs are prescribed strictly by the doctor.

Nasal sinuses are cavities located in the skull, filled with air and covered with mucous membranes inside. Their function is to warm, purify and humidify the inhaled air, as well as to protect against damage to the brain and eyeballs. In addition to this, they protect us from viruses and bacteria and give our voice a personality.

However, in some cases, they themselves become foci of infection.This occurs when the excretory ducts of the nasal sinuses, which connect them to the nasal cavity, are closed (for example, due to polyps in polyposis sinusitis).

Pansinusitis is one of the forms of acute purulent sinusitis. With pansinusitis, all the paranasal sinuses of the skull become inflamed at once, which is accompanied by the accumulation of a large amount of pus and mucus in them. These are paired (left and right) maxillary, wedge-shaped, ethmoid and frontal sinuses (Fig. 1).

Fig.1. Anatomy of the paranasal sinuses

This variant of the inflammatory process is the most severe, carries more risks of complications (including inflammation of the meninges – meningitis), especially in patients with reduced immunity, and more often tends to turn into a chronic process. One of the important features of the disease is that it can develop quickly (within 1-2 days) after a common acute viral infection (ARVI).

Pansinusitis symptoms

Symptoms of acute pansinusitis may include:

• headache, feeling of heaviness in the head,
• pain in the face, especially when tilting the head,
• nasal congestion,
• Large amount of thick, yellow-green nasal discharge,
• drainage of discharge along the back of the pharynx (postnasal flow),
• reduced sense of smell,
• pain in the area of ​​the teeth of the upper jaw,
• weakness,
• congestion in the ears.

However, none of these symptoms are exclusive to acute pansinusitis, the diagnosis can only be made by a doctor after examination.

Diagnostics of pansinusitis

One of the main criteria for the diagnosis of pansinusitis is the persistence of the above complaints for more than 10 days. Another important factor is the repeated deterioration of the patient’s condition after the initial improvement.

Methods of choice for diagnosing acute pansinusitis are :

• Computed tomography (CT) of the paranasal sinuses,
• endoscopic examination of the nasal cavity.

Additional diagnostic methods:

• general blood test,
• C-reactive protein,
• nasal cytology,
• culture of exudate from the middle nasal passage or sinus lumen.

Treatment of acute pansinusitis

Until recently, the treatment of acute pansinusitis was carried out in a hospital setting, as complications often occurred. Currently, it is possible to effectively prevent them due to the availability of modern diagnostic and treatment algorithms, therefore, patients with pansinusitis can be treated on an outpatient basis, but with mandatory monitoring of the condition.If you find the first signs of complications, contact your doctor immediately, because surgery may be necessary.

Signs of complications:

• intense headache that does not go away with conventional analgesics (ibuprofen),
• sudden onset of nausea and vomiting,
• photophobia,
• depression of consciousness,
• edema in the eye and orbit,
• limitation of mobility of the eyeballs,
• visual impairment,
• high fever that does not decrease after taking nonsteroidal anti-inflammatory drugs.

Complications of pansinusitis

One of the most formidable complications is meningitis . This inflammation of the meninges, which can potentially threaten the patient’s life, causes depression of the central irregular system and requires treatment in the intensive care unit or intensive care unit. But the primary is the surgical treatment of the focus in the nasal sinus.

Orbital complications (orbital abscess, orbital phlegmon) – inflammatory diseases of the eye that can cause partial or complete loss of vision.Such a complication requires urgent surgical intervention in the sinuses to eliminate the main focus of inflammation.

Sepsis is a systemic inflammatory reaction of the body, which can be accompanied by a disruption in the work of many organs and systems. The condition in such patients is regarded as severe and requires treatment in the distant intensive care.

Separately, it should be said about the importance of monitoring the condition of the paranasal sinuses after the acute period of pansinusitis, when most of the symptoms disappear. With inflammation in all paranasal sinuses, there is a very high probability of developing a chronic process in one of them, which may not manifest itself in any way.

Only coordinated and joint work of a doctor and a patient, an open discussion of the prognosis and nuances of an individual clinical case, and competent therapy can guarantee a complete cure for this pathological condition.

References:

1. Cummings Otolaryngology, 7th Edition by Paul W.Flint, MD, Bruce H. Haughey, MD, FACS, Valerie J. Lund, CBE, MS, FRCS, FRCSEd, K. Thomas Robbins, MD, FACS, J. Regan Thomas, MD, FACS, Marci M. Lesperance, MD and Howard W. Francis

2. Meltzer EO, ​​Hamilos DL, Hadley JA, et al. Rhinosinusitis: Establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg 2004; 131: S1.

3. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 2015; 152: S1.

4. Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: national health interview survey, 2012. Vital Health Stat 10 2014; :one.

5. Wilson JF. In the clinic. Acute sinusitis. Ann Intern Med 2010; 153: ITC31.

Postnasal drip syndrome – causes, symptoms, diagnosis and treatment

Postnasal drip syndrome is a combination of clinical symptoms caused by irritation of the mucous membranes of the posterior pharyngeal wall and larynx with catarrhal or purulent discharge from the nasal cavity or accessory sinuses.Manifestations include cough that worsens at night and immediately after waking up, a lump sensation, dryness and burning in the back of the nose, and voice changes. Diagnosis is based on the results of a visual examination of the pharynx and nasal cavity, laboratory tests, radiography or computed tomography. Treatment consists in eliminating the primary focus of inflammation by medication or surgery.

General

Postnasal drip syndrome (PDS) is a very common pathological condition.According to many experts, it is one of the most common causes of cough. The disease occurs everywhere, regardless of the socio-economic indicators and climatic characteristics of the region of residence. In more than 35% of cases, SD is caused by acute and chronic rhinitis, in another 20-25% – by various forms of sinusitis. Concomitant malformations of the nasopharyngeal cavity and nose are present in 15-25% of patients. Complications in the form of inflammatory lesions of the larynx and tracheobronchial tree are detected relatively often – in 20% of patients.

Postnasal drip syndrome

Causes

This syndrome is the result of diseases of the ENT organs, in which the work of regional exocrine glands that produce mucus is disrupted. Under normal conditions, they provide moistening and cleaning of the nasal cavity, nasopharynx, and accessory sinuses from inhaled substances. Dysfunction of these glands and excessive mucus synthesis can be caused by the following factors:

• Infectious and allergic pathologies. Overproduction of mucus is provoked by inflammatory reactions of various etiologies. Most often these are allergic, bacterial, fungal or viral sinusitis, vasomotor, drug or post-infectious rhinitis, rhinitis of pregnant women. Less often, the pathological condition causes the proliferation of adenoid vegetations and their inflammation – adenoiditis.
• Congenital and acquired anomalies. The classic form of postnasal flow syndrome is potentiated by a congenital formation of the midline of the nasopharynx – Thornwaldt’s cyst.Curvature of the nasal septum, bullous deformation of the turbinates, and other defects of the pharynx and nasal cavity can act as contributing factors.
• Diseases of the gastrointestinal tract. Rare causes of SDS include pathologies of the digestive system, accompanied by the reflux of stomach contents into the lumen of the nasopharynx and oropharynx – esophageal diverticulum, hiatal hernia, and laryngopharyngeal reflux.

