Sinusitis, - What ? Why? How? Effect?

Sinusitis, also known as a sinus infection or rhinosinusitis, is inflammation of the sinuses resulting in symptoms

Sinusitis can be caused by infection, allergies, air pollution, or structural problems in the nose.

Conditions that can cause sinus blockage include:

The common cold.

Allergic rhinitis, which is swelling of the lining of the nose.

Small growths in the lining of the nose called nasal polyps.

A deviated septum, which is a shift in the nasal cavity.

Nasal mucus, a plugged nose, and pain in the face

How to conform Sinusitis?

X-rays are not typically needed unless complications are suspected.

In chronic cases confirmatory testing is recommended by either direct visualization or computed tomography.

Examine Examine MRI

Ref:Rosenfeld, RM; Piccirillo, JF; Chandrasekhar, SS; Brook, I; Ashok Kumar, K; Kramper, M; Orlandi, RR; Palmer, JN; Patel, ZM; Peters, A; Walsh, SA; Corrigan, MD (April 2015). "Clinical practice guideline (update): adult sinusitis executive summary.".Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 152 (4): 598–609.

Computed tomograph

•Acute rhinosinusitis – A new infection that may last up to four weeks and can be subdivided symptomatically into severe

and non-severe.

•Recurrent acute rhinosinusitis – Four or more separate episodes of acute sinusitis that occur within one year.

•Subacute rhinosinusitis – An infection that lasts between four and 12 weeks, and represents a transition between acute and

chronic infection

•Chronic rhinosinusitis – When the signs and symptoms last for more than 12 weeks.

•Acute exacerbation of chronic rhinosinusitis – When the signs and symptoms of chronic rhinosinusitis exacerbate, but

return to baseline after treatment

All these types of sinusitis have similar symptoms, and are thus often difficult to distinguish. Acute sinusitis is very

common. Roughly ninety percent of adults have had sinusitis at some point in their life

Pearlman AN, Conley DB (June 2008). "Review of current guidelines related to the diagnosis and treatment of rhinosinusitis". Current Opinion in Otolaryngology & Head and Neck Surgery. 16 (3): 226–30.

By location

Maxillary – can cause pain or pressure in the maxillary (cheek) area

It is the largest air sinus in the body. Found in the body of the maxilla.

Frontal – can cause pain or pressure in the frontal sinus cavity

Ethmoidal – can cause pain or pressure pain between/behind the eyes, the sides of the upper part of the nose

Sphenoidal – can cause pain or pressure behind the eyes, but often refers to the skull vertex (top of the head), over the mastoid processes, or the back of the head

Treatment for Sinusitis

Antibiotics are not recommended for most cases.[1] (Maxillary)

There is tentative evidence for nasal irrigation.[3]

Decongestant nasal sprays containing oxymetazoline may provide relief, but these medications should not be used

for more than the recommended period. Longer use may cause rebound sinusitis.[4]

1. Consumer Reports; American Academy of Allergy, Asthma, and Immunology (July 2012), "Treating sinusitis: Don't rush to antibiotics" (PDF), Choosing Wisely: an initiative of the ABIM Foundation, Consumer Reports, retrieved August 14, 2012.

2. Harvey R, Hannan SA, Badia L, Scadding G (2007). Harvey, Richard, ed. "Nasal saline irrigations for the symptoms of chronic rhinosinusitis". Cochrane Database Syst Rev (3): CD006394. doi:10.1002/14651858.CD006394.pub2. PMID 17636843.

3. King, D; Mitchell, B; Williams, CP; Spurling, GK (20 April 2015). "Saline nasal irrigation for acute upper respiratory tract infections.". The Cochrane database of systematic reviews. 4: CD006821. doi:10.1002/14651858.CD006821.pub3. PMID 25892369.

4. Rhinitis medicamentosa at eMedicine5. Shaikh, N; Wald, ER (Oct 27, 2014). "Decongestants, antihistamines and nasal irrigation for acute sinusitis in children.". The Cochrane database of systematic reviews. 10:

CD007909. doi:10.1002/14651858.CD007909.pub4. PMID 25347280.

specific agents and the optimal mechanisms of delivery remain subjects of active investigation and debate?

It is a standard of care for the treatment of medically recalcitrant chronic rhinosinusitis (CRS).

