Manajemen Multiaspek Sinusitis Kronik

Sebagian besar kasus sinusitis kronis terjadi pada pasien dengan sinusitis akut yang tidak respon atau tidak mendapat terapi. Peran bakteri sebagai dalang patogenesisi sinusitis kronis saat ini sebenarnya masih dipertanyakan juga.

Jangan sepelekan pilek yang terus menerus. Boleh jadi pilek yang tak kunjung sembuh itu bukan sekadar flu biasa. Menurut Nuty W. Nizar, Sp.THT(K) dari Subbagian Rinologi Departemen Ilmu Telinga Hidung Tenggorokan FKUI RSCM, Jakarta, dalam keadaan ini, selain kecurigaan atopik, perlu dipikirkan juga sinusitis yang bersifat kronis .

Secara umum sinusitis kronik didefinisikan sebagai infeksi sinus paranasal lebih dari tiga bulan. Kondisi ini biasanya memiliki manifestasi klinis yang sangat berbeda dibanding sinusitis akut. Gejala yang biasanya muncul sangat bervariasi: rhinorrhea, post nasal drip, sesak napas (subyektif), nyeri sinus, sakit kepala, sakit tenggorokan, batuk-batuk, eksaserbasi asma, telinga berdengung, telinga sakit, agak tuli, rasa penuh di telinga, bisa juga sangat tidak spesifik fatigue, puyeng, hingga malaise.

Mampet di Rongga Sinus

Terjadinya sinusitis secara kronis tak lepas dari proses inflamasi yang terdapat pada sinus paranasal. Manusia memiliki empat pasang sinus paranasal yang terdiri dari epitel kolumnar semu dengan silia. Di sela-sela epitel tersebut terdapat sel goblet yang terus menjaga kelembaban daerah sinus. Mukosa sinus menempel langsung pada tengkorak yang sering sekali menyebabkan penyebaran infeksi ke daerah orbita dan kompartemen intrakranial. Biasanya penyebaran infeksi ini terjadi pada pasien sinusitis akut yang tidak sempurna pengobatannya.

Sinus paranasal itu sendiri sebenarnya merupakan invaginasi dinding saluran napas ke dalam rongga-rongga tengkorak. Tidak terlalu jelas mengapa bentuk anatomis sinus paranasal seperti ini, namun fungsi yang diketahui hingga saat ini ialah sebagai rongga resonansi dan penyeimbang tekanan udara dalam tubuh. Invaginasi sinus ini terbagi menjadi sinus frontal, maksila, etmoid, dan sfenoid. Daerah sinus maksila, sinus frontal, dan sinus etmoid anterior bermuara ke dalam hidung melalui kompleks osteomeatal yang terletak lateral dari meatus medial. Sinus etmoid posterior dan sinus sfenoid membuka menuju meatus superios dan resesus sfenoetmoidal. Sedangkan ostium dari sinus maksila tersambung ke rongga hidung melalui saluran kecil yang dinamakan infundibulum. Saluran ini terletak di bagian tertinggi dari sinus, padahal letak maksila agak sedikit lebih ke bawah dari rongga hidung. Dengan demikan saluran ini melawan gaya gravitasi untuk mengalirkan mukus ke dalam rongga hidung. Lantai sinus maksila pun bersentuhan langsung dengan prosesus alveolaris gigi geligi. Akibatnya, infeksi gigi akan mudah menyebar menuju sinus maksila. Namun jika tidak ada infeksi, biasanya rongga sinus akan tetap steril meskipun terdapat jutaan kuman di dalam rongga hidung.

Nah, sinusitis terjadi jika kompleks osteomeatal di hidung mengalami obstruksi mekanis, baik itu akibat edema mukosa setempat atau akibat berbagai etiologi semisal ISPA atau rhinitis alergi. Keadaan ini membuat statis sekresi mukus di dalam sinus. Stagnasi mukosa ini membentuk media yang nyaman untuk pertumbuhan patogen. Awalnya, terjadi sinusitis akut dengan gejala klasik dan biasanya terdiri dari satu macam bakteri aerob saja. Jika infeksi ini dibiarkan terus-menerus, akan tumbuh pula berbagai flora, organisme anaerob, hingga kadang tumbuh jamur di dalam rongga sinus. Sebagian besar kasus sinusitis kronis terjadi pada pasien dengan sinusitis akut yang tidak respon atau tidak mendapat terapi. Peran bakteri sebagai dalang patogenesisi sinusitis kronis saat ini sebenarnya masih dipertanyakan juga. Infeksi sinus yang berulang dan persisten dapat terjadi tidak hanya akibat timbunan bakteri, tapi memang dari lahir orang tersebut sudah mengalami imunodefisiensi kongenital atau penyakit lain seperti fibrosis kistik.

Tidak Demam

Di dunia, sinusitis kronik dapat dijumpai hampir di seluruh negara, terutama dengan kadar polusi udara yang relatif tinggi, seperti di Indonesia. Iklim dan kelembaban udara juga memegang peranan penting dalam menyebabkan sinusitis. Di belahan bumi utara, sinusitis biasanya terjadi akibat konsentrasi pollen di udara. Seperti penyakit lainnya, sinusitis yang menjadi kronis akan meningkatkan morbiditas bahkan mortalitas. Penyebaran perkontinuitatum sinusitis mampu mengakibatkan komplikasi hingga menjadi meningitis dan abses otak. Selain itu sinusitis yang kronis juga memicu eksaserbasi asma bagi para pengidapnya.

