Module 3. Sinusitis and Congestion

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1 Module Sinusitis and Congestion

What are sinuses? Sinuses are air-filled spaces or cavities within the skull that are lined with mucous membranes a. What is sinusitis?

How to Spot Sinusitis Here are some common symptoms to look out for in both acute and chronic sinusitis: Humans have four pairs of sinuses a : Congestion in the nose a Pain and swelling in the sinus

especially at night a Discoloured discharge can be found in severe cases of sinusitis a, while a postnasal drip that irritates the throat is associated specifically with chronic sinusitis a.

2 What are sinuses? Sinuses are air-filled spaces or cavities within the skull that are lined with mucous membranes a. What is sinusitis? Sinusitis is the inflammation of the air cavities within the passages of the nose a. How to Spot Sinusitis Here are some common symptoms to look out for in both acute and chronic sinusitis: Humans have four pairs of sinuses a : Congestion in the nose a Pain and swelling in the sinus areas a Frontal sinuses in the forehead Ethmoid sinuses between the eyes Maxillary sinuses behind the cheeks Decreased sense of smell a Headache, toothache, earache and eye pain a Productive cough especially at night a Discoloured discharge can be found in severe cases of sinusitis a, while a postnasal drip that irritates the throat is associated specifically with chronic sinusitis a. Sphenoid sinuses deep behind the ethmoids The tiny hairs (cilia) in the sinuses make sure mucus gets dispelled b. But an increase in mucus production due to viral, bacterial or fungal infections can block the sinuses b, which leads to sinusitis. The Causes of Sinusitis Sinusitis, or the inflammation of the sinuses, can be caused by any of the following: Viral infections a Bacterial infections a Fungal infections b Allergic reactions c,5,c Nasal polyps d Dehydration b Medications b 60 6

Sinusitis Due to a Cold or the Flu Let s take a step-by-step look at how sinusitis usually develops from a b : Facial pain and tenderness c Productive cough especially at night c 5 6 During a cold

3 Sinusitis Due to a Cold or the Flu Let s take a step-by-step look at how sinusitis usually develops from a b : Facial pain and tenderness c Productive cough especially at night c 5 6 During a cold the mucous membranes in the nasal cavity swell up and block the openings of the sinuses. More air in the sinuses is absorbed into the bloodstream. Pressure inside the sinuses decreases, drawing fluid into the sinuses and causing discomfort. The build-up of trapped fluid encourages bacteria to multiply. White blood cells and more fluid enter the sinuses to fight off the bacteria. This leads to continued pressure changes and pain. Congestion in the nose c Swelling over the infected sinus c Decreased sense of smell c Possible bad breath or halitosis c Headache due to pressure in blocked sinuses, bending down can increase pain c General feeling of fatigue due to fever, immune response or coughing c Key Symptoms of Sinusitis Toothache caused by pressure on surrounding nerves and tissues c Earache caused by pressure on surrounding nerves and tissues c Eye pain caused by pressure on surrounding nerves and tissues c Discoloured nasal discharge in severe cases c Postnasal drip this irritates the throat tissue c and is associated with chronic sinusitis c Diagnosis: Top Tip Ask your patient whether they are experiencing fever and chills, because when these develop it may mean the infection has spread beyond the sinuses e. Knowing the exact symptoms will help you establish what the best course of action is. Sinusitis in Children At first, it can be tricky to distinguish sinusitis from an upper respiratory tract infection in children f. Sinusitis is, however, usually the suspect when pus-filled nasal discharge continues for more than 0 days, and the child remains tired with a persistent cough d. 6 6

What is Congestion? Congestion refers to the stuffiness or fullness patients experience in the nasal or breathing passageways and in the sinuses when they get sick 6.

This increase happens because white blood cells rush to the area to defend you. This narrows the air passages in your nose, which restricts airflow. What Can Your Patients Do About Congestion?

