Treatment of sinusitis

Before planning the treatment of sinusitis, it is important to be alert, in unilateral cases, for dental infections, foreign bodies of the nasal cavities and tumors. And we must remember that the recurring sinusitis in children may represent manifestations of muscovite or culinary duskiness. In immunocompromised patients, including patients with AIDS, be alert for the presence of microscopist.

We must remember also that the ophthalmic veins can lead to infection of the method cavernous, and can result in complications of endurance. The high-resolution computed tomography and magnetic resonance imaging are effective means to clarify the diagnostic dilemmas.

The treatment of sinusitis in two groups consists of general measures and specific measures, both of equal importance. The general measures aimed at activating the body's defenses to prevent viral infections of the upper airway, improve ventilation and nasal sinus, optimize monocularly function and suppress or modulate the inflammatory phenomena. Specific treatment is intended to use substances, usually antimicrobial to disable or destroy pathogens.

General Measures

1. Sinonasal reflex vasoconstrictor. It is accomplished through the following methods:
   • Sleeping in supine with the head of the bed elevated 30-45 º; this posture improves nasal patency of patients by 20%.
   • Making vigorous exercise, such as exercise bike, sit-ups and others. They improve nasal patency by inducing vasoconstriction and increase in 10% of the diameter of the maxillary osmium in healthy individuals (unfortunately this does not always occur in patients with chronic disease of the jaws).
   • Use hyperthermia, which is the most universal methods of treatment of sinusitis. Inhaling warm has wide acceptance throughout the world. Temperatures above 43 ° C block the replication of rhinovirus, response able for 60 to 90%% of viral infections of upper airways. The use of flavorings, usually derived from menthol and eucalyptus, is extremely popular, but its therapeutic activity is questionable and often detrimental.
   • Systemic Decongestants have routine use in the treatment of acute and chronic sinusitis, in order to maintain or extend the patency of the ostia, reduce swelling of the turbinates and reduce congestion. The oral decongestants have the ability to reduce nasal respiratory resistance at around 30%, but can not increase the patency of the ostium in patients with sinusitis, only in normal individuals. The effectiveness of decongestants should not exceed the safety standards and its association with caffeine has been respons ble for the majority of severe hypotensive. Its main drawback is to produce rapid dehydration of the secretions, particularly significant in pharmaceutical preparations including anticholinergics, and this dehydration can lead to failure of mucociliary function and promote the chronicity of infection.
   • Topical decongestants are useful for a short time (three to seven days) and in very specific circumstances: acute viral or bacterial infections, before air travel, to prevent exacerbation of symptoms or problems with the eustachian tube, nasal congestion in unresponsive to exercise, to reduce the mucociliary clearance in cases of excess mucus and early treatment with intranasal anti-inflammatory agents to improve the absorption of them.
   • Anti-inflamatories tablets can be used as adjuncts to treatment. The most widely used will: corticosteroids, cromolyn, the NSAIDs and aspirin.
   • The corticosteroids are potent anti-inflammatory drugs in widespread use and generally abusive. They are the most potent anti-inflammatory drugs available, modulate the inflammatory mediators, inhibit or suppress inflammatory cells, prevent damage to the riparian system and also improves the patency of the ostia. The use of systemic corticosteroids is usually limited to sinusitis with polyps on the initial type phases, because they reduce the size of polyps.
   • The topical corticosteroids can be used in patients with chronic sinusitis who have proven nasal allergy (type I).
   • The cromolyn should be the first anti-inflammatory to be used for colds, but there is no evidence that his action spreads to the nasal sinuses. Its anti-inflammatory action is by stabilizing mast cells, which induces a blockade of the immediate reactions and delayed nasal response to allergens.
   • The use of NSAIDs and aspirin in sinusitis is quite controversial. You should avoid its use, especially in children, due to two facts: the first is the possibility of hypersensitivity reactions and the cross would be his second home in the adjunct treatment of nasal polyposis, especially in atopic individuals.
2. Optimization of mucociliary function. The mucociliary function is dependent on several factors such as temperature, humidity, pH, concentrations of oxygen and carbon dioxide and integrity of the cilia. The improvement of mucociliary function in patients with sinusitis, particularly chronic, can be a major factor in healing. On average 60% of all the children with chronic infections of the upper airways has changed its ciliary function and feature loss of viscoelastic properties of mucus.
   • The hydration is an important adjunctive treatment in chronic sinusitis and can be accomplished in two ways: ingestion of about six glasses of water per day and / or irrigation of the nasal cavities or of the with isotonic saline solution to prevent dehydration secretions and their transformation into crusts.
   • The fragment has the property of the glycoproteins and mucus and the macromolecules are widely used in sinusitis, with the aim of decreasing the viscosity and adhesiveness of the mucus.
   • The supporting cast are excellent expectorant in the treatment of subacute and chronic sinusitis, even when there is no spread of infection to the lower airways, its fundamental property is to reflexively increase the elimination of mucus from submucosal glands.
   • The antihistamine drugs are usually contraindicated in patients with diseases sinus.
   • Dos anticholinergic, ipratropium bromide has gained rapid acceptance in the treatment of vasomotor rhinitis, but there is no evidence that this action extends into the

Specific measures

Most sinusitis can be treated with oral antibiotics. In acute and subacute cases, the antibiotic therapy is usually 14 days. Chronic sinusitis in the mean time of antibiotic therapy should be 21 days. The incidence of sinusitis is extremely high, amounting to millions of new cases per year. Virtually all known antibiotics have been tried, many showing exceptional results with up to 100% cura.O common sense and knowledge of the actions, side effects, dosages and routes of administration of each antimicrobial agent will be critical to handling.

Amoxicillin is considered the drug of choice in uncomplicated sinusitis. It is absorbed twice as well as ampicillin, have longer average life, is effective and very safe to use, especially in children. Cephalosporins are considered as the second choice, have structures similar to those of penicillins and are classified as the second choice, t6em structures similar to those of penicillins and are classified as antibicrobianos B-lactam antibiotics. The patient should show signs and symptoms of improvement in the first 72 hours of treatment if you do not, we should add another antimicrobial or replace the first.

In chronic sinusitis due to the enormous range of etiological possibilities are fundamental to culture and antibiograma.As cultures of nasal secretion do not always give the same bacteria in. Substances that have shown greater effectiveness in complicated sinusitis are cefuroxime, erythromycin-sulfixasol the association, the association amoxicillin-clavulonato hatred and cefixime.

Surgical Treatment

The surgical treatment of sinusitis is intended removal of predisposing factors, the reestablishment of ventilation and drainage of the s and recovery of the local immune system and function mucocilar. Microsurgical techniques, either via the external and endonasal microsurgery is considered a breakthrough because it provides better lighting and magnification of the surgical areas. Currently endoscopic surgery provides the best functional results, but are also respons ables a large number of complications. To succeed in these interventions are key to accurate preoperative evaluation and careful postoperative control.