There are a number of factors that do not directly cause SDR, but contribute to the development of existing violations.Their list includes tobacco smoking, unfavorable environmental conditions, working with volatile chemicals or in conditions of increased dry air, hormonal imbalances of various origins, prolonged or uncontrolled intake of certain systemic pharmacotherapeutic agents and vasoconstrictor nasal drops.

Pathogenesis

The disease develops against the background of inflammatory lesions of the upper respiratory tract. As a result of a local increase in the permeability of blood vessels and exudation, purulent or mucous pathological masses are released, and the work of the mucous glands is enhanced.Accumulating, the discharge flows down the back of the pharynx into the vestibular larynx. In this area, mechanical irritation of the nerve endings of the afferent part of the cough reflex arc occurs, which provokes a cough. In the daytime, the clinic is less pronounced. This is due to the fact that the patient swallows a significant part of the secretions, which is why they do not fall on the cough zones – the mucous membranes of the epiglottis and the vocal folds. At night, when the body is in a horizontal position, mucus or pus flows freely to the reflexogenic areas of the laryngopharynx, stimulating a cough.

Postnasal syndrome symptoms

The clinical picture is dominated by nonspecific symptoms characteristic of acute respiratory viral infection. Often, the leading place is occupied by manifestations of the primary disease – rhinitis, sinusitis and others. These can be disturbances in nasal breathing, a feeling of stuffiness, dryness or burning in the nose, nasal soundness, headache, general weakness, malaise, low-grade fever. Discomfort and a sensation of mucus accumulation in the posterior parts of the nasopharynx, less often pain in this area, indicate the formation of SDS.Patients describe this condition as a “lump” that does not disappear with swallowing and slightly decreases with coughing. There is a dry cough that occurs in the first half of the day, especially in the morning. In severe cases, patients cough up mucous clots of a pale orange or orange-yellow color, and experience severe coughing attacks at night.

Complications

Complications of postnasal drip syndrome are associated with the spread of the inflammatory process to the lower respiratory tract.In the absence of timely treatment of the underlying pathology, recurrent or chronic pharyngitis and laryngotracheitis are formed. With a prolonged course and synthesis of a large number of pathological masses, protracted, difficult to treat bronchitis and pneumonia can occur. Less commonly, secretions enter the esophagus, causing esophagitis.

Diagnostics

The diagnosis of postnasal syndrome is based on the results of an objective examination, anamnestic data, patient complaints.Laboratory and instrumental methods are of an auxiliary nature, aimed at identifying the root cause of the pathology, choosing the most appropriate treatment tactics. When interviewing a patient, the otolaryngologist focuses on recent diseases and existing anomalies in the development of the upper respiratory system, an increase in symptoms at a certain time of the day. Further diagnostic program consists of:

• Rhinoscopy. On external examination of the nasal cavity, there is swelling and hyperemia of the mucous membranes, the presence of clots, especially at the bottom and under the posterior ends of the inferior concha.An endoscopically negative variant of the SDS is distinguished, in which there are no clots of secretion in the nasal cavity.
• Mesopharyngoscopy. A characteristic sign of the disease is the presence of yellowish mucous cords passing along the hyperemic, somewhat edematous posterior wall of the oropharynx from the soft palate from the nasopharynx.
• Complete blood count. Changes in the CBC at the onset of the disease depend on the leading etiological factor. With viral pathologies, neutropenia and lymphocytosis are determined, with allergic ones – eosinophilia.With bacterial etiology of SDS and against the background of a pronounced clinical picture, leukocytosis with neutrophilia and an increase in ESR characteristic of all variants are found in the blood test.
• Beam research methods. Used in endoscopically negative cases to detect paranasal sinus lesions. The basic method is radiography of the paranasal sinuses, less often computed tomography of this area is used. The presence of sinusitis is evidenced by thickening of the mucous membrane of a particular sinus, complete or partial darkening of its lumen.

Treatment of postnasal syndrome

Therapeutic tactics depend on the nature and etiology of the disease. In most cases, conservative therapy is sufficient. Surgical interventions are resorted to only when it is impossible to eliminate the focus of inflammation with medication. The list of possible therapeutic measures includes:

• Etiotropic therapy. For bacterial infections, the drugs of choice are antibiotics, selected on the basis of a preliminary bacteriological study.For fungal infections, antimycotic drugs are prescribed. With viral and allergic etiology, only symptomatic treatment is often used.
• Pathogenetic and symptomatic agents. Removal of swelling of the mucous membranes and suppression of secretion is possible with the use of topical corticosteroids, antihistamines. If necessary, the therapy program is supplemented with antipyretics, vitamin complexes. Antitussives are indicated only for severe coughing attacks.
• Surgical treatment . Usually resort to endoscopic surgery on the intranasal structures and paranasal sinuses. If necessary, correction of a deviated nasal septum is performed (septoplasty), resection of bullous conchas of the nose, or removal of Thornwaldt’s cyst. Positive results are obtained by cervical resection of the posterior ends of the inferior turbinates or their bipolar coagulation.

Forecast and prevention

The forecast for health in case of timely detection and appropriate correction of the main etiological factor is favorable.Elimination of the pathological process in the primary focus of inflammation leads to the complete disappearance of the symptoms of the disease. Specific preventive measures for this syndrome have not been developed. Non-specific prevention is based on early treatment of bacterial, viral and fungal infections of the ENT organs, which may be accompanied by mucus hypersecretion or the formation of purulent masses. An important role is played by the correction of congenital and acquired anomalies of the nasal cavity and pharynx, relief of seasonal allergic reactions.

Postnasal syndrome ›Diseases› DoctorPiter.ru

Postnasal syndrome, also known as postnasal drip syndrome, is an inflammatory process in the nasal cavity, sinuses or nasopharynx, in which mucous discharge flows into the lower respiratory tract.

Features

The symptoms of postnasal syndrome are similar to those of a common ARVI. This is nasal congestion, cough with phlegm, difficulty in nasal breathing.Headache and soreness in the sinuses are possible. Constant coughing, shortness of breath, and wheezing in the lungs are also common. But the main symptom is the accumulation of mucus in the posterior parts of the nasal cavity and its flowing down the posterior wall of the nasopharynx. The mucous clots can sometimes be orange-brown in color.

