Sinusitis/ Allergic Rhinitis/ Nasal Problems
For most us who live in Ho Chi Minh City or another major city within Viet Nam, rather than in the mountains of Da Lat or Kon Tum ,where the air is crisp, clean, and clear, we are being perpetually expoosed to dust, dirt, fumes, molds, and polluted, parrticle-filled air in general. A drive or walk down any major urban area will usually mean we pass many of these exposures. For children it can be even worse, as they are closer to ground level, where the air they breathe often has even more particles or parts per million than fully grown adults who are taller in height. This is a major reason why there are so many Rhinitis and Sinusitis sufferers in our urban areas compared to those who get to breathe the clean air in the mountians or by the seaside.
Rhinitis is defined as the occurrence of annoying nasal symptoms including discharge, itching, sneezing, nasal congestion, and nasal pressure. Many cases can be classified into a specific syndrome, each with its own causes and treatments. The rhinitis syndromes are principally recognized by clinical patterns.
Allergic Rhinitis is associated with significant morbidity. Individuals affected have a quality of life significantly worse than otherwise healthy ones. Unfortunately, only a relatively small number of patients undergo remission over time. Some physicians prefer the term Rhinosinusitis to the separate terms rhinitis and sinusitis. This is because rhinitis and sinusitis do frequently occur together. Rhinitis commonly leads to sinusitis and nasal symptoms are common with sinusitis, and the nose and sinus mucosa are contiguous with one another.
Sinusitis, as an infection can result from either viral or bacterial infection. Patients who suffer from Allergic Rhinosinusitis are more at risk of developing a complicating bacterial infection of the sinuses, or of developing Recurrent or Chronic Sinusitis.
Due to different management strategies, Allergic Rhinosinusitis should be distinguished from the other forms of Rhinosinusitis (Rhinitis/runny nose coming from a cold infection for example) . A working knowledge of the particular allergic particles in the air present in the patient's geographic location and the allergens that could be found in any one individuals’s home and work areas is essential in this process. Examples of such allergic particles in the air could be things like cat salivary proteins, mouse or rat urinary proteins, pollens from flowers or plants, or molds, or house dust mite feces, all of these may provoke acute nasal symptoms that usually can be easily diagnosed as an episodic allergic rhinitis.
Perennial (Yearly) Allergic Rhinitis is defined as having symptoms almost daily for two hours or longer for 9 months or more of the year, and such people can suffer terribly for days on end as you can imagine. This form of Allergic Rhinitis usually reflects allergy to indoor allergens like dust mites, cockroaches, or animal dander, but other allergic particles in the air may cause perennial rhinitis particulalry in tropical climates like Viet Nam. Seasonal Rhinitis can occur, for example, during the entire rainy season. This form is common in tropical regions with long pollinating seasons and ever present molds and dust mite allergens, and can also occur with occupational exposure.
Some statistics are;
The condition is also associated with multiple episodes of sneezing, runny nose, blocked-up nose/nasal congestion, itching of the eyes, nose, and palate. It is also frequently associated with postnasal drip, cough, irritability, and fatigue.
Allergic Rhinosinusitis or other forms of Rhinosinusitis, can lead to nasal and sinus obstruction as the tissue swells and becomes inflammed, and this then can lead to Acute Bacterial Sinusitis, Recurrent Bacterial Sinusitis, or Chronic Bacterial Sinusitis which can lead to scarring of the sinuses and nasal passageways. The typical symptoms of one of these infections includes the nasal symptoms listed above but often also includes a frontal headache or pain around the cheeks, a sense of pressure in the the sinus areas, colored (green, yellow, brown, or even bloody) nasal discharge, and sometimes fever.
In the past, when patients reached the point of bacterial infection of the Sinuses, antibiotic courses were used to clear these episodes. Treating Acute, Recurrent, or Chronic Sinusitis can be difficult as the sinuses are a space where antibiotics penetrate poorly, and the courses of antibiotics are often longer and the dosages for the antibiotics are often greater than when dealing with bacterial infections in other locations or tissues.