Diperlukan keterampilan anamnesis yang jeli untuk menegakkan diagnosis sinusitis kronis. Soalnya, tidak seperti sinusitis akut, sinusitis yang kronis jarang ditemui demam dan nyeri ketok sinus paranasal. Pasien biasanya datang karena hidungnya mampet terus-menerus, ingusan yang mengganggu, postnasal drip, sakit kepala, batuk kering terus-menerus, hiposmia, tenggorokan 'gatal', malaise, bersin-bersin tak karuan, asma yang kambuh terus-meneurs, gangguan pendengaran, nggak nafsu makan, pandangan kabur,

hingga sakit gigi. Semua ini terjadi karena patofisiologi sinus kronis berkaitan erat dengan struktur anatomi sinus yang melekat ke berbagai organ di sekitarnya.

Ketika diperiksa, masih terdapat rasa tidak nyaman ketika palpasi daerah sinus, terutama maksila dan frontal. Pemeriksaan transiluminasi sinus juga berguna untuk mengetahui kandungan rongga sinus tersebut. Jika diinspeksi ke rongga mulut akan ditemui eritema orofaringeal disertai sekresi purulen, kadang-kadang ada gigi-geligi yang bolong, terutama gigi bagian atas (maksila). Jika memungkinkan untuk dilakukan endoskopi (rhinoskopi) akan ditemui eritema mukosa hidung, edema mukosa, sekresi purulen, obstruksi nasal akibat deviasi septum nasal atau hipertrofi konka, kadang-kadang juga ada polip nasal. Selain itu, inflamasi kronis terutama pada sinus frontal juga tak jarang mendesak duktus lakrimalis sehingga menyebabkan kongesti konjungtiva, lakrimasi, proptosis, hingga kelumpuhan otot motorik mata. Jika infeksi dari sinus maksila sudah menyebar hingga ke rongga orbita, dapat pula terjadi pandangan yang kabur.

Penyebab itu semua sampai saat ini akibat bakteri patogen yang memulai infeksi sinusitis akut, yakni Streptococcus pneumoniae, Haemophillus influenzae, serta Moraxella catarrhalis. Dari endoskopi atau punksi sinus, bakteri tersebut juga sering menyebabkan kelanjutan menjadi sinusitis kronik. Selain itu, pada sinusitis yang kronik terdapat pula flora normal dan beberapa patogen lain, misalnya Staphylococcus aureus, stafilokokus koagulase negatif, Streptococcus viridans, Streptococcus intermedius, Pseudomonas aeruginosa, serta spesies Nocardia dan bakteri anaerob. Sedangkan jamur yang sering ditemukan pada sinusitis kronis ialah spesies Aspergillus, Cryptococcus neoformans, Candida sp., Sporothrix schenkii, dan spesies Alternatia.

Selain akibat ulah kuman-kuman tersebut, sinusitis yang kronik disebabkan oleh obstruksi osteometal yang permanen, alergi, polip, atau status imunodefisiensi. Hal-hal ini memang mengakibatkan overgrowth dan menimbulkan infeksi bakteri sekunder.

Tidak Perlu Kultur

Dewasa ini, mengutip dari berbagai jurnal Amerika dan Eropa, banyak sekali predisposisi sinusitis kronis yang telah diungkap. Bisa akibat abnormalitas kompleks osteomeatal (mis. Deviasi septum, konka bullosa, deviasi prosesus uncinatus, atau Haler cells), rhinitis alergi, polip nasal, rhinitis nonalergi (mis. Rhinitis vasomotor, rhinitis medikamentosa, pentalahgunaan kokain). Selain itu, bisa juga ulah dokter setelah intubasi nasogaster, bisa juga akibat hormon seks seperti pubertas, kehamilan, atau kontrasepsi. Obstruksi tumor, fibrosis kistik, kelainan motilitas silia, infeksi saluran napas atas, hingga GERD mampu menjadi faktor predisposisi sinusitis yang kronik. Ditambah satu faktor risiko lagi, yakni polusi udara dan merokok.

Dalam penegakan diagnosis dari pemeriksaan lab, kultur flora nasal tidak perlu dilakukan karena tidak memiliki nilai diagnostik (rongga sinus bersifat steril dan rongga hidung penuh flora normal). Namun swab hidung berguna untuk melihat adanya eosinofil untuk mengetahui kemungkinan alergi. Jika memang alergi, perlu ditelusuri alergennya. Pemeriksaan darah perifer lengkap juga tidak terlalu bermakna, kecuali pasien demam. Pada kasus yang parah, kultur darah dapat bermanfaat untuk mengetahui adanya jamur atau untuk pemeriksaan HIV (jika diperlukan).

Penegakan diagnosis sinusitis kronik yang terbaik ialah dengan menggunakan pencitraan radiologis. Rontgen thorax yang biasa dapat menunjukkan penebalan mukosa sebagai tanda sinusitis. Ketinggian fluida udara jarang ditemui di kasus sinusitis kronis. Ditambah lagi, pemeriksaan ini tidak mampu menggambarkan sinus yang lebih dalam, misalnya sinus etmoid dan kompleks osteomeatal.