Symptoms are worse in the morning, often people with postnasal syndrome wake up with a feeling of discomfort in the throat.

Pharyngitis symptoms are sometimes noted. This is due to the drainage of the mucous discharge along the back of the pharynx, breathing through the mouth and the abuse of vasoconstrictor drops.

Description

This condition was first described in 1794 by Frank. He called it “the pharyngeal form of chronic catarrh.” And in 1886, Dobell found out that postnasal catarrh can be acute and chronic, but this is not an independent pathology, but a manifestation of other diseases. At that time, this condition was also called “American Qatar”, since it was more common in America than in Europe. M. McKenzie and J. McDonald believed that the dry and dusty American climate was to blame.In 2005, the UK coined the term rhinosinusitis for this condition.

Most often, postnasal syndrome develops with vasomotor rhinitis, sinusitis, allergic rhinitis, rhinitis caused by the pathology of the structure of the nasal cavity, rhinitis of pregnant women. Also, the cause of postnasal leakage syndrome can be Torvaldt’s bag – a cyst-like formation near the pharyngeal tonsil.

In any inflammatory process in the upper respiratory tract, the mucous discharge flows down the back of the pharynx into the laryngopharynx.Moreover, the effect of this depends on the position of the person’s body. So, when a person is in a horizontal state, the mucous discharge, flowing down, falls into the zones that stimulate coughing. And in an upright position, this does not happen, that is, the mucus flows down, but the person reflexively swallows it, it almost does not get on the epiglottis, the receptors that stimulate the cough reflex do not irritate and, accordingly, does not cause coughing.

Diagnostics

Doctors often mistake this condition for chronic bronchitis.And in order to correctly diagnose and prescribe treatment, a thorough examination of the ENT organs is necessary. The diagnosis of “postnasal leakage syndrome” is made on the basis of a physical examination, the patient’s characteristic complaints (drainage of secretions along the back of the pharynx), and the result of an x-ray examination.

Treatment

To get rid of postnasal syndrome, it is necessary to cure the underlying disease. And there are many ways to treat diseases accompanied by postnasal flow syndrome.Steroid therapy (for allergic rhinitis) and long-term antibiotic therapy are often used. Sometimes surgical intervention is also necessary, since there is a need to restore the normal anatomy of the nasal cavity and normalize the aerodynamics in it. This is necessary, for example, with a deviated nasal septum. If Thornwaldt’s bag is present, it is removed under the control of an endoscope.

Prevention

Prevention of postnasal syndrome consists in the prevention or, if you are already sick, in the timely treatment of diseases that cause this syndrome.That is, allergy sufferers, depending on the cause of the allergy, need to follow the flowering calendar of plants, the presence of pets in the environment, nutrition or cleanliness in the house. Those who catch cold easily need to temper, take vitamins, in general, strengthen the body and, of course, dress warmer.

In addition, if there are any defects in the structure of the nasal cavity, it is better to correct them so that in the future, due to these defects, postnasal flow syndrome does not develop.

© Dr. Peter

90,000 Curvature of the nasal septum – ENT clinic No. 1

Recently, Starokha Alexander Vladimirovich, gave an interview to the TV2 news agency, on the issue: Curvature of the nasal septum.

Original article:
https://tv2.today/Na-stile/Pochemu-nelzya-dyshat-rtom-mify-ob-iskrivlenii-nosovoy-peregorodki

What do we do when it becomes difficult for us to breathe through our nose? We reach for vasoconstrictor drops or spray. Pshiknuli, dripped – and forgot. Are you sure this is just a runny nose, and not a curvature of the nasal septum? Why is this happening and is it necessary to correct something? Can an unresolved nose problem somehow affect the health of the body as a whole? Alexander Starokha, professor, doctor of medical sciences, otolaryngologist of the highest category, head of the center of innovative otorhinolaryngology “ENT clinic” spoke about this to TV2.

1. If the nose is not breathing – it is a runny nose. We must treat him.

Any difficulty in nasal breathing is a symptom. Therefore, you always need to look for the disease that caused it. There can be many of them: vasomotor or allergic rhinitis, polyps, adenoids, tumors, foreign bodies of the nasal cavity, etc. Often the cause of difficulty in nasal breathing can be the curvature of the septum. In this case, no sprays or drops will save you, but only form an addiction to the drug, which will aggravate the problem.Only an operation that corrects the deformation of the septum will correct the situation and help to abandon vasoconstrictors.

2. The curvature of the nasal septum is only a cosmetic defect. It does not affect breathing.

No. Curvature of the nasal septum in most cases leads to a violation of nasal breathing. This, in turn, leads to the fact that an insufficient amount of oxygen enters the blood and brain, and decreases physical and mental performance.Often the curvature of the septum causes persistent inflammation in the sinuses. As a result, the symptoms turn into a chronic form, a person gets permanent sinusitis, chronic rhinitis, his sense of smell and sleep are disturbed, hearing problems may occur, the broncho-pulmonary and cardiovascular systems of the body suffer.

Difficulty in nasal breathing interferes with the normal outflow of blood and lymph from the brain, this leads to a headache. Children who find it difficult to breathe through their nose have problems with perseverance, concentration, and they often lag behind in development.

In addition, the air we breathe through the mouth is not warmed up and the nasal cavity is not cleaned. Inhaling it increases the risk of contracting respiratory infections.

3. Snoring – Consequence of problems with the nasal septum

Not only. Snoring is a complex problem. Snoring 60% of the population after 40 years and 20% of the general population. Social complications in snoring are problems in the family, common life, on business trips. Life-threatening consequences are: hypercoagulability, hypertension and vasospasm, increasing the risk of thrombosis and embolism, stroke and heart attack, the risk of car accidents due to daytime sleepiness.Snoring (ronchopathy) is a sound phenomenon with a volume of up to 120 dB (!), Produced on inhalation by vibration of hypertrophied soft tissues of the oropharynx – the soft palate and uvula. There are many reasons for its appearance: problems from the soft palate, larynx, larynx-pharynx. Or maybe a problem with the nasal cavity is the lack of free nasal breathing.

Normally, a person should breathe through the nose. Oral breathing is considered pathological. If the mouth is open, it means that the nose is not breathing. A person gets used to this too.And in vain. Chronic oral breathing since childhood, changes the shape of the maxillofacial bones, affects the voice, dries the mucous membranes of the oropharynx, and also increases nighttime snoring up to apnea.

Both a healthy person under the influence of alcohol and a person with obesity can snore. In any case, it is only necessary to find out the cause of snoring and fight it with the help of an otolaryngologist. No pins on your nose will help here. We need a comprehensive solution to the problem.