Physicians now try to think of these bacterial infections of the sinuses as the end point of the process, while the best time to act to prevent these infections is earlier in the process when the nasal passageways are inflammed and congested. The medical management of Chronic or Recurrent Sinusitis is now focused upon controlling the inflammation that predisposes patients to obstruction, thus minimizing the incidence of infections. Despite this, Recurrent and Chronic Sinusitis are associated with poor sinus drainage and secondary bacterial infections often occur. Most patients require antibiotics to clear infections at the outset of therapy, and intermittently thereafter to treat acute exacerbations.
Depending on the point in the process of where a patient with Sinusitis or Allergic Rhinosinusitis is, different treatments can be applied. Salt water nasal sprays and washes can be used to help clear some of obtruction and achieve better drainage. Other times the symptoms require medications, either and/or both oral antihistamines, nasal steroid sprays, and in the most severe cases, antibiotic courses.
Anyone who has recurrent, seasonal, or perennial Allergic Rhinosinusitis, or Recurrent or Chronic Sinusitis episodes will very likely benefit from an evaluation with a physician with experience in evaluating and treating these conditions, because of the complexity of factors that can be involved in each patient’s history, for example, environmental, occupational, home exposures are considered in a good history, while treatment options should be considered carefully and methodically. So many patients in Viet Nam end up going directly to a pharmacy and try to obtain relief symptomatically with the purchase of medications that are most often used incorrectly to deal with the conditions. They would end up in much better shape by coming in for physician evaluation after they recognize one of these recurrent or chronic symptoms in themselves. They will achieve better management, better treatment, and better education about their condition.
The physicans at Stamford Medical Centre have expertise and experience in treating all these forms of Rhinosinusitis and Infectious Sinusitis conditions.
Written by: Dr. Mark L. Siefring M.D.: Key Resource with some paraphrasing from UpToDate
For most us who live in Ho Chi Minh City or another major city within Viet Nam, rather than in the mountains of Da Lat or Kon Tum ,where the air is crisp, clean, and clear, we are being perpetually expoosed to dust, dirt, fumes, molds, and polluted, parrticle-filled air in general. A drive or walk down any major urban area will usually mean we pass many of these exposures. For children it can be even worse, as they are closer to ground level, where the air they breathe often has even more particles or parts per million than fully grown adults who are taller in height. This is a major reason why there are so many Rhinitis and Sinusitis sufferers in our urban areas compared to those who get to breathe the clean air in the mountians or by the seaside.
Rhinitis is defined as the occurrence of annoying nasal symptoms including discharge, itching, sneezing, nasal congestion, and nasal pressure. Many cases can be classified into a specific syndrome, each with its own causes and treatments. The rhinitis syndromes are principally recognized by clinical patterns.
Allergic Rhinitis is associated with significant morbidity. Individuals affected have a quality of life significantly worse than otherwise healthy ones. Unfortunately, only a relatively small number of patients undergo remission over time. Some physicians prefer the term Rhinosinusitis to the separate terms rhinitis and sinusitis. This is because rhinitis and sinusitis do frequently occur together. Rhinitis commonly leads to sinusitis and nasal symptoms are common with sinusitis, and the nose and sinus mucosa are contiguous with one another.
Sinusitis, as an infection can result from either viral or bacterial infection. Patients who suffer from Allergic Rhinosinusitis are more at risk of developing a complicating bacterial infection of the sinuses, or of developing Recurrent or Chronic Sinusitis.
Due to different management strategies, Allergic Rhinosinusitis should be distinguished from the other forms of Rhinosinusitis (Rhinitis/runny nose coming from a cold infection for example) . A working knowledge of the particular allergic particles in the air present in the patient's geographic location and the allergens that could be found in any one individuals’s home and work areas is essential in this process. Examples of such allergic particles in the air could be things like cat salivary proteins, mouse or rat urinary proteins, pollens from flowers or plants, or molds, or house dust mite feces, all of these may provoke acute nasal symptoms that usually can be easily diagnosed as an episodic allergic rhinitis.