Pemeriksaan yang baik ialah dengan CT-scan sinus. CT terpaksa dikerjakan kalau pasien dirasa tidak respon terhadap terapi atau sebagai persiapan operasi. CT Scan koronal dapat menggambarkan posisi anatomis dengan baik untuk persiapan operasi. Dengan CT Scan juga dapat terlihat letak-letak obstruksi secara tajam dan akurat. CT scan bahkan mampu mendeteksi entitas spesifik dalam hidung semacam aspegilloma. Sedangkan kerabatnya, MRI, tidak terlalu sering dilakukan karena mahal. Namun sebenarnya MRI baik untuk melihat kontras jaringan lunak serta mendeteksi massa seperti neoplasma, komplikasi kranial dan intraorbital, serta sinusitis akibat jamur.

Berbagai Pendekatan

Kalau sudah kronis, cara terbaik sebenarnya ialah lakukan operasi. Namun pengobatan medikamentosa diberikan juga untuk menurunkan faktor predisposisi, mengobati serangan infeksi berulang, mengurangi edema jaringan sinus, serta memfasilitasi drainase sekresi sinus. Secara umum, obat yang diberikan berupa antibiotak oral untuk menghilangkan sisa-sisa pertumbuhan bakteri, dekongestan untuk konstriksi pembuluh darah mukosa, serta kortikosteroid topikal bagi penderita sinusitis dengan rhinitis alergi, polip nasal, dan rinitis medikamentosa. Pasien alergi juga dapat diberika stabilizer sel Mast (golongan kromolin). Nasal spray dapat membantu melembabkan sekresi yang kering, mengurangi edema mukosa, serta mengurangi viskositas mukus. Meski tidak ada evidence-based data, literatur menyebutkan ekspektoran dapat digunakan (Guaifenesin) untuk mengurangi gejala klinis sinusitis kronis.

Dibutuhkan banyak pendekatan medis untuk mengontrol atau memodifikasi penanganan sinusitis kronik. Infeksi saluran pernapasan atas memegang kunci timbulnya sinusitis, dari yang akut hingga menjadi kronis. Karenanya, pasien terutama anak-anak, mesti dididik untuk menjaga kesehatan, rajin berolah raga, dan biasakan makan sayur atau buah. Akan lebih baik lagi jika mampu menghindarkan diri dari debu-debu, asap rokok, serta iritan kimia lingkungan lainnya. Pemberian antihistamin, kromolin, steroid topikal, atau imunoterapi mungkin perlu untuk mencegah timbulnya rhinitis alergi, lagi-lagi terutama pada anak-anak. Pencegahan GERD dapat bermanfaat untuk mencegah eksaserbasi penyakit saluran napas dan saluran cerna, semisal asma dan sinusitis kronik. Siapa tahu ada pasien juga dengan status imunodefisiensi, maka perlu diberikan terapi peningkatan status imun agar kondisi sinusitis kroniknya dapat membaik.

Gejala-gejala superfisial sinusitis, biasanya berupa pilek yang tak sembuh-sembuh, pada prinsipnya dapat dikurangi dengan dekongestan, steroid topikal, antibiotik, irigasi salin normal ke hidung, kromolin tropikal, atau mukolitik. Semua obat ini tidak menyembuhkan, tapi dapat membantu memotivasi pasien untuk bisa sembuh. Agar cepat reda, kelembaban sekresi mukus dari sinus harus tetap dijaga, edema mukosa mesti dikurangi, serta viskoditas mukus sebaiknya dikurangi.

Untuk terapi pembedahan, prosedurnya dinamakan Functional Endoscopic Sinus Surgery (FESS). FESS mampu menghilangkan penyakit dengan cara mengembalikan aerasi dan drainase yang adekuat pada pasien, menguatkan komplek osteomeatal, namun tidak meninggalkan jejas dan rasa tidak nyaman dalam bernapas. FESS mampu mengembalikan kesehatan sinus dengan gejala kekambuhan kurang dari 10% pasien. Setelah itu, pasien mesti dilanjutkan dengan terapi medis berkelanjutan dan pemantauan yang baik. (Farid)

Sinus Infection

Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

What is sinus infection?

Inflammation of the air cavities within the passages of the nose (paranasal sinuses) is referred to as sinusitis. Sinusitis is one of the more common conditions that can afflict people throughout their lives. Sinusitis commonly occurs when environmental pollens irritate the nasal passages, such as with hay fever. Sinusitis can also result from irritants, such as chemicals or the use and/or abuse of over-the-counter nasal sprays and illegal substances that may be snorted through the nose. Sinusitis can also be caused by infection (by viruses or bacteria). This article is a review of sinus infection.

What are the paranasal sinuses?

The paranasal sinuses are air-filled cavities in the dense portions of the bones of the skull, which were formed to decrease the overall weight of the skull. These air filled cavities are formed essentially in four left and right pairs. The frontal sinuses are positioned behind the area of the forehead, while the maxillary sinuses are behind the cheeks. The sphenoid and ethmoid sinuses are found deeper in the skull behind the eyes and maxillary sinuses. The sinuses are lined by mucous secreting cells. The air gets into the sinuses through small openings in the bones that allow connection to the nasal passageways, called ostia. If any of these openings become blocked, air can't properly pass into the sinuses and likewise the mucous produced by the cells lining the sinuses can't drain out.

What causes sinus infection?