4. Is the curvature of the nasal septum necessary to correct? Can you live your whole life with this?

No.There is no need to talk about a full-fledged healthy life with a curved septum. Problems that she carries: difficulty in nasal breathing, the occurrence of chronic rhinitis. A runny nose is not just a nasal discharge. This is itching in the nose, and sneezing, and swelling of the mucous membranes, which patients call congestion. All this can lead to addiction to vasoconstrictor drops. Using them for more than five days is already abuse. Paresis of vasomotors occurs, the vessels contract less and less and the mucous membrane changes.This is rhinitis medication (or vasomotor rhinitis).

There are many treatments for rhinitis. In case of unsuccessful treatment, we perform the reduction of the turbinates, using the method of radio wave vasotomy. This is a very gentle operation. A special tool helps to bloodlessly reduce the shell, nasal breathing is restored. Consequently, drops are rejected. This is a one-day operation and is performed under local anesthesia. An hour and a half after the operation, the patient goes home, experiencing a runny nose.And after a week, the sensations in the nose get better, every day the effect increases. Respiratory recovery takes place. This is the simplest highly effective method, BUT if there is no curvature of the nasal septum. If it is, a more serious operation is needed, because a deviated septum is a provocation. The ridge gradually penetrates into the side wall and from this there is edema, nasal obstruction.

5. Curvature of the nasal septum in children does not require treatment or intervention

Children also have a curvature of the septum.But this is another matter. The facial skeleton is finally formed: in a woman – by the age of 18, in a man – by the age of 22-24. Up to this point, there is also the growth of the nasal septum. The deformation ridges by this time may increase, and may remain in the same form. In this regard, over time, there may be prospects for improving nasal breathing.

But if this is such a curvature that leads to persistent respiratory failure, which means that all other ENT organs are affected, then children have to be operated on.It happens even at an early age. Or suddenly other circumstances: a young man, for example, strives for an officer’s school, linking his future with aviation. A candidate with a curvature of the nasal septum will not be accepted there, as in any other military school. Therefore, you should worry about surgical treatment in adolescence in advance.

6. Sinusitis is a sign that the nasal septum is deviated.

Not a sign, but a consequence of this. Sinusitis, frontal sinusitis, sinusitis and other pathologies are often the result of difficulty in nasal breathing.Constant swelling of the mucous membrane, blockage of natural openings, impaired drainage and ventilation in the sinus lead to sinusitis. In this case, an operation to correct the septum will also help to get rid of constant exacerbations.

7. You can independently find out if a person has a curved nasal septum.

Not allowed. This can only be detected by an otolaryngologist using special equipment, using optical endoscopes to examine the nasal cavity and nasopharynx.In our clinic, video endoscopic examination of ENT organs is a mandatory procedure for initial treatment. The revealed features of the endoscopic picture are shown to the patients on the monitor.

When do you need to do operation by patch nasal septum ?

The indication for surgery is dysfunction of the nasal cavity and paranasal sinuses, recurrent otitis media.The cause of the curvature of the nasal septum can be bone or cartilaginous deformity. In both cases, an operation is required, which requires high-quality endoscopic optics that allow a good view of the entire nasal cavity. Surgical intervention is always performed according to indications and only after consultation with a qualified otolaryngologist.

-More often, we operate under anesthesia, that is, when the patient is in a dream, – explains the Honored Doctor of Russia, Doctor of Medical Sciences, Professor Starokha Alexander Vladimirovich, – this allows you to instantly solve all existing problems: fix the nasal septum, remove polyps and cysts from the paranasal sinuses by performing a polysinusotomy.At the same time, reconstruct the pharynx in the presence of snoring and / or remove the adenoids. The technology of functional endoscopic rhinosurgery used and developed by us does not require hospitalization of the patient. After 4-5 hours, the patient leaves the clinic to continue treatment from the next day on the same day hospital in an outpatient setting. The recovery period after surgery depends on the severity of the problem and the complexity of the surgery. Usually for 1-2 weeks the patient has a certificate of incapacity for work.

90,000 Ethmoiditis (ethmoidal sinusitis): causes, symptoms, diagnosis, treatment

• Like any form of sinus infection, ethmoiditis can be acute or chronic.
• The main causes are viral infection, deviated nasal septum, narrowness of the nasal passages.
• The growth of polyps is characteristic of emoiditis.
• A distinctive feature of ethmoiditis is the presence of “eye” symptoms.
• Endoscopic ethmoidotomy is the most effective treatment.

What is ethmoiditis or sinusitis of ethmoidal sinuses?

Etmoiditis is an inflammatory process affecting the lining of ethmoid cells. Like any other sinusitis, it can be acute and chronic.

The paranasal or paranasal sinuses, as the name suggests, are located next to the nose in the bones of the facial part of the skull and connect to the nasal cavity. In a healthy state, these cavities usually do not cause any sensations.

The ethmoidal sinus or ethmoid cell system consists of 7-14 individual cells or capsules the size of a pea (Cellulae ethmoidales).

These cells are separated by very thin bony walls from each other and from the orbits. Ethmoid cells border the frontal sinus and connect to the nasal passage.

Reasons

The main cause of acute ethmoiditis are viral infections. The most common “viral” cause is respiratory diseases (ARI, ARVI, etc.).

Anatomical features – narrowness of the nasal passages, curvature of the nasal septum, hypertrophy of the nasal mucosa, etc.

Chronic diseases: otitis media, tonsillitis, dental pathologies.

Separately, it is necessary to highlight the reason, since many people forget about it – these are injuries of the nose and other parts of the maxillofacial apparatus. Especially if such injuries occur regularly.

Symptoms of ethmoiditis

General symptoms (common to all sinusitis):

• “Bad-smelling” nasal discharge – up to causing nausea and vomiting.
• Muco-purulent discharge from the nose (throat), also called postnasal drip syndrome.
• Hoarseness.
• Snoring.
• Headache (of varying intensity) and dizziness.
• Lack of nasal breathing.
• Decreased sense of smell and taste.
• Sore throat.
• Feeling of pressure in the sinuses.
• Chronic fatigue.
• Sensation of swollen nasal mucosa.
• Deafness due to simultaneous catarrhal inflammation (one of the rare symptoms)

Symptoms characteristic of ethmoiditis :

• With inflammation of ethmoidal cells, orbital symptoms are characteristic: pain in the inner corner of the eye, periosteum, forehead.In some cases, a dull, aching pain in the area of ​​the root of the nose.
• There may be swelling and edema of soft tissues in the area of ​​the inner corner of the eye and narrowing of the palpebral fissure.
• With the progression of orbital symptoms, exophthalmos appears (displacement of the eyeball forward (bulging eyes), in some cases with a shift to the side) and limitation of the mobility of the eyeball.
• Complete loss of smell is quite common.
• Almost always combined with other types of sinusitis and chronic rhinitis.
• A characteristic feature of the chronic form is the growth of polyps in the sinus.