The primary goal of functional endoscopic sinus surgery is

To improve patient symptoms by restoring ostial patency and mucociliary function.

As experience with endoscopic sinus surgery has grown, it has become apparent that these aims are achieved most

successfully when inflammatory sinus disease stems principally from anatomic obstruction.

Endoscopic sinus surgery

There are a number of devices on the market for topical saline delivery into the nose and paranasal sinuses.

Two common high-volume techniques

squeeze bottle (high pressure) Neti pot (low pressure) Nasal pump sprays 

Typical nasal pump sprays generate droplets of 50 to 100 µm in diameter size,

and deliver 70 to 150 µL of drug per puff,

at standard velocities of 7.5 to 20 L/min5.

A large fraction of the spray is deposited in the anterior nasal cavity without any significant penetration into the

paranasal sinuses.

Nasal drug delivery

• local or systemic effects.

• Low molecular weight drugs with are rapidly absorbed through nasal mucosa.

• High permeability, fairly wide absorption area, porous and thin endothelial basement membrane of the nasal epithelium.

• limitations such as the high molecular weight (HMW) of drugs may impede drug absorption through the nasal mucosa.

• Mucociliary clearance.

• Due to their hydrophilic structure, the nasal bioavailability of peptide and protein drugs is normally less than 1%.

Ozsoy, Yıldız, Sevgi Gungor, and Erdal Cevher. "Nasal delivery of high molecular weight drugs." Molecules 14.9 (2009): 3754-3779.

Nasal route consists of three functional areas,

• Vestibular

• Respiratory

• Olfactory areas

The nasal respiratory mucosa is covered with mucus.

The mucus is 5 µm thick and has a viscous gel on the upper part and an aqueous sol layer on the lower part .

The mucosal secretion contains 95% water, 2% mucin, 1% salts, 1% albumin, immunoglobulin, lysozyme, lactoferrin and other proteins and 1% lipids.

Nasal mucus also contains IgA, IgE and IgG. Nasal epithelia are covered with a new mucus layer approximately every 10 minutes .

Retention of nasally-applied drugs in this area is subject to various factors

• Size of the drug,

• Density,

• shape and hygroscopicity,

• respiration

• Presence of pathologic conditions

Sciarra, J.J. Remington: The Science and Practice of Pharmacy; Gennaro, A.R., Ed.; Mack Publishing Company: Easton, PA, USA, 1995; Chapter 95, p. 1676.

Sanders, P.; Washington, N.; Frier, M.; Wilson, C.G.; Feely, L.C.; Washington, C. The deposition of solution-based and suspension-based aerosols from metered dose inhalers in healthy subjects and asthmatic patients. S.T.P. Pharm. Sci. 1997, 7, 300-306.

Ingemann, M.; Frokjaer, S.; Hovgaard, L.; Brøndsted, H. Peptide and Protein Drug Delivery Systems for Non-Parenteral Routes of Administration. In Pharmaceutical Formulation Development of Peptides and Proteins; Frokjaer, S., Hovgaard, L., Eds.; Taylor & Francis: Philadelphia, PA, USA, 2000; Chapter 10, p.189.

Drug is released from the particles through certain mechanisms (a) release from the particle surface, 

(b) diffuson of the drug from the swollen polymer matrix, or 

(c) drug release through the erosion of polymers . 

Agnihotri, S.A.; Mallikarjuna, N.N.; Aminabhavi, T.M. Recent advances on chitosan-based micro- and nanoparticles in drug delivery. J. Control. Release 2004, 100, 5-28.

Nose spray

Saline

If your nasal and sinus secretions are too dry, sinus pain, nasal congestion, sinusitis, and other symptoms can develop.

Antihistamines , glucosamine,

Reduce or block histamines, so they stop allergy symptoms.

Antibiotics

Reduce microbial infection

http://www.everydayhealth.com/ear-nose-throat/nasal-sprays.aspx

Nanoparticle based antibiotic therapy for sinusitis

Erythrosine encapsulated poly-lacticco-glycolic acid (PLGA) nanoparticle

Garapati, Chandrasekhar, et al. "Development and characterization of erythrosine nanoparticles with potential for treating sinusitis using photodynamic therapy." Photodiagnosis and photodynamic therapy 12.1 (2015): 9-18.