Sinus infection may be caused by anything that interferes with airflow into the sinuses and the drainage of mucous out of the sinuses. The sinus openings may be obstructed by anything which causes swelling of the tissue lining and adjacent nasal passage tissue, for example colds, allergies, and tissue irritants (OTC nasal sprays, "coke," cigarette smoke). Sinuses can also become obstructed by tumors or growths which are in the proximity of the sinus ostia. The drainage of mucous from the sinuses can be impaired by thickening of the mucous secretions, by decrease in hydration (water content) of the mucous brought on by disease (cystic fibrosis), drying medications (antihistamines), and lack of sufficient humidity in the air. The mucous producing cells have small hairlike fibers, called cilia, which move back and forth to help the mucous move out of the sinuses. These small cilia may be damaged by many irritants, especially smoke, which then prevents them from assisting the mucous from draining from the sinuses. Stagnated mucous then provides a perfect environment for bacteria and in some circumstances (i.e.: AIDS) fungus to grow in the sinus cavities.

What are the types of sinus infections?

Sinus infection may be classified in at least two ways, based on the time span of the problem (acute, subacute, or chronic ) and the type of inflammation (either infectious or noninfectious). Acute sinus infection is usually defined as being of less than 30 days duration; subacute sinus infection as being over 1 month but less than 3 months; and chronic sinus infection as being greater than 3 months duration. Infected sinusitis is usually caused by uncomplicated virus infection. Far less frequently bacterial growth causes sinus infection. Noninfectious sinusitis can be caused by irritants and allergic conditions. Subacute and chronic forms of sinus infection usually are the result of incomplete treatment of an acute sinus infection.

What are the symptoms of sinus infection?

Commonly the symptoms of sinus infection are headache, facial tenderness or pain, and fever. However, as few as 25% of patients may have fever associated with acute sinus infection. Other common symptoms include cloudy, discolored nasal drainage, a feeling of nasal stuffiness, a sore throat, and a cough. Some people notice an increased sensitivity or headache when they lean forward. In allergic sinusitis other associated allergy symptoms of itching eyes and sneezing may be common.

How is sinus infection diagnosed?

Sinus infection is most often diagnosed based on a history and examination made by your doctor. Because plain x-ray studies of the sinuses may be misleading and procedures such as CT scans and MRI scans, which are much more sensitive in their ability to diagnose sinus infection, are so expensive, most cases of sinus infection are initially diagnosed and treated based on clinical findings on examination. These physical findings may include redness and swelling of the nasal passages, purulent (pus like) drainage from the nasal passages, tenderness to percussion (tapping) over the cheeks or forehead region of the sinuses, and swelling about the eyes and cheeks. If sinus infection fails to respond to the initial treatment prescribed, then more in-depth studies such as the above scans may be performed. Rhinoscopy, a procedure for directly looking in the back of the nasal passages with a small flexible fiber optic tube, may be used to directly look at the sinus openings and check for obstruction of these openings by either swelling or growths. It may sometimes be necessary to perform a needle aspiration of a sinus to confirm the diagnosis of sinus infection, and to get infected material to culture to determine what bacteria is actually causing the sinus infection. Cultures of the nasal passages are rarely helpful in determining what bacteria or fungus is causing a sinus infection.

How is sinus infection treated?

For sinusitis caused by virus infection, no antibiotic treatment is required. Frequently recommended treatments include pain and fever medications (such as acetaminophen/Tylenol) and decongestants. Bacterial infection of the sinuses is suspected when facial pain, pus nasal discharge and symptoms persist for longer than a week and are not responding to over-the-counter nasal medications. Acute sinus infection from bacteria is usually treated with antibiotic therapy aimed at treating the most common bacteria known to cause sinus infection, since it is unusual to be able to get a reliable culture without aspirating the sinuses. The five most common bacteria causing sinus infections are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Streptococcus pyogenes. The antibiotics that are effective treatment for sinus infection must be able to kill these bacterial types. Amoxicillin (Amoxil) is an acceptable first antibiotic for an uncomplicated acute sinus infection. In the penicillin allergic patient, cefaclor (Ceclor), loracarbef (Lorabid), clarithromycin (Biaxin), azithromycin (Zithromax), sulfamethoxazole and trimethoprim (Bactrim, Septra) may be used as first choices. If a patient is not improving after five days of treatment with amoxicillin, the patient may be switched to one of the above drugs or amoxicillin-clavulanate (Augmentin). Generally an effective antibiotic needs to be continued for a minimum of 10-14 days. It is however not unusual to need to treat sinus infection for 14-21 days. Taking decongestants (pseudoephedrine) and mucolytics (guaifenesin) orally may be helpful in assisting drainage of sinus infection. In general, antihistamines should be avoided unless it is felt that the sinus infection is due to allergy, such as from pollens, dander, or other environmental causes. It is likely that the use of a topical nasal steroid spray will help reduce swelling in the allergic individual without the drying that is caused by using antihistamines. The treatment of chronic forms of sinus infection require longer courses of drugs such as Augmentin and may require a sinus drainage procedure. This drainage typically requires a surgical operation to open the blocked sinus under general anesthesia.

What are complications of sinus infection?

While serious complications do not occur frequently, it is possible for sinus infection to cause a direct extension of infection into the brain, creating a life threatening emergency.