Possible complications

As with other forms of sinus inflammation, ethmoiditis can lead to complications , such as:

• Loss of smell – anosmia.
• Eye infections (diseases), including blindness.
• Bone infections – osteitis, osteomyelitis.
• Cyst formation.
• Sepsis (blood poisoning).
• Increased risk of asthma.
• Brain (membranes) – meningitis, encephalitis, etc.
• Heart disease – pericarditis, endocarditis, etc.

Although many of these risks are rare, it is important to receive timely treatment in any case. Even with an acute form of ethmoiditis, it is important to treat inflammation at an early stage, and not to bring it to a chronic course.

Diagnostics

Regardless of whether you go to an ENT specialist or a therapist, a detailed story about your illness should always be detailed – this is an integral part of diagnostics .

Subsequent palpation of the nose and face can provide additional important information for the diagnosis of ethmoiditis and other forms of sinusitis. Laboratory tests are often done, such as a complete blood count, including triggers of inflammation or a nasal swab.

For a more accurate examination of the mucous membrane and nasal cavity, and to evaluate the data in the paranasal sinuses, nasal endoscopy is recommended. A nasal endoscope can also be used to take tissue samples (biopsies) to diagnose or remove polyps.

Imaging methods (ultrasound, MRI, CT) can help for accurate diagnosis. They are used, in particular, to determine if an operation is necessary. CT imaging is preferred for diagnosing sinusitis because CT images can very accurately reproduce bone changes.

Treatment

Treatment of acute ethmoiditis

Conservative therapy is the main treatment for acute ethmoiditis . In the acute period are appointed:

• Intranasal vasoconstrictor (sprays or drops) – up to 5 days,
• Mucolytics – for softening the contents of the ethmoidal sinus,
• Systemic antibacterial drugs – taking antibiotics.Injectable forms may be recommended.

Additionally recommended are nasal sprays with anti-edema and anti-inflammatory action.

Surgical correction of the nasal cavity is recommended after the relief of the acute period of ethmoiditis.

Treatment of chronic ethmoiditis

If a chronic course of ethmoiditis occurs, then surgical treatment is recommended . It is primarily necessary to remove the contents of the sinus, as well as to correct the anatomical structures of the nasal cavity – provoking this condition.

The most effective method of this type of treatment is endoscopic sinus surgery or ethmoidotomy. This method allows to reduce not only the risk of postoperative complications, but also significantly reduces the recovery period and the patient’s stay in the hospital.

Brinarga eye drops 1% + 0.5% fl. 5ml No. 1

Short description

Eye drops. Combined antiglaucoma agent (carbonic anhydrase inhibitor + beta-blocker). Suspension is white or almost white.

Roster

Composition (per 1 ml): Active ingredients: Brinzolamide 10 mg; Timolol maleate 6.83 mg, equivalent to timolol 5 mg. Excipients: Benzalkonium chloride 0.1 mg; disodium edetate 0.1 mg; sodium chloride 1.0 mg; tyloxapol 0.25 mg; mannitol 33 mg; carbomer 974P 4.2 mg; sodium hydroxide and / or hydrochloric acid to pH 7.3; water for injection up to 1.0 ml.

Pharmacological action

Pharmacodynamics Mechanism of action Brinarga’s drug contains two active substances: brinzolamide and timolol maleate, which reduce increased intraocular pressure (IOP), primarily by reducing the secretion of intraocular fluid, but in different ways.The combined effect of brinzolamide and timolol exceeds the effect of each substance separately for lowering IOP. Brinzolamide is a carbonic anhydrase inhibitor ??. Inhibition of carbonic anhydrase in the ciliary body of the eyeball reduces the production of intraocular fluid, presumably due to a slowdown in the formation of bicarbonate ions with a subsequent decrease in sodium and fluid transport. Timolol is a non-selective beta-adrenergic receptor blocker without sympathomimetic activity, does not have a direct depressive effect on the myocardium, and does not have membrane stabilizing activity.A number of studies have shown that when applied topically, timolol reduces the formation of intraocular fluid and slightly increases its outflow. Pharmacokinetics Absorption When applied topically, brinzolamide and timolol enter the systemic circulation. The maximum concentration (Cmax) in erythrocytes is about 18.4. In the equilibrium state, after the use of brinzolamide and timolol, the average Cmax of timolol in plasma and the area under the concentration-time curve for 12 hours (AUC0-12h) of timolol was 0.824 × 0.453 ng / ml and 4.71? 4.29 ng * h / ml, respectively, and the average Cmax of timolol was reached at 0.79? 0.45 hrsDistribution Brinzolamide binds moderately to plasma proteins (about 60%) and accumulates in erythrocytes as a result of selective binding to carbonic anhydrase II and, to a lesser extent, to carbonic anhydrase I. Its active metabolite N-desethylbrinzolamide also accumulates in erythrocytes, where it binds mainly to carbonic anhydrase I Due to the affinity of brinzolamide and its metabolite to erythrocytes and tissue carbonic anhydrase, their plasma concentration is low. Metabolism The metabolism of brinzolamide occurs by N-dealkylation, O-dealkylation and oxidation of the N-propyl side chain.The main metabolite, N-desethylbrinzolamide, in the presence of brinzolamide, binds to carbonic anhydrase I and also accumulates in erythrocytes. In vitro studies have shown that the metabolism of brinzolamide is mainly responsible for the CYP3A4 isoenzyme, as well as the CYP2A6, CYP2B6, CYP2C8 and CYP2C9 isoenzymes. Timolol metabolism occurs in two ways: with the formation of an ethanolamine side chain on the thiadiazole ring and with the formation of an ethanol side chain at the morpholine nitrogen and a similar side chain with a carbonyl group attached to nitrogen.Timolol metabolism is carried out mainly by CYP2D6. Excretion Brinzolamide is excreted mainly in the urine and feces in comparative amounts of 32% and 29%, respectively. About 20% is excreted in the form of metabolites in the urine. Mainly brinzolamide and N-desethylbrinzolamide are found in urine, as well as residual amounts (& lt1%) of other metabolites (N-desmethoxypropyl and O-desmethyl). Timolol and its metabolites are excreted mainly by the kidneys. About 20% of timolol is excreted in the urine unchanged, the rest in the form of metabolites.T1 / 2 of timolol is 4.8 hours after topical combined use of brinzolamide and timolol.

Indication

Reduction of increased intraocular pressure in open-angle glaucoma and intraocular hypertension in patients in whom monotherapy was insufficient to reduce intraocular pressure.

