Mbak,
Ini bagian kedua ya, sinusitis kronik. Dua artikel ini saya ambil dari
www.mayoclinic.com
Chronic sinusitis
Introduction
Chronic sinusitis is one of the most commonly diagnosed chronic illnesses in
the United States, affecting 30 million to 40 million Americans each year.
Chronic sinusitis begins with an inflammation of the mucous membranes in
your sinuses — the air-filled passages around your nose and throat. The
inflammation causes fluid buildup eventually plugging the sinus cavity and
preventing normal mucus drainage.
Chronic sinusitis can be a miserable condition that significantly impairs
your quality of life. If you have chronic sinusitis, you may have difficulty
breathing through the nose, experience frequent headaches and tenderness in
the face or aching behind the eyes. You may also have frequent yellow or
greenish discharge from your nose or drainage down the back of your throat.
Chronic sinusitis can be caused by infections of the upper respiratory tract
— the nose, pharynx, sinuses and throat — but there are noninfectious
triggers too. Allergies are a common cause, and anatomical problems such as
a deviated nasal septum can bring on chronic sinusitis. Other suspected
causes include mold or fungi in the sinuses.
Most cases of sinusitis are acute, meaning they resolve in less than four
weeks. However, when the condition recurs or endures longer than 12
consecutive weeks, you've developed a case of chronic sinusitis.
Signs and symptoms
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The signs and symptoms of chronic sinusitis are similar to acute sinusitis,
except they last longer and often cause more significant fatigue. Chronic
sinusitis usually does not cause fever.
The signs and symptoms of chronic sinusitis include:
- Facial pain and pressure especially in the forehead, temples,
cheeks, nose and behind the eyes
- Difficulty breathing through the nose
- Drainage of a thick, yellow or greenish discharge from the nose or
down the back of the throat
- Reduced sense of smell or taste
- Nasal obstruction or congestion
- Aching in your upper jaw and teeth
- Headache
- Teeth pain
- Bad breath (halitosis)
- Ear pain
- Fatigue
- Cough
- Nausea
- Sore throat
Causes
Anything that inflames the membranes of the sinus cavity or blocks the sinus
passages from draining normally can cause sinusitis.
Common causes of sinus blockage include allergies, viral and bacterial
infections, and nasal polyps.
- *Allergies.* Anything that causes an allergic reaction, such as
pollen, pet dander or dust mites, can trigger an attack response from your
body. The results of this battle mimic the signs and symptoms of a cold,
such as stuffy nose, itchy eyes and cough, and can cause congestion in the
sinuses.
- *Respiratory tract infections.* Infections in your respiratory tract
— most commonly, colds — can inflame and thicken your sinus membranes,
impeding mucus drainage and creating conditions ripe for growth of bacteria.
These infections can be viral, bacterial or fungal in nature.
- *Nasal or sinus obstructions.* Nasal polyps are small growths that
can obstruct the sinus passages. Sinus blockagecan also be triggered by
other anatomical problems such as a deviated or crooked septum — the wall
between your nostrils — or particularly small openings between your sinuses
and nasal cavity.
- *Other medical conditions.* The complications of cystic fibrosis,
HIV and other immunodeficiency diseases can result in nasal blockage. For
example, with cystic fibrosis your body's secretions become thick and sticky
in your sinuses as well as in your lungs.
- *Trauma to the face.* A fractured or broken facial bone may cause
obstruction of the sinus passages.
- *Mold in the sinuses.* Some experts believe that chronic sinusitis
is triggered by an allergic reaction to mold in the nasal cavity.
- *Airborne fungus.* Some experts believe that the cause of chronic
sinusitis is due to an inflammatory reaction to certain types of airborne
fungi. These fungi are present in virtually everyone. However, sufferers of
chronic sinusitis may react to the fungi by producing cytokines or elevated
levels of eosinophils in the sinuses. Cytokines are compounds that cause or
regulate inflammation and other immune responses. Eosinophils are a type of
white blood cell that can cause inflammation in the sinuses. This reaction
may trigger the inflammation that leads to chronic sinusitis in some people.
When to seek medical advice
People may have several episodes of acute sinusitis, lasting less than four
weeks, before developing chronic sinusitis. If you've had sinusitis a number
of times and the condition fails to respond to treatment, or if your
infection has lasted more than three months, ask your doctor to test for
chronic sinusitis. You may be referred to an allergist or an ear, nose and
throat specialist.