Conclusions

Sinus infection, when treated in an appropriate manner early in the course of the illness, can usually be treated effectively. It is important to seek the advice and evaluation of your physician if you suspect that you have sinus infection. If you are prone to recurrent bouts of sinus infection it may be important for you to consider allergy testing to see if this is the underlying cause of your recurring problem.

Sinus Infection At A Glance

• Sinus infection is a form of inflammation of air cavities (sinusitis) caused by infection.
• Sinusitis can be caused from allergies, irritants, or infection within the sinuses.
• Sinus infection can cause pain in the face, teeth, or head.
• Infected sinusitis is usually caused by uncomplicated virus infection.
• Bacterial infection of the sinuses is suspected when facial pain, pus nasal discharge and symptoms persist for longer than a week and are not responding to over-the-counter nasal medications.
• Bacterial sinusitis is usually threated with antibiotic therapy.

Sinusitis

You're coughing and sneezing and tired and achy. You think that you might be getting a cold. Later, when the medicines you've been taking to relieve the symptoms of the common cold are not working and you've now got a terrible headache, you finally drag yourself to the doctor. After listening to your history of symptoms, examining your face and forehead, and perhaps doing a sinus X-ray, the doctor says you have sinusitis.

Sinusitis simply means inflammation of the sinuses, but this gives little indication of the misery and pain this condition can cause. Chronic sinusitis, sinusitis that persists for at least 3 weeks, affects an estimated 32 million people in the United States. Americans spend millions of dollars each year for medications that promise relief from their sinus symptoms.

Sinuses are hollow air spaces, of which there are many in the human body. When people say, "I'm having a sinus attack," they usually are referring to symptoms in one or more of four pairs of cavities, or spaces, known as paranasal sinuses. These cavities, located within the skull or bones of the head surrounding the nose, include the frontal sinuses over the eyes in the brow area; the maxillary sinuses inside each cheekbone; the ethmoids just behind the bridge of the nose and between the eyes; and behind them, the sphenoids in the upper region of the nose and behind the eyes.

Each sinus has an opening into the nose for the free exchange of air and mucus, and each is joined with the nasal passages by a continuous mucous membrane lining. Therefore, anything that causes a swelling in the nose -- an infection or an allergic reaction -- also can affect the sinuses. Air trapped within an obstructed sinus, along with pus or other secretions, may cause pressure on the sinus wall. The result is the sometimes intense pain of a sinus attack. Similarly, when air is prevented from entering a paranasal sinus by a swollen membrane at the opening, a vacuum can be created that also causes pain.

Symptoms

Sinusitis has its own localized pain signals, depending upon the particular sinus affected. Headache upon awakening in the morning is characteristic of sinus involvement. Pain when the forehead over the frontal sinuses is touched may indicate inflammation of the frontal sinuses. Infection in the maxillary sinuses can cause the upper jaw and teeth to ache and the cheeks to become tender to the touch. Since the ethmoid sinuses are near the tear ducts in the corner of the eyes, inflammation of these cavities often causes swelling of the eyelids and tissues around the eyes, and pain between the eyes. Ethmoid inflammation also can cause tenderness when the sides of the nose are touched, a loss of smell, and a stuffy nose. Although the sphenoid sinuses are less frequently affected, infection in this area can cause earaches, neck pain, and deep aching at the top of the head.

However, most patients with sinusitis have pain or tenderness in several locations, and symptoms usually do not clearly define which sinuses are inflamed.

Other symptoms of sinusitis can include fever, weakness, tiredness, a cough that may be more severe at night, and runny nose or nasal congestion. In addition, drainage of mucus from the sphenoids (or other sinuses) down the back of the throat (postnasal drip) can cause a sore throat and can irritate the membranes lining the larynx (upper windpipe). On rare occasions, acute sinusitis can result in brain infection and serious complications.

Causes

Most cases of acute sinusitis are preceded by virus-induced "colds." These viral "colds" do not cause symptoms of sinusitis, but they do cause inflammation of the sinuses. Both the "cold" and the sinus inflammation usually resolve without treatment in two weeks. However, the inflammation might explain why colds increase the likelihood of developing acute sinusitis. For example, the nose reacts to an invasion by viruses that cause infections such as the common cold, flu, or measles by producing mucus and sending white blood cells to the lining of the nose, which congest and swell the nasal passages. When this swelling involves the adjacent mucous membranes of the sinuses, air and mucus are trapped behind the narrowed openings of the sinuses. If the sinus openings become too narrow to permit drainage of the mucus, then bacteria, which normally are present in the respiratory tract, begin to multiply. Most healthy people harbor bacteria, such as Streptococcus pneumoniae and Haemophilus influenzae, in their upper respiratory tracts with no ill effects until the body's defenses are weakened or drainage from the sinuses is blocked by a cold or other viral infection. The bacteria that may have been living harmlessly in the nose or throat can multiply and cause an acute sinus infection.

Sometimes, fungal infections can cause acute sinusitis. Although these organisms are abundant in the environment, they usually are harmless to healthy people, indicating that the human body has a natural resistance to them. Fungi, such as Aspergillus, can cause serious illness in people whose immune systems are not functioning properly. Some people with fungal sinusitis have an allergic-type reaction to the fungi.

Chronic inflammation of the nasal passages (rhinitis) also can lead to sinusitis. Allergic rhinitis or hay fever (discussed below) may be complicated by episodes of acute sinusitis. Patients with allergic rhinitis also often have chronic sinusitis. Vasomotor rhinitis, caused by humidity, cold air, alcohol, perfumes, and other environmental conditions, also may be complicated by sinus infections.

