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Jul18
Posted by Dr. Nitin Hundre Md on Saturday, 18th July 2015
It is difficult to distinguish between allergy symptoms allergic rhinitis and sinusitis. This is no small problem. Of all the chronic diseases from which we suffer, allergic rhinitis is the most common. Approximately 30 million Indian or 15% of the Indian, population suffer from allergic rhinitis. Sinusitis, on the other hand, is one of the most common complications of allergic rhinitis. The problem with differentiating these two conditions occurs, because allergic rhinitis and sinusitis may both present with the same symptoms, such as fatigue, runny nose, chronic cough, congestion, post nasal drainage, headaches, facial or teeth pain, loss of taste or smell, and difficulty sleeping. Asthma, the other major complication of allergic rhinitis, is a lower airway lung disease that may present with cough, shortness of breath, and chest tightness, and in some studies, up to 40% of patients with allergies, have asthma.Think then of a triangle: with allergic rhinitis on the left, causing sinusitis on the right, and both conditions causing asthma on the bottom. All three conditions can occur separately, but are closely interconnected. Remember that sinuses are simply empty cavities that surround the eyes. Air must be present in the sinuses to allow the linings of the sinuses to breathe and this is accomplished via small openings from the sinuses into the nasal passages. These openings also allow mucous from the sinuses to naturally drain into the nasal passages. If anything causes a blockage of the openings, the lack of air causes linings to use up the surrounding air supply, and like a vacuum, the resulting negative pressure will draw fluid out of the sinus linings. Fluid may then collect and fill the sinuses, which allows for bacteria to grow and cause infections. This can lead to facial pain, infected post nasal drainage and headaches. With increasing inflammation and thickening of the sinus linings, swollen tissue may round up and form nasal polyps that may cause and lead to loss of taste and smell. Allergic rhinitis and common viral colds are the leading causes of sinusitis, and the history and physical examination will help your provider distinguish the two conditions. Allergic rhinitis may be seasonal, lasting weeks, months or even year round, and is caused by pollen, dust mites. Fever and discolored nasal drainage are uncommon, unless sinusitis is also present. Conversely, typical viral colds last 3-7 days, so any fever, discolored drainage, sore throat, headache or fatigue lasting longer that 7 days is very unlikely to be a simple viral cold, and is most probably sinusitis. On physical examination, patients with allergic rhinitis and sinusitis may both have dark circles under the eyes (shiners), swollen, pale nasal tissue, congestion and discharge. Patients with sinusitis, however, may also have discolored discharge. Studies have shown that greater than 50-75% of allergic adults and children with asthma have abnormal sinus, and asthmatic symptoms did not improve until the sinusitis is treated completely.
ALLERGIC RHINITIS
Most patients 10-20% of the population with sneezing, congestion, runny and itchy nose rhinitis, postnasal drip and itchy, red eyes during spring and fall have allergies to seasonal pollens. A high percentage of allergic individuals will be children. Whether someone will develop
Allergies depends on two factors: (1) Hereditary - Is there a family history of allergy?
(2) Environmental- Is the individual old enough and been exposed to enough pollen? Symptoms due to allergies may be severe enough to cause a loss of time from work and school.
Interestingly, a percentage of patients with classic symptoms will be absolutely and unequivocally negative on skin testing. Allergy injections are not indicated and not possible, because these patients are not allergic. And yet patients are just as symptomatic, and just as miserable as the rest of us. How is this possible and what treatment is available?
Definition and Pathophysiology
The diagnosis of rhinitis without positive skin tests is divided into two subgroups. One subgroup, non-allergic rhinitis with eosinophilia, presents with allergy symptoms in addition to conditions such as nasal polyps and nasal eosinophilia, asthma and frequently sinusitis. The other subgroup, vasomotor rhinitis, presents with symptoms, especially congestion, but lacks other associated conditions.
The nasal mucosal lining has a rich blood supply that is under the control of the nervous system called the autonomic nervous system. Nonspecific stimuli such as rapid changes in weather, temperature and humidity, drafts, exposure to chemicals, odors, perfumes, smoke and dust, emotions or stress may increase blood flow to tissue, resulting in swelling, congestion and rhinitis. A significantly deviated septum may induce changes in the mucosa, worsen the non-allergic or vasomotor rhinitis and cause more nasal congestion and drainage. Hormonal changes that occur with pregnancy, menstruation, menopause, hypothyroidism and oral contraceptives may cause symptoms of chronic non-allergic rhinitis.