Complications
Chronic sinusitis can increase the frequency and severity of asthmatic
flare-ups in people with asthma. In cases where sinusitis is caused by an
underlying infection, complications may include meningitis, in which
infection spreads to the lining of the brain, and vision problems should the
infection spread to the eye socket.
Screening and diagnosis
Because the symptoms of chronic sinusitis can resemble those of colds or
allergies, chronic sinusitis can be difficult to diagnose. Tell your doctor
as much as possible about your symptoms.
Your doctor may use several methods to help screen for chronic sinusitis:
- *Nasal endoscopy.* A thin, flexible tube (endoscope) with a
fiber-optic light inserted through your nose allows your doctor to visually
inspect the inside of your sinuses.
- *Imaging studies.* Images taken using computerized tomography (CT)
or magnetic resonance imaging (MRI) can show details of your sinuses and
nasal area. These may identify a deep inflammation or physical obstruction
that's difficult to detect using an endoscope.
- *Nasal and sinus cultures.* Laboratory tests are generally
unnecessary for diagnosing chronic sinusitis. However, in cases in which the
condition fails to respond to treatment or is progressing, tissue cultures
may help pinpoint the cause, such as identifying a bacterial pathogen.
- *An allergy test.* If your doctor suspects that the condition may be
brought on by allergies, an allergy skin test may be recommended. A skin
test is safe and quick and can help pinpoint the allergen that's responsible
for your nasal flare-ups.
Treatment
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A doctor's approach to treating chronic sinusitis will aim to clear the
nasal passages and also eliminate the underlying cause.
Treatments for chronic sinusitis include:
- *Antibiotics.* A course of antibiotics can help eliminate sinusitis
caused by a bacterial infection. Your doctor may prescribe antibiotic
therapy for three to 12 weeks, or until you've been symptom-free for seven
days.
- *Corticosteroids.* Your doctor may prescribe corticosteroids to
reduce swelling if you have severe inflammation of your sinuses.
Corticosteroids may be delivered through the nose, such as Flonase, Beconase
or Nasacort, or taken orally, as in the case of prednisone.
- *Decongestants and antihistamines.* Taken orally or in the form of a
nasal spray, decongestants or antihistamines can help dry up or shrink the
backed-up mucus and give temporary relief by helping to drain the sinuses.
Examples of these medications include Afrin, Sudafed, Allegra and Claritin.
- *Moisture and humidification.* Flushing the nasal cavity with saline
nasal sprays can help loosen dried mucus. In dry climates, installing
misters or humidifiers in the home can promote nasal drainage.
- *Immunotherapy.* If allergies are contributing to the sinusitis,
stimulating the antibodies that block the body's reaction to specific
allergens may help alleviate the condition.
In cases that continue to resist treatment or medication, endoscopic sinus
surgery may be an option. For this procedure, the doctor uses an endoscope,
a thin, flexible tube with an attached light, to explore your sinus
passages. Then, depending on the source of obstruction, the doctor may use
various tools to remove tissue or shave away a bone or polyp that's causing
nasal blockage. Enlarging a narrow sinus opening may also be an option to
promote drainage.
Another treatment method that may become more common is balloon rhinoplasty
which helps open the sinuses by inserting and then inflating a balloon
inside the sinus cavities. The procedure is less invasive than is sinus
surgery. However, it's relatively new and long-term results are still
unclear.
Prevention
You can reduce your risk of developing chronic sinusitis by:
- *Good hygiene.* Wash your hands frequently, especially before meals,
to avoid contracting viral, bacterial or fungal infections.
- *Carefully managing allergies.* Work with your doctor to get
symptoms quickly under control.
- *Treating cold symptoms immediately.* Drink plenty of fluids and
keep your nasal passages clear when you contract a cold. Use decongestants
and try to prevent a cold from lingering.
- *Avoiding cigarette smoke and polluted air.* These contaminants can
irritate and inflame your nasal passages.
- *Using a humidifier.* Adding moisture to the air can keep your nasal
passages clear.
- *Taking care to prevent asthma attacks.* Try to eliminate potential
triggers of an asthma attack. Limit exposure to allergens, tobacco smoke and
other causes.
Self-care
You can help alleviate the symptoms of chronic sinusitis:
- Avoid bending over, which may increase the pressure or pain you feel
in the face.
- Apply warm facial packs to relieve discomfort.
- Inhale steam from a kettle or basin of boiling water to help clear
the nasal passages.
- Install a humidifier to keep the air in your home moist and clean.
- Drink plenty of fluids to help dilute your nasal secretions.