Acute sinusitis is much more common in certain patients than in the general population. For example, sinusitis occurs more often in patients with reduced immune function (such as patients with immune deficiencies and HIV infection) and with abnormality of mucus secretion or mucus movement (such as cystic fibrosis and diseases of abnormal cilia (Kartagener's syndrome)).

Chronic Sinusitis

Chronic sinusitis refers to inflammation of the sinuses that continues for at least 3 weeks, but often continues for months or even years.

As noted above, allergies are frequently associated with chronic sinusitis. Patients with asthma have a particularly high frequency of chronic sinusitis. Inhalation of airborne allergens (substances that provoke an allergic reaction), such as dust, mold, and pollen, often set off allergic reactions (allergic rhinitis) that, in turn, may contribute to sinusitis. People who are allergic to fungi can develop a condition called "allergic fungal sinusitis."

Damp weather, especially in northern temperate climates, or pollutants in the air and in buildings also can affect people subject to chronic sinusitis.

Like acute sinusitis, chronic sinusitis is more common in patients with immune deficiency or abnormalities of mucus secretion or movement (e.g., immune deficiency, HIV infection, cystic fibrosis, Kartagener's syndrome). In addition, some patients have severe asthma, nasal polyps, and severe asthmatic responses to aspirin and aspirin-like medications (so-called non-steroidal anti-inflammatory drugs, or NSAIDs). These latter patients have a high frequency of chronic sinusitis.

Diagnosis

Although a stuffy nose can occur in other conditions, like the common cold, many people confuse simple nasal congestion with sinusitis. A cold, however, usually lasts about 7 to 14 days and disappears without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than just a cold. A doctor can diagnose sinusitis by medical history, physical examination, X-rays, and if necessary, MRIs or CT scans (magnetic resonance imaging and computed tomography).

Treatment

After diagnosing sinusitis and identifying a possible cause, a doctor can prescribe a course of treatment that will reduce the inflammation and relieve the symptoms.

Acute sinusitis is treated by re-establishing drainage of the nasal passages, controlling or eliminating the source of the inflammation, and relieving the pain. Doctors generally recommend decongestants to reduce the congestion, antibiotics to control a bacterial infection, if present, and pain relievers to reduce the pain.

Over-the-counter and prescription decongestant nose drops and sprays, however, should not be used for more than a few days. When used for longer periods, these drugs can lead to even more congestion and swelling of the nasal passages.

Most patients with sinusitis that is caused by bacteria can be treated successfully with antibiotics used along with a nasal or oral decongestant. An antibiotic that fights the bacteria most commonly associated with sinusitis is the initial treatment recommended.

Many cases of acute sinusitis resolve without antibiotics. However, patients with underlying allergic disease, and infectious sinusitis, need to be treated to relieve their allergy symptoms. Patients with asthma and infectious sinusitis often have exacerbations of asthma which need to be treated. Many physicians feel that some patients with severe asthma have dramatic symptom improvement when their chronic sinusitis is treated with antibiotics.

Doctors often prescribe steroid nasal sprays, along with other treatments, to reduce the congestion, swelling, and inflammation of sinusitis.

Chronic sinusitis is often difficult to treat successfully, as symptoms persist even after prolonged courses of antibiotics. In general, the treatment of chronic sinusitis, such as with antibiotics and decongestants, is similar to treatment of acute sinusitis. However, the role of bacterial infections, and hence the usefulness of antibiotics in treating chronic sinusitis, is debated. Steroid nasal sprays are commonly used to reduce inflammation in chronic sinusitis. Although these nasal sprays are occasionally used for long-term treatment for patients with chronic sinusitis, the long-term safety of these medications, especially in children, is not fully understood, and the benefits and risks need to be balanced. For patients with severe chronic sinusitis, a doctor may prescribe oral steroids, such as prednisone. Because oral steroids can have significant side effects, they are prescribed only when other medications have not been effective.

Although sinus infection cannot be cured by home remedies, people can use them to lessen their discomfort. Inhaling steam from a vaporizer or a hot cup of water can soothe inflamed sinus cavities. Another treatment is saline nasal spray, which can be purchased in a pharmacy. A hot water bottle; hot, wet compresses; or an electric heating pad applied over the inflamed area also can be comforting.

When medical treatment fails, surgery may be the only alternative for treating chronic sinusitis. Studies suggest that the vast majority of patients who undergo surgery have fewer symptoms and better quality of life. In children, problems often are eliminated by removal of adenoids obstructing nasal-sinus passages. Adults who have had allergic and infectious conditions over the years sometimes develop nasal polyps that interfere with proper drainage. Removal of these polyps and/or repair of a deviated septum to ensure an open airway often provides considerable relief from sinus symptoms. The most common surgery done today is functional endoscopic sinus surgery, in which the natural openings from the sinuses are enlarged to allow drainage. This type of surgery is less invasive than conventional sinus surgery and serious complications are rare.

Prevention

Although people cannot prevent all sinus disorders -- any more than they can avoid all colds or bacterial infections -- they can take certain measures to reduce the number and severity of the attacks and possibly prevent sinusitis from becoming chronic.