Perennial (Yearly) Allergic Rhinitis is defined as having symptoms almost daily for two hours or longer for 9 months or more of the year, and such people can suffer terribly for days on end as you can imagine. This form of Allergic Rhinitis usually reflects allergy to indoor allergens like dust mites, cockroaches, or animal dander, but other allergic particles in the air may cause perennial rhinitis particulalry in tropical climates like Viet Nam. Seasonal Rhinitis can occur, for example, during the entire rainy season. This form is common in tropical regions with long pollinating seasons and ever present molds and dust mite allergens, and can also occur with occupational exposure.
Some statistics are;
80 percent of patients with seasonal symptoms have an apparent allergic cause.
70 percent of patients with perennial symptoms with seasonal exacerbations have a probable allergic cause.
Approximately 50 percent of patients with rhinitis and perennial symptoms alone have allergic rhinitis.
There is a strong statistical association between allergic rhinitis and asthma. Twenty-eight to 50 percent of patients with asthma appear to have allergic rhinitis.
The most common symptoms in Allergic Rhinosinusitis are intense nasal itching which is associated with nose rubbing, reddening and skin breakdown can occur on the sides of the external nose, and pushing the tip of the nose up with the hand--the "allergic salute".
Allergic Rhinosinusitis or other forms of Rhinosinusitis, can lead to nasal and sinus obstruction as the tissue swells and becomes inflammed, and this then can lead to Acute Bacterial Sinusitis, Recurrent Bacterial Sinusitis, or Chronic Bacterial Sinusitis which can lead to scarring of the sinuses and nasal passageways. The typical symptoms of one of these infections includes the nasal symptoms listed above but often also includes a frontal headache or pain around the cheeks, a sense of pressure in the the sinus areas, colored (green, yellow, brown, or even bloody) nasal discharge, and sometimes fever.
In the past, when patients reached the point of bacterial infection of the Sinuses, antibiotic courses were used to clear these episodes. Treating Acute, Recurrent, or Chronic Sinusitis can be difficult as the sinuses are a space where antibiotics penetrate poorly, and the courses of antibiotics are often longer and the dosages for the antibiotics are often greater than when dealing with bacterial infections in other locations or tissues.
Physicians now try to think of these bacterial infections of the sinuses as the end point of the process, while the best time to act to prevent these infections is earlier in the process when the nasal passageways are inflammed and congested. The medical management of Chronic or Recurrent Sinusitis is now focused upon controlling the inflammation that predisposes patients to obstruction, thus minimizing the incidence of infections. Despite this, Recurrent and Chronic Sinusitis are associated with poor sinus drainage and secondary bacterial infections often occur. Most patients require antibiotics to clear infections at the outset of therapy, and intermittently thereafter to treat acute exacerbations.
Depending on the point in the process of where a patient with Sinusitis or Allergic Rhinosinusitis is, different treatments can be applied. Salt water nasal sprays and washes can be used to help clear some of obtruction and achieve better drainage. Other times the symptoms require medications, either and/or both oral antihistamines, nasal steroid sprays, and in the most severe cases, antibiotic courses.
Anyone who has recurrent, seasonal, or perennial Allergic Rhinosinusitis, or Recurrent or Chronic Sinusitis episodes will very likely benefit from an evaluation with a physician with experience in evaluating and treating these conditions, because of the complexity of factors that can be involved in each patient’s history, for example, environmental, occupational, home exposures are considered in a good history, while treatment options should be considered carefully and methodically. So many patients in Viet Nam end up going directly to a pharmacy and try to obtain relief symptomatically with the purchase of medications that are most often used incorrectly to deal with the conditions. They would end up in much better shape by coming in for physician evaluation after they recognize one of these recurrent or chronic symptoms in themselves. They will achieve better management, better treatment, and better education about their condition.
The physicans at Stamford Medical Centre have expertise and experience in treating all these forms of Rhinosinusitis and Infectious Sinusitis conditions.
Written by: Dr. Mark L. Siefring M.D.: Key Resource with some paraphrasing from UpToDate