Sinus infections can spread beyond the sinuses to the bones of the face and other structures within the skull, including the brain. If you experience swelling around the eyes, fever, altered consciousness, swelling in your forehead, or limited eye movement, call your doctor immediately Table 02. The most common complication of sinusitis is inflammation of the bone that forms the eye socket (orbital cellulitis). Symptoms include fever, swelling and redness around the eyes, and bulging eyes. If untreated, resulting pressure on the optic nerve can lead to vision loss, and the infection can spread to the brain. If orbital sinusitis is confirmed, intravenous antibiotic treatment must begin. If an abscess (a pus-filled cavity, often the result of tissue destruction) is present, it must be drained. If there is no improvement within 24 hours of the start of drug treatment, your sinuses should be drained as well.
Surgery may be necessary if inflammation spreads to your forehead. Figure 03 Inflammation of the frontal bone of the forehead, which occurs when frontal sinusitis spreads, is called osteomyelitis. The main symptoms are headache, fever, and a tender, doughy swelling of the forehead called Pott's puffy tumor. The swelling is treated by surgical drainage, and then the patient is given a six-week course of intravenous antibiotics. Patients may be given decongestants and the affected bone may have to be surgically removed.
Figure 03. Pott’s Puffy Tumor
If infection spreads to the brain, you will require high-dose intravenous antibiotics and possibly surgery to remove the infected tissue. Pus-filled cavities on the brain and meningitis can occur when a sinus infection spreads to the brain. Symptoms of these complications include changes in vision, limited loss of nerve function, such as the inability to use the muscles in one arm, symptoms of elevated cranial pressure such as severe headaches and vomiting, seizures, and coma. The infection can be fatal if left untreated. If your infection has spread, you will need high-dose intravenous antibiotics and possibly surgery.
Invasive fungal sinusitis requires emergency surgery. The most common type of invasive fungal sinusitis is a life-threatening condition called rhinocerebral mucormycosis. Patients experience facial pain, headache, and fever, and may also have symptoms of orbital cellulitis and altered mental status. The physician will look inside the nasal passages for characteristic black patches of dead tissue. If these are found, they must be biopsied immediately. Treatment involves intravenous drug therapy and surgically removing affected and dead tissue.
Table 2. Warning Signs of Sinusitis Complications
Severe swelling and redness of the tissues around the eye Limitations of eye movement Swelling of the forehead High fever Altered consciousness
Raise the head of your bed by 45 degrees Table 03. Changing the angle of your bed can help to promote drainage. If one side of your head is affected, try sleeping on the other side.
Get regular exercise. Aerobic exercise can be helpful, as it stimulates the flow of mucus.
Drink plenty of fluids, and use over-the-counter medications. Fluids thin-out the mucus and promote proper functioning of the sinuses. You should aim to drink least six to ten glasses of fluids a day. Other nondrug treatments include inhaling warm vapor through the nose, irrigating the nasal passages with saline solution, and placing a warmed cloth against painful areas. For over-the-counter medications, you may want to try Sudafed as well as painkillers, such as Tylenol. Antihistamines should not be used, as they can actually thicken the mucus, worsening the symptoms.
Table 3. Self-care Checklist
Humidity can ease discomfort and help sinuses to drain properly. Boil water, let it cool slightly, and pour it into a large bowl. Lean over the water and breathe in the steam. Draping a towel over your head and around the bowl will concentrate the steam. Drink plenty of fluids (water is best) to keep mucus flowing. Hot beverages such as herbal tea with lemon and honey may be particularly helpful. Exercise (if you feel up to it) to stimulate mucus production and accelerate sinus drainage. Take over-the-counter painkillers such as Tylenol for sinus pain and headache. Elevate the head of your bed 45 degrees to help keep your sinuses draining at night. A warmed cloth held against the face can help to ease sinus pain. Use a saline nasal spray to irrigate the nasal passages. You can buy saline nasal spray in the drug store, or make your own using 1/4 teaspoon each of salt and baking soda and 8 ounces of warm water. Place the mixture in an ear-bulb syringe. Over-the-counter decongestants like Sudafed may be helpful. Consult your physician before using a decongestant spray, because these medications in some cases can actually worsen congestion. Avoid alcohol, which can cause dehydration of the nasal passages and increase discomfort.
Your doctor is the best source of information on the drug treatment choices available to you.
Surgery to widen the ostia can cure some cases of chronic sinusitis. Surgery may be used to increase the size of the sinus openings in patients with chronic sinusitis, or in those with acute sinusitis that does not respond to antibiotic treatment. In the operation, a tube containing a scope is inserted into the nasal passage via the nostril. Surgical instruments are then introduced into the tube. This procedure can be done under local anesthesia with sedation, or under general anesthesia.
In complicated cases of sinusitis, surgical drainage of sinuses or debridement of affected tissue may be necessary.
Surgery to remove dead and infected tissue is the main treatment for fungal sinusitis.
From 70% to 80% of patients with acute sinusitis will respond well to antibiotic treatment.
Some will go on to develop chronic sinusitis. Medical and surgical treatment cures more than 60% of cases of chronic sinusitis.
In sinusitis caused by fungal infection, even in patients with intact immune systems, mortality is high.
If symptoms worsen at any stage of your treatment, call your doctor. If your doctor prescribes antibiotics, you should begin feeling better within 72 hours of beginning the course of treatment. If, after a week, you still feel sick, call your doctor.
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