Sinusitis and Respiratory Conditions

Sinusitis

• The sinuses are hollow areas located above the eyes and behind and lateral to the nose, serving to lighten the weight of the head, give resonance to the voice, and provide additional surface area for the sticky, mucous membrane lining to trap pathogens during inhalation.

Anatomy

• Frontal, Ethmoidal, Sphenoidal, and Maxillary Sinuses
• Frontal and Occipital bones, Zygomatic Arch, Supra and Infra orbital margins, Mandible and Temporomandibular joint, Sphenoid bone, Cervical spine (particularly the Atlanto-occipital and Atlanto-axial joints)
• Frontalis and Occipitalis, Sub-occipitals, Upper Trapezius, Levator Scapula, Splenius Capitus, Splenius Cervicis, Sternocleidomastoid, Scalenes, and Masseter muscles

Signs and Symptoms

• Guarded head and neck movement
• Pained facial expression
• FEVER
• Malaise, muscle/joint ache
• Insomnia
• Loss of Appetite (anorexia)
• Swelling, redness around eyes and cheeks
• Watery eyes
• Itchy eyes, nose, throat
• Cough
• Mucous: thin & watery or thick & sticky
• Colour of mucous: clear, yellow, green
• Headache (especially in the morning)
• Muscle stiffness of head and neck
• Pain upon forward flexion
• Irritability
• Inability to concentrate
• Toothache
• Conjunctivitis
• Signs of Meningitis (rapid onset stiff neck and severe headache)

Types of Sinusitis

• Acute or chronic, recurrent inflammation of the mucous membranes in the para-nasal sinuses
• Caused by:
  • Viral or bacterial infection
  • Allergic reaction/rhinitis
  • Structural obstruction
  • Fungal infection
  • Intolerance to medicine

Sinus Headache

• A painful headache that often accompanies a sinusitis
• Location and quality defined by the location of maximum sinus irritation
• Types:
  • Frontal Sinus Headache: located in the frontal area above the eyes
  • Ethmoidal Sinus Headache: causes both a frontal headache that is described as "splitting" and pain behind the eyes
  • Sphenoidal Sinus Headache: less well localized, causing pain in both the frontal and occipital area
  • Maxillary Sinus Headache: causes pain in the maxillary area under the eyes, a frontal headache, and often toothache

Causes

• Viral/Bacterial:
  • May require medical treatment
  • Usually occurs when the immune defenses are low
  • Mucous is often thick, sticky, and green or yellow in colour
  • Client often has accompanying symptoms of malaise, fever, and chills
  • If left untreated, the infection can infiltrate the facial bones causing osteomyelitis and permanent bone damage or can infect the central nervous system causing Meningitis
• Allergic Sinusitis/Rhinitis:
  • Related to allergic reactions and is seasonal in nature
  • Hay Fever is the most common culprit along with wind-borne pollens
  • Characterized by the onset of itchy eyes, roof of mouth, pharynx, and eyes followed or accompanied by nasal congestion, sneezing, clear watery nasal discharge, watery eyes, frontal headache, and possible conjunctivitis
• Structural Obstruction:
  • A deviated septum or nasal polyps are the most common obstructions
  • While they are not infectious in and of themselves, they tend to obstruct the normal flow and drainage of the sinuses and create a desirable growth medium for bacterial infection
• Fungal Infections:
  • Most common in people who are immune-suppressed and as such, are more susceptible to infection by common fungi such as Aspergillus and Curvularia
  • Treated aggressively with IV therapy and paras nasal sinus surgery as this condition can often become a fatal infection
• Medication Intolerance:
  • On rare occasions, people can have reactions to medications such as aspirin or ibuprofen, which leads to inflammation of the sinuses but not infection
• Rebound Sinus Headache:
  • Overuse of nasal sprays that contain decongestants and anti-inflammatory medication

Bronchitis

• Acute bronchitis: self-limited inflammation of the tracheobronchial tree with eventual healing and return to function
• Chronic bronchitis: prolonged exposure to nonspecific bronchial irritants resulting in hypersecretion of mucus and productive cough for a period of 3 months for two consecutive years
• Types of chronic bronchitis:
  • Simple chronic: mild, persistent cough with clear sputum
  • Mucopurulent: thick, yellowish sputum due to bacterial infection
  • Obstructive: structural damage due to continual infection and inflammation, leading to obstruction and obliteration of small airways

Anatomy

• Joints involved: C and T spine, Costovertebral and Sternocostal joints, and Sternoclavicular joints
• Muscles involved: diaphragm, intercostals, abdominal muscles, Pectoralis Major and minor, SCM, Scalenes, Thoracic erectors, and Posterior cervical muscles