4 What is Congestion? Congestion refers to the stuffiness or fullness patients experience in the nasal or breathing passageways and in the sinuses when they get sick 6. Nasal and sinus congestion is usually caused by increased blood volume in the vessels that line the passages of the nose 6. This increase happens because white blood cells rush to the area to defend you. This narrows the air passages in your nose, which restricts airflow. What Can Your Patients Do About Congestion? e Inhale steam over a hot basin or from a vaporiser Place hot, wet towels over the sinuses Consume hot drinks Flush the nose with saline spray Use a decongestant What is a Decongestant? Spencer has come to the pharmacy to ask for advice. He tells you that his nose is blocked and that he is experiencing facial pain. He also cannot smell anything and his head and ears are aching. On top of this, he s feeling lethargic. Case Study Spencer, 9, Nature Photographer He would like to know what OTC product he can take to help him get over his symptoms and focus on his next shoot. Ask the following questions A decongestant reduces the swelling in the passages of your nose and allows you to breathe more easily 7. Decongestants are often available in spray form e, often with xylometazoline or phenylephrine, and in oral form, often with pseudoephedrine e.! Complications of sinusitis include f,c :. Swelling of the tissue around the eye. Vision changes Urgent Assistance. Severe headaches. Confusion 5. Meningitis/Neck stiffness 6. Rare fungal infections How long have the symptoms lasted for? Where is he experiencing facial pain? How severe is his headache? Does he have toothache? Does he have a fever? Does he have a cough? Does he have discoloured nasal discharge? Is he experiencing a feeling of malaise? Does he have a postnasal drip? Has he taken any other medicine for the condition? Is he experiencing problems with his vision? Patients with such symptoms/conditions should seek medical treatment immediately f. As stipulated in Section A subsection and 5 of the Medicines and Related Substances Act 0 of 965, product recommendations can only be made by Pharmacists and Pharmacist Assistants acting under the personal supervision of a pharmacist (S S). Any customer seeking medical advice from a Front Shop 6 65

He has not taken any other medication for his symptoms yet. Diagnosis: You establish that Spencer has sinusitis.

5 Spencer tells you that the symptoms started 8 hours before he came to your pharmacy. He s feeling fatigued and a bit shivery and he says his face aches above and underneath his eyes, but he does not have discoloured discharge or a postnasal drip that he s aware of. He has not taken any other medication for his symptoms yet. Diagnosis: You establish that Spencer has sinusitis. It s likely a cold or the flu that s lead to Spenser s condition, but it s not a severe case of sinusitis, as he doesn t have discoloured nasal discharge. It s also an acute case as it only recently started and he doesn t have a postnasal drip. If the pain Spencer is experiencing is severe, you can also recommend: Sinus Pain Extra Strength Severe sinus pain Treatment You can recommend the following OTC products to help Spencer cope with the symptoms of sinusitis*: Sinus Allergy Congestion & Pain Pseudoephedrine Hydrochloride 0 mg per tablet Codeine Phosphate 0 mg per tablet Chlorpheniramine Maleate mg per tablet Paracetamol 500 mg per tablet Dosage Adults & children over years: tablets every 6 hours. Do not exceed 8 tablets in hours. Children 6 years: A half to tablet every 6 hours. Do not exceed tablets in hours. Children under 6 years: Not recommended. Mild to moderate sinus and allergy pain Pseudoephedrine Hydrochloride 0 mg per tablet Chlorpheniramine Maleate mg per tablet Paracetamol 500 mg per tablet Dosage Adults & children over years: tablets every 6 8 hours. Do not exceed 8 tablets in hours. Children under years: Not recommended. If the congestion is bothering him too much and disrupting his regular functions, he can use Nasal Spray to alleviate this. Nasal Spray Nasal congestion caused by colds, hay fever, allergic rhinitis and sinusitis Xylometazoline local vasoconstrictor to help open nasal passages and relieve congestion and a runny nose Dosage Adults & children over years: One spray into each nostril times per day, as required. Do not exceed sprays per day. Do not use for more than three days. * 66 67

Sinus Allergy Sinus Congestion & Pain Pain Extra Strength Nasal Spray Saline Spray Mild to moderate sinus and allergy pain Age: + Pseudoephedrine: Decongestant helps clear congested nasal passages

