**1.9 Malignancy of sinusitis**

Sinusitis may spread to the soft tissues of eye orbits, face and bones. Due to the malignancy periorbital cellulitis, facial cellulitis, blindness and orbital abscess may develop. Sinusitis can breach into the brain and cause intra cranial disorders such as meningitis, epidural or subdural empyema and cavernous sinus thrombosis [11].

### **1.10 Treatment strategies**

Treatment for sinusitis include, nasal wash, decongestants, humidification, nasal sprays, corticosteroids, antibiotics and nasal surgery [12].

## *1.10.1 Saline nasal wash*

Saline nasal wash are in the form of nasal sprays or nasal solutions, which are intended to rinse away allergens and irritants and also to reduce drainage [13].

### *1.10.2 Nasal decongestants*

Topical as well as systemic nasal decongestants can be used such as pseudoephedrine. Caution should be taken in using decongestants. Oxymetazoline should not be used for more than 3 days as it causes rebound congestion. Oral decongestants should be used with special care in hypertensive patients [14].

## *1.10.3 Nasal corticosteroids*

Nasal corticosteroids help in reduction and treatment of inflammation. Nasal corticosteroid sprays include beclomethasone, fluticasone, budesonide, mometasone, and triamcinolone. Topical nasal sprays effectively treat mucosal edema but they are more effective in chronic sinusitis [15].

### *1.10.4 Parenteral or oral corticosteroids*

These corticosteroids are used in severe inflammation especially if patient is suffering from nasal polyps. Oral corticosteroids have serious side effects when used for long term so, it should be used only to treat severe symptoms [16].

#### *1.10.5 Antibiotics*

Antibiotics are given in case of bacterial sinusitis. In case of bacterial infection amoxicillin or amoxicillin-clavulanate for 10–14 days is the first line treatment. Trimethoprim-sulfamethoxazole is effective for some population but there is high rate of resistance. If symptoms do not resolve in 7 days then broader spectrum agents are used such as augmentin, axetil, cefuroxime, second or third generation cephalosporins, fluoroquinolones and clindamycin. For anaerobic bacterial infection metronidazole can also add in the therapy [17].

#### *1.10.6 Aspirin desensitization treatment*

If patient is sensitize to the aspirin and may develop sinusitis then under medical supervision gradually larger doses are given to patient to increase the tolerance of aspirin.

#### *1.10.7 Immunotherapy*

Patients who are sensitive to allergens and these allergens may contribute to sinusitis. Immunotherapy is suggested to those individuals. Which help to reduce the body reaction against specific allergens.

**29**

*Sinusitis, Asthma and Headache*

*1.10.8 Endoscopic sinus surgery*

*1.11.1 Topical steroids*

*1.11.2 Systematic steroids*

**1.12 Prognosis of sinusitis**

*DOI: http://dx.doi.org/10.5772/intechopen.90210*

used to remove mucous or to scrap polyps [18].

40 years. Among steroids hydrocortisone is the first to be used.

Generally more potent steroids have more side effects.

of the medicine, disease relapses quickly [19].

**1.13 Progression of acute sinusitis into asthma**

known as sinusitis related asthma [21, 22].

**2. Sinusitis related asthma**

**1.11 Use of steroids in atopic patients**

If the medications are not effective in treatment of sinusitis then endoscopic sinus surgery would be an option. In this surgery endoscope is used to explore sinuses. Depending upon the obstruction source different instruments might be

Atopy is the development of allergic hypersensitive reactions or IgE-mediated reactions. Atopic patients may develop genetic allergic diseases such as asthma, rhinitis, and atopic dermatitis. Atopy usually associated with the inhaled or food allergens. Topical corticosteroids are the major steroids used for atopy over

Acute atopic attack is treated by medium to high strength topical steroid for upto 2 weeks. These steroids should not be used for face and neck area because of side effects. Ointment should be apply within 5 min of twice daily bathing. Patients may also suffer from side effects such as atrophy, hypopigmentation, thinning of skin.

The use of systematic steroid is under controversy for acute atopy. Most of the prescribers do not prescribe systematic steroids for acute atopy. For severe cases oral prednisone at usual dose of 20 mg/day for 7 days are used. But after discontinuation

Patients with acute sinusitis are treated effectively as outpatient with better prediction of disease. Whereas, severe sinusitis of sphenoid and frontal area associated with air and fluid accumulation require I/V injection of antibiotics and keep under care in hospital. High mortality and morbidity rates are associated with fungal sinusitis. Immunocompromised patients should also get hospitalized [20].

Acute sinusitis often begins with the symptoms of common cold. These symptoms may fade away in less than 4 weeks but if symptoms persist for more than 12 weeks despite of proper medical treatment then acute sinusitis is converted into chronic sinusitis. In chronic sinusitis airways get severely inflamed with either bacterial or viral infection, which leads to the development of asthma. Which is

Asthma is a chronic disorder that involves airflow obstruction, an underlying inflammation and bronchial hyper responsiveness. Asthma is complicated disorder