Many people with sinusitis find partial relief from their symptoms when humidifiers are installed in their homes, particularly if room air is heated by a dry forced-air system. Air conditioners help to provide an even temperature, and electrostatic filters attached to heating and air conditioning equipment are helpful in removing allergens from the air.

A person susceptible to sinus disorders, particularly one who also is allergic, should avoid cigarette smoke and other air pollutants. Inflammation in the nose caused by allergies predisposes a patient to a strong reaction to all irritants. Drinking alcohol also causes the nasal-sinus membranes to swell.

Sinusitis-prone persons may be uncomfortable in swimming pools treated with chlorine, since it irritates the lining of the nose and sinuses. Divers often experience congestion with resulting infection when water is forced into the sinuses from the nasal passages.

Air travel, too, poses a problem for the individual suffering from acute or chronic sinusitis. A bubble of air trapped within the body expands as air pressure in a plane is reduced. This expansion causes pressure on surrounding tissues and can result in a blockage of the sinuses or the eustachian tubes in the ears. The result may be discomfort in the sinus or middle ear during the plane's ascent or descent. Doctors recommend using decongestant nose drops or inhalers before the flight to avoid this difficulty.

People who suspect that their sinus inflammation may be related to dust, mold, pollen, or food -- or any of the hundreds of allergens that can trigger a respiratory reaction -- should consult a doctor. Various tests can determine the cause of the allergy and also help the doctor recommend steps to reduce or limit allergy symptoms.

Quiz : Do I Have Sinusitis?

Sinusitis is inflammation of the lining membrane of any sinus. Take the following quiz to see if you have sinusitis.

Choose "yes" if you have any of the following symptoms for ten days or longer; otherwise, choose "no."

1. Facial pressure/pain?

yes no


2. Headache pain?

yes no


3. Congestion or stuffy nose?

yes no


4. Thick, yellow-green nasal discharge?

yes no


5. Low fever (99-100°)?

yes no


6. Bad breath?

yes no


7. Pain in the upper teeth?

yes no

If you answered "Yes" to three or more of the symptoms listed above, you may have a sinus infection resulting from allergies, bacteria, or a response to fungi. An examination by an ear, nose, and throat specialist may be warranted.

©Editor's Note: The text from this quiz may be freely used. Attribution to the American Academy of Otolaryngology - Head and Neck Surgery is required.

Sembuh dari sinusitis tanpa operasi

Oleh dr. Oetomo Hasdisoedarmo

Apa Sinusitis?

Adalah infeksi pada sinus (rongga disekitar mata, pipi dan hidung), sehingga berisi nanah (lendir kental kuning atau kehijauan.

Pada awalnya lendir dapat dikeluarkan lewat hidung atau tenggorok. Bila penyakitnya berlanjut kerana tidak diberikan pengobatan secara benar akan terjadi pembengkakan mukosa sinus yang menutup lubang lintasan dari sinus ke hidung dan tenggorok. Akibatnya nanah makin tertimbun di rongga sinus sehingga menyebabkan rasa tertekan dan nyeri pada daerah tersebut.

Apa penyebab Sinusitis?

Infeksi saluran napas bagian atas, alergi hidung atau penyebab lain mengakibatkan penyumbatan pada lubang lintasan dari sinus ke hidung dan tenggorok mengakibatkan lendir tertimbun di sinus. Lendir ini merupakan media yang sangat baik untuk pertumbuhan bakteri atau jamur yang menyebabkan sinusitis.

Apa gejala utama Sinusitis?

• Hidung tersumbat dan berair disertai Keluarnya lendir kental warna kuning atau kehijauan lewat hidung atau langit langit tenggorok.
• Nyeri dan rasa tertekan pada daerah sinus yang terkena. Rasa nyeri dipicu bila daerah tersebut diketuk dengan jari (nyeri ketuk) atau bila kepala digelengkan dengan kuat.
• Sinusitis maxillaris akan menimbulkan nyeri di pipi dan gigi atas,
• Nyeri pada dahi bawah dan alis mata adalah sinusitis frontalis.
• Nyeri dibelakang mata, pada puncak kepala, pada pelipis oleh karena Sinusitis sphenoid.
• Nyeri dibalik mata oleh sinusitis ethmoid.

Apa gejala lainnya?

Sakit kepala, demam, batuk, berkurangnya penciuman dan taste lidah, bau tidak sedap dari mulut atau hidung.

Apakah bahaya sinusitis?

Dapat meluas menjadi infeksi tulang muka, abces, infeksi menjalar ke otak, telinga, mata..

Kondisi apa yang meningkatkan resiko mendapat sinusitis?

• bila terserang flu atau infeksi saluran napas bagian atas (virus, bakteri).
• menderita pilek alergi (pilek tiap pagi, ingus encer seperti air)
• kelainan anatomi pada tulang hidung atau sinus
• polyp hidung.
• faktor lain seperti merokok, polusi udara, terlalu sering memakai nasal spray dekongestan, cuaca dingin, perubahan tekanan udara mendadak (naik pesawat, diving)

Kapan harus ke dokter?