Clinical Features
Patients complain of chronic nasal congestion, rhinitis, postnasal drip and sneezing. Congestion and blockage may alternate from side to side and are usually constant, though seasonal weather changes may trigger symptoms that mimic dust allergies. Symptoms may be worse upon awakening in the morning. Examination reveals marked pink or pale nasal swelling obstruction and thick nasal secretions. In all cases, skin tests are negative. Patients with non-allergic but not vasomotor rhinitis will have eosinophils present in nasal secretions and frequently nasal polyps complicating the obstruction.
SINUSITIS
Sinusitis
Sinusitis is an infection or inflammation of sinuses. Sinuses are the air-filled pockets or spaces found in the bones of face, around eyes and nose. They produce mucus, which, under normal circumstances, drains into the nose. Normally the sinuses produce about 1.5 litres of mucus a day and the quantity increases during allergy, inflammation and infection and this also changes the character of the mucus. Infection of sinuses is one of the common health care complaints.
Pathology
Sinusitis occurs when the mucus-producing lining of sinuses become inflamed and block the opening of the sinuses. Due to this, foreign material cannot get out, oxygen levels drop within the sinus and bacteria in the nasal cavity slither into the sinuses causing the sinus walls to swell and fill with pus. If the infection does not subside, the body sends in disease-fighting cells to kill the bacteria, which in turn can do considerable damage to the sinus walls. These defender cells can damage the cilia, the hair-like structure in the sinuses that help expel foreign matter. In addition, scarring can be caused which can result in the formation of sores.
Causes of Sinusitis
Infection due to bacteria, virus, fungi
Allergy: Most commonest causes are dust, animal dander, smoke, food and pollutants
Upper respiratory tract infection such as common cold or flu
Nasal polyps
Nasal Septum deviation
Chronic tonsillitis and adenoiditis
Climatic factors like sudden temperature changes
Swimming in infected water
Low immunity
Dental causes like an abscessed or badly decayed tooth, following dental treatment
Diseases like diabetes and HIV can create a predisposition to sinusitis
Symptoms of sinusitis
Nasal congestion leading to nasal obstruction, difficulty breathing through the nose
Thick nasal discharge (may be yellowish or greenish in colour in case of infection)
Sensation of fullness in the face
Sensation of pressure behind the eyes
Postnasal drip
Cheeks feel tender and pain may be similar to toothache in upper jaw
Mild fever and headache over one or both eyes (if frontal sinuses are affected)
Headache is usually worse in the mornings and made sharper by bending forwards
Sore throat
Foul smell in nose
Nasal sounding speech
Possibly, pus-like nasal discharge
Dry tickling cough
Tiredness
Asthmatic Attack
In the initial stage there is an asthmatic aura sometimes sneezing, flatulence, Drowsiness or restlessness irritability will be present. There can be a dry cough along with wheezing breathlessness these are some of the symptoms before the actual asthmatic attack.
Sense of oppression in the chest suddenly in the middle of the night is experienced.
There is a sense of suffocation and the patient leans forward fighting for his breath; or he may go to the open window to relieve the suffocation.
Anxiety, perspiration, cold extremities and cyanosis might be present.
Wheezing is present and can be heard from a distant.
In severe airways obstruction airflow maybe so reduced that the chest is almost silent on auscultation.
Inspiration is short and high pitched while the expiration is prolonged. On auscultation there are plenty of rhonchi and rales heard.
Termination is spontaneous or due to medication. As the bronchial spasm is less the patient is able to breathe and he can also cough which brings out viscid sputum which relieves him.
The duration of the attack varies from a few minutes to hours. The attacks can last for many hours in paroxysms this state is known as Status asthmaticus. In this state the patient has to be admitted to the hospital so that he can be supplied with oxygen and other auxiliary methods of treatment
For many patients with asthma, the concern that this “reversible” though serious, potentially life-threatening persistent lung disease may progress into emphysema, is real and worrisome. After all, asthma along with emphysema and chronic bronchitis, the latter two conditions known as Chronic Obstructive Pulmonary Diseases (COPD), all have inflammation with airway narrowing, mucus production and airway obstruction. Homeopathy Management
Suppression of colds by high doses of conventional medicine leads to recurrent attacks. When you use a groom to clean your room, do you push all the dust in a corner of the room or collect it and throw away? It is a common sense that if you push to the corner of the room, in due course the dust will spread in the entire room again and make it dirtier. Same is the case with the disease affecting your body. If you suppress the disease, where will it go? It will remain in dormant state inside the body and express itself again when the body meets any of the allergic triggers. The homeopathic medicines however through the principle of “like cures like” stimulate the vital force and immunity in order to enhance the body’s capacity to repel further allergies and infections. The constitutional medicines that are found by considering the physical, mental, and emotional aspects of an individual can only lead him on the road of permanent recovery from those allergic spells. Not only these medicines cater the problem of allergy but also impart great health on all planes, as it treats the patient as a whole and not just his disease.
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