Way
application and dosage

Locally. Shake the bottle before use. 1 drop into the conjunctival sac of the eye 2 times a day.After using the drug, to reduce the risk of developing systemic adverse reactions, it is recommended to lightly press with a finger on the projection area of ​​the lacrimal sacs at the inner corner of the eye for 1-2 minutes after instillation of the drug – this reduces the systemic absorption of the drug. If a dose has been missed, then treatment should be continued with the next scheduled dose. The dose should not exceed 1 drop in the conjunctival sac of the eye 2 times a day. In case of replacing any antiglaucoma drug with Brinarga, you should start using Brinarga the next day after the previous drug is canceled.Do not touch the tip of the dropper stopper to any surface to avoid contamination of the bottle and its contents. The bottle must be closed after each use.

Side effects

Safety Profile Review The most frequently reported adverse reactions in clinical trials were blurred vision, eye irritation, and eye pain, which occurred in approximately 2-7% of patients. Below are the adverse reactions noted during clinical studies of Brinarga and its individual components – brinzolamide and timolol.Infectious and parasitic diseases Frequency unknown: nasopharyngitis, pharyngitis, sinusitis, rhinitis. Disorders from the blood and lymphatic system Frequency unknown: a decrease in the number of red blood cells, an increase in the content of chlorides in the blood. Immune system disorders Frequency unknown: anaphylaxis, systemic lupus erythematosus, systemic allergic reactions, including angioedema, local and generalized rash, hypersensitivity, urticaria, pruritus. Metabolic and nutritional disorders Frequency unknown: hypoglycemia, decreased appetite.Mental disorders Uncommon: insomnia. Frequency unknown: depression, memory loss, apathy, depressed mood, decreased libido, nightmares, nervousness. Nervous system disorders Often: dysgeusia. Frequency unknown: cerebral ischemia, cerebrovascular disorder, syncope, increased signs and symptoms of myasthenia gravis, drowsiness, motor dysfunction, amnesia, memory impairment, paresthesia, tremor, hypesthesia, ageusia, dizziness, headache. Disturbances from the organ of vision Often: blurred vision, eye pain, eye irritation.Uncommon: corneal erosion, punctate keratitis, effusion into the anterior chamber of the eye, photophobia, dry eye syndrome, discharge from the eye, itching in the eye, sensation of a foreign body in the eyes, redness of the eyes, hyperemia of the sclera, increased lacrimation, conjunctival hyperemia, erythema of the eyelids … Frequency unknown: increase in optic nerve disc escavation, detachment of the choroid after filtering surgery, keratitis, keratopathy, defect of the corneal epithelium, impaired corneal epithelium, increased IOP, deposits in the eye, staining of the cornea, corneal edema, decreased sensitivity of the cornea, conjunctivitis, inflammation of the mei , diplopia, decreased contrast of vision, photopsia, decreased visual acuity, blurred vision, pterygium, discomfort in the eye, “dry” keratoconjunctivitis, eye hypesthesia, pigmentation of the sclera, subconjunctival cyst, visual impairment, swelling of the eyes, allergic reactions of the eye, madarosis, disorders eyelids, eyelid edema, ptosis, blepharitis, asthenopia, crusting on the edges of the eyelids, increased lacrimation.Hearing disorders and labyrinthine disorders Frequency unknown: vertigo, ringing in the ears. Cardiac disorders Frequency unknown: cardiac arrest, heart failure, chronic heart failure, AV block, cardiorespiratory distress syndrome, angina pectoris, bradycardia, irregular heart rate, arrhythmia, palpitations, tachycardia, increased heart rate, pain in the chest, swelling. Vascular disorders Uncommon: decrease in blood pressure.Frequency unknown: hypotension, hypertension, increased blood pressure, Raynaud’s phenomenon, cold hands and feet. Respiratory, chest and mediastinal disorders Uncommon: cough. Frequency unknown: bronchospasm (mainly in patients with a history of bronchospastic disease), shortness of breath, asthma, epistaxis, bronchial hyperresponsiveness, irritation of the larynx, nasal congestion, upper respiratory tract congestion, postnasal drip syndrome, sneezing, feeling of dryness of the nose, pharyngolaryngitis pain, rhinorrhea …Disorders from the gastrointestinal tract (GIT) Frequency unknown: vomiting, upper abdominal pain, abdominal pain, diarrhea, dry mouth, nausea, esophagitis, dyspepsia, abdominal discomfort, stomach discomfort, increased peristalsis, gastrointestinal upset, hypoesthesia and paresthesia of the oral cavity, flatulence. Liver and biliary tract disorders Frequency unknown: impaired liver function. Disorders from the skin and subcutaneous tissues Frequency unknown: urticaria, maculopapular rash, generalized pruritus, skin tightening, dermatitis, alopecia, psoriasiform rash or exacerbation of psoriasis, rash, erythema.Musculoskeletal and connective tissue disorders Frequency unknown: myalgia, muscle spasms, arthralgia, back pain, limb pain. Renal and urinary tract disorders Frequency unknown: pain in the kidney area, pollakiuria. Violations of the genital organs and mammary gland Frequency unknown: erectile dysfunction, sexual dysfunction, decreased libido. General disorders and disorders at the injection site Frequency unknown: chest pain, pain, fatigue, asthenia, malaise, chest discomfort, abnormal sensations, anxiety, irritability, peripheral edema, drug residues.Laboratory and instrumental data The frequency is unknown: an increase in the content of potassium in the blood, an increase in the content of lactate dehydrogenase in the blood. Description of selected adverse reactions Dysgeusia (bitter or unusual taste in the mouth after instillation) is a frequently reported systemic adverse reaction associated with the use of Brinarga during clinical trials. This is probably due to brinzolamide and is caused by the penetration of eye drops into the nasopharynx through the lacrimal canal. Occlusion of the lacrimal canals or careful closure of the eyelids after instillation can help reduce this effect (see.section “Method of administration and dosage”). Brinarga’s drug contains brinzolamide, which is a carbonic anhydrase inhibitor and has systemic absorption. The effects arising from the gastrointestinal tract, nervous system, blood and lymphatic system, kidneys and urinary tract, metabolism and nutrition are mainly associated with the systemic action of carbonic anhydrase inhibitors. Similar undesirable reactions characteristic of oral forms of carbonic anhydrase inhibitors can be observed with their topical application.When applied topically, timolol enters the systemic circulation, which can cause undesirable reactions similar to those that occur with systemic administration of beta-blockers. The listed adverse reactions include reactions that occur with the use of other beta-blockers in the form of eye drops. Additional undesirable reactions associated with the use of individual active ingredients, which can potentially be with the use of Brinarga, are described above. The incidence of systemic adverse reactions with topical application is lower than with systemic administration.For information on reducing systemic absorption, see the section “Route of administration and dosage”.