6 Sinus Allergy Sinus Congestion & Pain Pain Extra Strength Nasal Spray Saline Spray Mild to moderate sinus and allergy pain Age: + Pseudoephedrine: Decongestant helps clear congested nasal passages through vasoconstriction Starts to work in 0 mins 8 Lasts up to 8 hours 8 Chlorpheniramine: Antihistamine helps combat allergy features such as itchy, runny nose and eyes, and is mildly sedating Starts to work in 0 mins 9 Lasts 6 hours 9 Paracetamol: An analgesic and antipyretic active chiefly in the central nervous system, and is effective in a wide variety of mild to moderate pain conditions and in conditions associated with fever Starts to work in 0 60 mins 0 Lasts 6 hours 0 S SINUTAB Sinus Allergy Congestion and Pain. Each tablet contains: Pseudoephedrine Hydrochloride 0 mg, Chlorpheniramine Maleate mg, Paracetamol 500 mg. Reg. No. 7/ 5.8/060. As stipulated in Section A subsection and 5 of the Medicines and Related Substances Act 0 of 965, product recommendations can only be made by Pharmacists and Pharmacist Assistants acting under the personal supervision of a pharmacist (S S). Any customer seeking medical advice from a Front Shop Severe sinus pain Age: 6+ Pseudoephedrine: Decongestant helps clear congested nasal passages through vasoconstriction Starts to work in 0 mins 8 Lasts up to 8 hours 8 Chlorpheniramine: Antihistamine helps combat allergy features such as itchy, runny nose and eyes, and is mildly sedating Starts to work in 0 mins 9 Lasts 6 hours 9 Codeine: An opioid-type analgesic that is metabolised to morphine in the body it exerts its actions in the central and peripheral nervous systems, and it helps to amplify the pain-relieving actions of other analgesics such as paracetamol and the NSAIDs Starts to work in hour Lasts 6 hours Paracetamol: An analgesic and antipyretic active chiefly in the central nervous system, and is effective in a wide variety of mild to moderate pain conditions and in conditions associated with fever Starts to work in 0 60 mins 0 Lasts 6 hours 0 S SINUTAB Sinus Pain Extra Strength. Each tablet contains: Pseudoephedrine Hydrochloride 0 mg, Codeine Phosphate 0 mg, Chlorpheniramine Maleate mg, Paracetamol 500 mg. Reg No. 7/5.8/09. Nasal congestion caused by colds, hay fever, allergic rhinitis and sinusitis Age: + Xylometazoline: Local vasoconstrictor to help open nasal passages and relieve congestion and a runny nose Starts to work in 0 minutes Lasts up to 0 hours Cleans and moisturises nasal passages Supportive treatment for nasal congestion Age: All, incl. infants & toddlers Isotonic saline solution: Physiological salt solution flushes, soothes and moisturises nasal passages S SINUTAB Nasal Spray. Xylometazoline Hydrochloride mg per ml (0, % w/v). Reg. No. P/6./

7 Test Your Knowledge You ve reached the end of the module. You can test your knowledge right away while the info is fresh, or you can complete the full Class Test in one go once you reach the end of this Study Pack. See the back page of the booklet for more details on how to complete and submit your test. Below are the questions from the Class Test that applies to the module you just finished. The full Class Test appears on the Fax Sheet included separately. Which of the following ingredients helps manage pain rather than decongestion? a Xylometazoline b Phenylephrine c Pseudoephedrine d Paracetamol Which one of the following symptoms requires urgent assistance when it comes to sinusitis? a Severe headaches and confusion References. Fae Farrer. Sinusitis and Allergic Rhinitis. South African Pharmacy Journal 0; 8(8):. Available at index.php/sapa/article/view/598/97. Accessed on 0 December 07. b c Eye pain A productive cough. MedicineNet.com. Allergies Centre. Sinus Infection (Sinusitis). Available at Accessed on December 07.. Porter RS (Ed). Nose and Sinus Disorders: Sinusitis. The Merck Manual Home Health Handbook. Available at com/home/ear-nose-and-throat-disorders/nose-and-sinus-disorders/sinusitis. Accessed on 0 December 07. Which Which d Earache of the following products helps with congestion? a Sinus Pain Extra Strength b Sinus Allergy Congestion and Pain c Nasal Spray d All of the above one of the following ingredients is not found in Sinus Pain Extra Strength?. Porter RS (Ed). Nose and Paranasal Sinus Disorders: Sinusitis. The Merck Manual of Diagnosis and Therapy. Available at www. merckmanuals.com/professional/ear-nose-and-throat-disorders/nose-and-paranasal-sinus-disorders/sinusitis. Accessed on 0 December Health. 8 quick sinusitis facts. Available at Accessed on December Very well. What is congestion? Available at Accessed on December NHS Choices. Five facts about colds. Available at Accessed on December Drugs.com. Pseudoephedrine. Available at Accessed on 5 January Chlorpheniramine. DrugDex Evaluations Tucci J, Bandiera E, Darwiche R, Medos Z, Nashed R, Trinh D.Paracetamol and Ibuprofen for Paediatric Pain and Fever. Jnl Pharmacy Practice Research. 009; 9(): Martindale, The Complete Drug Reference, nd Edition, page 07.. R Eccles, K Martensson, Shirley C. Chen, 00, Effects of intranasal xylometazoline, alone or in combination with ipratropium, in patients with, Current Medical Research & Opinion, Vol. 6, No., 00, page a b c d Pseudoephedrine Hydrochloride Codeine Phosphate Ibuprofen Paracetamol 70 7

How to spot allergies. What are allergies? What can your patients do about allergies? How allergies cause sinusitis. Module 5 Allergies

How to spot allergies. What are allergies? What can your patients do about allergies? How allergies cause sinusitis. Module 5 Allergies Module 5 Allergies What are allergies? Allergies occur when a patient s immune system has a hypersensitive response to a substance that the body comes into contact with 1a. These substances, called allergens,