Bila menderita batuk pilek tetapi setelah menum obat sendiri dalam beberapa hari penyakitnya tidak membaik bahkan memburuk disertai timbul nya gejala tambahan seperti:

• nyeri pada muka, pipi, dahi, belakang mata atau sakit kepala yang tidak sembuh walaupun sudah minum pain killer
• Atau panas badan naik tinggi sehingga lebih dari 38,5 derajat Celsius disertai perubahan lendir yang keluar dari hidung atau tenggorok yang mulanya jernih lengket menjadi tebal kental warna kuning atau kehijauan (sinusitis akut)
• menderita pilek lebih dari 2 minggu.
• nyeri kepala kronis yanf lebih dari 1 bulan

Bagaimana dokter mendiagnose Sinusitis?

• riwayat penyakit
• pemeriksaan pisik.
• Pemeriksaan penunjang: radiologi, CT scan, MRI dst

Bagaimana pengobatannya?

• Dokter akan memberikan antibiotika, dekongestan, pengencer lendir, analgetik antipiretik atau menganjurkan operasi (tergantung kondisi penyakit dan kondisi pasien).
• Tujuan operasi adalah untuk membersihkan dan mengeringkan lendir dari sinus, memperbaiki sistim drainage cairan sinus, memperbaiki kelainan anatomi tulang hidung dan sinus atau membuang polyp.

Apakah laserpuntur dapat mengobati Sinusitis?

Ya, meode ini terbukti efektif untuk drainage (membuang) nanah yang terjebak di rongga sinus.

Bagaimana cara bekerjanya terapi dengan metode ini?

Sinar laser jenis infrared disinarkan pada titik akupuntur tertentu di punggung dan dada atas, tengkuk, muka sekitar hidung dan sinus.

Sifat sinar ini adalah sebagai

anti radang sehingga akan mengurangi pembengkakan pada mukosa sinus sehingga lubang lintasan dari sinus ke hidung dan tenggorok akan terbuka dan cairan nanah akan keluar.

Memperlancar microsirkulasi dan meningkatkan metabolisme sel sehingga akan mempercepat pemulihan mukosa sinus kearah normal.

Rangsangan pada titik akupuntur terbukti meningkatkan sistim imun terhadap reaksi alergi hidung

Apakah pengobatan laserpuntur menimbulkan perasaan sakit?

Tidak ada rasa sakit, tidak ada efek samping sehingga pengobatan dengan cara ini disukai anak anak.

Apakah selama therapy diberikan obat?

Sinusitis adalah penyakit infeksi sehingga pada awal pengobatan harus diberikan antibiotika, dekongestan dan pengencer lendir.

Berapa lama pengobatannya?

Pengobatan laserpuntur harus dilakukan tiga hari berturut turut, kemudian selang satu hari dan dilanjutkan seminggu dua kali sehingga minimal sepuluh kali kunjungan..

Reaksi selama pengobatan lendir akan keluar banyak terutama pada pagi hari dari hidung atau tenggorok yang menandakan bahwa sumbatan sinus telah terbuka.

Bila rasa tersumbat sudah hilang dan lendir tidak ada lagi, tidak ada sakit kepala atau nyeri pada daerah sinus, bernapas lebih baik, tidur lebih nyenyak, penciuman dan taste normal. Hal ini menandakan bahwa sinusitis telah dapat diatasi dengan sangat memuaskan..

Dimana untuk mendapatkan keterangan lebih lengkap tentang pengobatan Laserpuncture?

Dapat menghubungi Dr Oetomoo di telfon no 0816 4333 501 atau (021) 548 4459.di Jalan Kemanggisan Utama Raya no F11, Slipi, Jakarta Barat

Bagaimana cara pengobatan sendiri di rumah?

• Minum obat flu untuk mengurangi panas, nyeri dan hidung tersumbat dan obat pengencer lendir.
• Minum banyak air untuk mengencerkan lendir.
• Kompres muka dengan handuk yang dibasahi air hangat selama 10 menit beberapa kali sehari.
• Bernafas dalam udara hangat yang lembab (steam shower) atau bernapas diatas uap panas (air mendidih di baskom)
• Hindari udara terlalu dingin kering (ruang AC).
• Irigasi hidung dengan air garam untuk menjaga agar lendir dan bakteri tercuci keluar.
• kumur air garam hangat.setengah gelas ditambah garam 1 sendok teh.
• Dapat dipergunakan nasal spray sebagai dekongestan.
• Apabila meniup melalui hidung, jangan terlalu kuat karena akan mendorong balik ledir kental kedalam sinus.Kedua lubang hidung tetap terbuka waktu meniup hidung pelan pelan.

Bagaimana pencegahan sinusitis?

• Obati segera bila menderita flu atau pilek alergi
• Hindari kontak dengan penderita flu, bila telah terjadi kontak pisik, segera cuci tangan.
• Hindari rokok karena asapnya dapat menyebabkan iritasi mukosa hidung dan sinus.
• Hindari udara kering, pakailah alat pelembab udara.dirumah atau dikantor
• Bila menderita alergi, hindari semua barang yang dapat memicu alergi

Apakah ada makanan dan suplemen yang dianjurkan?

Dianjurkan banyak konsumsi sayur dan buah segar, minum vitamin A, B, C dan anti oksidan, Hindari produk susu dan turunannya dan makanan yang alergi

Catatan

Sinusitis harus dibedakan dengan pilek atau rhinitis, pilek alergi atau rhinitis alergi, polip atau polyp hidung.Hidung tersumbat, sakit kepala, sakit dahi, sakit samping hidung, tidak mencium bau, sering bersin, keluar cairan hidung saau hidung berair sering di akibat sinusitis.