Contraindications

Individual hypersensitivity to drug components, sulfonamides or other beta-blockers. Reactive diseases of the respiratory tract, incl. bronchial asthma (BA), history of asthma, chronic obstructive pulmonary disease of severe course. Sinus bradycardia, sick sinus syndrome, sinoatrial block, II-III degree atrioventricular (AV) block, severe heart failure or cardiogenic shock.Severe allergic rhinitis. Hyperchloremic acidosis. Severe renal failure. Pregnancy, lactation period, children under 18 years of age. Application during pregnancy and breastfeeding Brinarga is contraindicated for use during pregnancy and during breastfeeding.

Overdose

Symptoms There may be symptoms of an overdose of beta-blockers in case of accidental ingestion of the drug: bradycardia, hypotension, heart failure and bronchospasm.As a result of the action of brinzolamide, electrolyte imbalance, the development of an acidosis state, and disturbances in the central nervous system can occur. Treatment Symptomatic and supportive therapy. Serum electrolyte levels (particularly potassium) and blood pH should be monitored. Studies have shown that timolol hemodialysis is ineffective.

Special
instructions

Systemic effects Brinzolamide and timolol may undergo systemic absorption.When applied topically, Timolol can cause the same adverse reactions from the cardiovascular and respiratory systems, as well as other undesirable reactions, as systemic beta-blockers. Hypersensitivity reactions characteristic of all sulfonamide derivatives can develop with the use of Brinarga due to systemic absorption. In case of serious adverse reactions or hypersensitivity reactions, the drug should be discontinued. Cardiac disorders In patients with cardiovascular disease (eg, ischemic heart disease, Prinzmetal’s angina, heart failure) and hypotension, β-blocker therapy should be critically evaluated and the possibility of treatment with other active substances should be considered.You should closely monitor the appearance of signs of exacerbation of the disease and adverse reactions in patients with cardiovascular diseases. Vascular disorders Precautions should be given to patients with severe impairment / disorder of peripheral circulation (Raynaud’s disease or severe Raynaud’s syndrome). Hyperthyroidism? -Blockers can mask the symptoms of hyperthyroidism. Muscle weakness Beta-blockers have been reported to increase muscle weakness that occurs with some of the symptoms of myasthenia gravis (eg, diplopia, ptosis, and general weakness).Respiratory System Disorders Respiratory system reactions have been reported, including death from bronchospasm in patients with asthma after taking topical beta-blockers. Hypoglycemia / Diabetes Beta-blockers should be used with caution in patients with a tendency to spontaneous hypoglycemia or in patients with labile diabetes, since these drugs can mask the symptoms of acute hypoglycemia. Violation of acid-base balance The development of acid-base balance disturbances with the use of oral forms of carbonic anhydrase inhibitors is described.In patients at risk of renal failure, the drug should be used with caution, due to the possible risk of metabolic acidosis. Concentration Carbonic anhydrase inhibitors administered orally may interfere with the ability to engage in activities requiring increased attention and / or physical coordination in older patients. These phenomena can be observed, because brinzolamide enters the systemic circulation when applied topically. Anaphylactic reactions Patients with atopy or severe anaphylactic reactions to various allergens in history, receiving beta-blockers, may react more strongly to the effects of these allergens, and may also be resistant to the usual doses of adrenaline in the treatment of anaphylactic reactions.Detachment of the choroid of the eye Cases of detachment of the choroid are described when using drugs that prevent the formation of intraocular fluid (for example, timolol, acetazolamide) after filtering operations. Surgical anesthesia The action of beta-blockers in ophthalmic drugs can block the systemic action of beta-agonists, such as adrenaline. The anesthesiologist should be informed about the patient’s intake of timolol. Concomitant therapy When using the drug Brinarga in patients who are taking systemic beta-blockers, it is necessary to take into account the possible mutual enhancement of the pharmacological action of the drugs both with respect to the known systemic effects of beta-blockers and with respect to reducing intraocular pressure.Careful monitoring of such patients is necessary. The combined use of two topical beta-blockers is not recommended. There is a possibility of increased systemic effects resulting from inhibition of carbonic anhydrase in patients taking oral carbonic anhydrase inhibitors and Brinarga. Simultaneous administration of Brinarga and oral carbonic anhydrase inhibitors is not recommended. Effects on the part of the organ of vision The effect of brinzolamide on corneal endothelial function in patients with corneal disorders (especially patients with a low number of endothelial cells) has not been studied.In patients wearing contact lenses, it is necessary to carefully monitor their state of the cornea when using brinzolamide, since carbonic anhydrase inhibitors can affect corneal hydration. Close monitoring of patients with corneal abnormalities, such as those with diabetes mellitus or corneal dystrophy, is recommended. Benzalkonium chloride Benzalkonium chloride, which is part of Brinarga’s preparation, can cause eye irritation and discoloration of soft contact lenses. Contact with soft contact lenses should be avoided.Before using the drug, contact lenses should be removed and reinstalled no earlier than 15 minutes after using the drug. Brinarga contains benzalkonium chloride, which can cause punctate keratopathy and / or toxic ulcerative keratopathy. With prolonged use of the drug, the patient’s condition should be carefully monitored. Liver dysfunction Brinarga should be used with caution in patients with severe hepatic impairment. Influence on the ability to drive vehicles, mechanisms Brinarga’s drug has an insignificant effect on the ability to drive and control mechanisms.If a patient has a temporary blurred vision after using the drug, it is not recommended to drive a car and engage in activities that require increased attention and reaction until it is restored. Carbonic anhydrase inhibitors can impair the ability to perform tasks that require concentration and / or coordination of movements.

Interaction with other drugs

Brinarga contains brinzolamide, a carbonic anhydrase inhibitor, which, when applied topically, can be absorbed systemically.Cases of violation of acid-base balance as a result of the use of oral carbonic anhydrase inhibitors have been described. The possibility of such disorders should also be taken into account in patients using Brinarga. Concomitant use with oral carbonic anhydrase inhibitors is not recommended, as there is a possibility of increased systemic adverse reactions. Cytochrome P-450 isoenzymes are responsible for the metabolism of brinzolamide: CYP3A4 (mainly), CYP2A6, CYP2B6, CYP2C8 and CYP2C9. Care should be taken to prescribe drugs that inhibit the CYP3A4 isoenzyme, such as ketoconazole, itraconazole, clotrimazole, ritonavir and troleandomycin, due to the possible inhibition of the metabolism of brinzolamide by the CYP3A4 isoenzyme.Caution should be exercised when co-administration of CYP3A4 isoenzyme inhibitors. However, accumulation of brinzolamide is unlikely as it is excreted by the kidneys. Brinzolamide is not an inhibitor of cytochrome P-450 isoenzymes. An increase in the systemic action of β-blockers (decreased heart rate, depression) can develop with the simultaneous use of CYP2D6 inhibitors (quinidine, fluoxetine, paroxetine) and timolol. There is a possibility of an increase in the hypotensive effect and / or the development of severe bradycardia with the simultaneous use of beta-blockers for topical use with calcium channel blockers for oral administration, guanethidine, beta-blockers, antiarrhythmic drugs (including amiodarone), digitalis glycosides and parasympathomimetics.beta-blockers can reduce the response to epinephrine in the treatment of anaphylactic reactions. Care should be taken to prescribe the drug to patients with atopy or a history of anaphylaxis (see section “Special instructions”). In some cases, as a result of the simultaneous use of beta-blockers for topical use and adrenaline (epinephrine), mydriasis may develop. The effect on intraocular pressure, or the known effects of systemic beta-blockers, may be enhanced if timolol is prescribed to a patient already receiving a systemic beta-blocker.These patients must be closely monitored. The use of two topical beta-blockers is not recommended. In the case of use with other local ophthalmic drugs, the interval between their use should be at least 5 minutes.

Conditions
storage

class = “h4-mobile”>

Store at temperatures from +4 to +30 C. Keep out of the reach of children. Expiration date: 2 years. 4 weeks after opening. Do not use after the expiration date.

Certificates

90,000 Abundant nasal discharge when exposed to irritants: description of the disease, causes, symptoms, cost of treatment in Moscow

A runny nose due to the action of irritants on the mucous membrane periodically occurs in 20% of people on Earth.The causes of the problem include irritation with mucous dust, allergens (such as plant pollen and animal hair particles) and air temperature. The problem is not as harmless as it might seem at first glance, and necessarily requires a visit to the doctor. The specialist identifies the irritant that leads to the appearance of mucous discharge from the nose, and prescribes the necessary treatment.

If therapy is postponed, then tissue edema spreads from the nasal mucosa to the auditory tube, from which the patient complains of hearing loss and pain in the ears.In such a situation, the patient will need additional treatment to eliminate problems with the auditory system.

In children, a runny nose caused by allergens is sometimes confused by parents with a cold, which is why the correct therapy is not started. Also, due to the imperfection of the immune system in children under 7 years of age, infectious rhinitis is often added to allergic rhinitis, significantly worsening the patient’s condition.

Types of rhinitis

The problem is divided by doctors into 2 forms.Depending on which of them the violation belongs to, treatment is selected. The irritant is detected using a special immunological test.

1. Seasonal allergic rhinitis. The most common form of the disease. With her, mucous, abundant nasal discharge is transparent and appears at a certain time every year. This effect is usually observed in the case of intolerance to the pollen of some plants.

2. Persistent allergic rhinitis.The phenomenon is observed all year round and is associated with constant exposure to the body of allergens. In this case, in addition to the flow from the nose, there is also constant eye irritation, which is manifested by their redness and moderate lacrimation.

The patient can independently determine the type of allergic rhinitis, depending on the characteristics of its appearance and duration.

Stages

In a runny nose, which occurs due to constant exposure to irritants on the nasal mucosa, there are 4 stages.They are the same for adults and children. The easiest way to solve the problem is at the first 2 stages of its development. With seasonal allergic rhinitis, the progression of the disease and changes in the state of the mucous membrane are not observed.

1. Vasotic stage. In this state, in addition to the secretion of transparent mucus, there is periodic nasal congestion, which goes away by itself without vasoconstrictor drugs within a few minutes, and less often – 2 hours. At this moment, the patient is more worried about the congestion, and not the watery mucus.

2. Vasodilation is the second stage in the development of allergic rhinitis, which is characterized by the appearance of a larger volume of mucus and periodic congestion, which cannot be eliminated without drops with a vasoconstrictor effect.

3. Chronic edema of the mucous membrane is the third stage in which reversible changes in the mucous membrane occur. The discharge of mucus becomes abundant, it is no longer only watery, but often opaque, of medium density, whitish.Nasal congestion is constant and is removed by vasoconstrictor drugs only for a while.

4. Hyperplasia of the mucosa. The last stage of the disease, when, in addition to the constant abundant secretion of mucus, a change in the mucous membrane appears, which is its proliferation. Treatment is surgical, in which the overgrown mucous membrane is removed.

The doctor, after examining the patient and rhinoscopy, can determine the stage of the disease before carrying out other diagnostic measures.

Differences between a runny nose due to irritants and a cold

Some patients confuse rhinitis with a cold and a runny nose, manifested due to the effect of irritants on the nasal mucosa. As a result, the disease is treated incorrectly and this becomes the cause of the worsening of the condition. If it is not possible to independently determine the cause of the abundant mucous discharge from the nose, a mandatory visit to an ENT specialist is required. The doctor will be able to identify why it is flowing from the nose, and prescribe a therapy that will be effective in a particular case.

For a runny nose, which is caused by an irritant, the following manifestations are characteristic, which do not occur with a cold form:

• unexpected development – it is not preceded by general malaise or headache;

• intense itching and burning – felt especially strongly in the back of the nasal passages;

• paroxysmal sneezing – not very strong, but can be prolonged;

• swelling of the eyelids;

• the release of a large amount of transparent mucus (extremely rarely white), which looks more like water.For colds, the mucus is yellow and thicker.

With all these manifestations of the disease, an appeal is necessary to an allergist, and not to an otolaryngologist. You should not expect that the problem will go away on its own and will not arise again. If you do not carry out therapy, then the mucous discharge will be repeated over and over again at the slightest appearance of an irritant.

Runny nose due to temperature conditions

An allergy can also be to the temperature of the air that a person breathes.Too hot and dry or too cold can easily cause a profuse nasal flow. In such a situation, it is not uncommon for a skin manifestation of allergies to develop simultaneously with a runny nose – rashes and itching.

With intolerance to cold, the flow from the nose is very abundant and occurs at the moment when there is a sharp drop in air temperature when leaving a warm room to the street and in the opposite order after a long stay in the cold when entering the heat. The appearance of an allergy to cold is associated with a feature of the body, in which at the time of a drop in air temperature, an increased production of cryoglobulin protein occurs, which is why the mechanism of abundant production of mucus and its release is triggered.In this case, the person gets the impression that fluid is flowing from the nose.

A profuse discharge of nasal mucus may also appear when exposed to hot dry air. In such a situation, the drying out of the mucous membrane occurs excessively quickly, and to moisturize it, the body begins to produce an increased amount of mucus. When an allergic reaction occurs, the amount of secretion produced is excessive. As a result, a person has nasal congestion and a flow from it, which cause severe discomfort.

These allergies can also be treated, albeit more severely than those caused by irritants such as dust, pollen or wool particles. This is due to the fact that it is impossible to exclude the effect of the allergen on the mucous membranes.