Signs and Symptoms

• Acute:
  • Preceded by cold or flu
  • Chills, fever, back and muscle pain, sore throat
  • Onset of cough signals onset of bronchitis
  • Cough is initially dry and non-productive, becomes productive after a few days
  • Sputum is suggestive of bacterial infection
  • Persistent fever suggests pneumonia
• Chronic:
  • Cough, sputum, wheeze, dyspnea
  • May have a mild smoker’s cough
  • Cough, wheeze, recurrent respiratory infections
  • Copious sputum with signs of infection
  • Tendency to be “Blue Bloaters” in later stages
  • Extended or slowed forced expiration (taking longer than 4 seconds) with some wheeze noted towards the end

Causes

• Smoking is the most common cause of bronchitis
• Pollution
• Viral or bacterial agents
• Dust, Solvent, fumes, Acids, etc.
• Repeated attacks of acute bronchitis

Assessment and Testing

• Case history: general health, history of smoking, history of respiratory infections, diagnosis of chronic bronchitis, onset, symptoms, presence of productive cough, color/quality of sputum, presence of blood in sputum, medications, other treatments and results, complicating factors
• Observations: postural assessment, tachypnea, cough and sputum, possible cyanosis of lips and nail beds
• Palpation: increased tone of accessory muscles of respiration, palpate muscles of the upper chest and shoulders for increased tone, movement of thoracic cage during breathing
• Testing: vocal fremitus, percussion tests, breath sounds

Treatment Aims and Techniques

• Facilitate removal of secretions
• Restore or maintain thoracic mobility
• Eliminate muscle spasming and trigger points in overused muscles of respiration or muscles overused due to excessive coughing
• Educate client re: FDB and proper coughing and smoking cessation
• Address postural conditions
• Techniques: myofascial techniques, general Swedish techniques, tapotement, airway clearance, shaking, huff technique, assisted forced expiration/cough technique, joint play, thoracic mobilizations, trigger point therapy, and stretching

Contraindications and Precautions

• Fever, infection which indicate contagious disease
• Osteoporosis is a precaution due to heavy tapotement in the treatment
• Some medications may alter the client’s sensation to pain
• People with severe asthma may have to have treatment intensity altered
• Some positions and treatment depth may have to be altered in people with circulatory and cardiac complications

Frequency and Remedial Exercise and Self-Care

• Frequency: depends upon general health, frequency and severity of condition
• Treat for two weeks, 1x week for two weeks, reassess
• Remedial exercise and self-care: teach DDB and a productive cough, pec, scalene, SCM stretching, Clapp’s crawl, thoracic self-mobilizations, intercostal and abdominal strengthening

Emphysema

• A condition in which the alveoli of the lungs become fibrous and inelastic, limiting the exchange of oxygen and carbon dioxide.
• Characterized by the merging of alveoli, decreasing the surface area, and limiting gas exchange.
• Classed with Chronic Bronchitis as a Chronic Obstructive Pulmonary Disease (COPD).

Causes

• Exposure to irritants such as smoking, pollution, and grain dust damages the alveoli.
• Long-term exposure to irritants can overcome the protective protein Alpha-1 Antitrypsin (AAT), leading to the destruction of alveolar elastin fibers.
• Chronic irritation results in chronic bronchitis, leading to the destruction of the alveoli.

Signs and Symptoms

• Pain with breathing
• Difficulty breathing on exertion
• Little interest in eating
• Rales (bubbles, rasps when breathing)
• Difficulty exhaling (takes longer)
• Pursed lip exhalation
• Barrel chest
• Diminished diaphragmatic breathing
• Loss of general muscle tone due to decreased activity

Complications

• More prone to influenza and other respiratory conditions
• Bullae may rupture, causing lung collapse
• Blood clots
• Pulmonary embolism
• Heart failure

Assessment

• General health
• Current symptoms
• Onset
• Breathlessness and activities that cause it
• Productive cough (chronic bronchitis)
• Blood pressure
• Precipitating factors (smoking, pollution, work-related)
• Medication
• Other therapies
• Activities that must be modified (hot bath or shower, climbing stairs)

Observations

• Postural assessment
• Barrel chest
• Prolonged or pursed lip breathing
• Head forward posture
• Weight loss
• Rosy appearance (Pink Puffers)
• Bluish appearance (Blue Bloaters – indicates chronic bronchitis)
• Clubbed ends of fingers
• Palpation of all muscles of respiration and accessory muscles for hypertrophy and trigger points

Treatment Aims

• Early stage: remove irritating stimulus, promote stress reduction, and encourage full diaphragmatic breathing
• Later stage: promote relaxation, address general tissue health, and consider contraindications

Remedial Exercise and Self-Care

• Teach full diaphragmatic breathing
• Teach pursed lip breathing rather than forced expiration
• Gentle stretching for neck, shoulders, and chest

Prognosis

• Emphysema is an irreversible disease
• If found and treated early, further damage can be avoided
• Medical attention may include bronchodilators, diuretics, oxygen supplementation, and surgery

Sinusitis

• No information provided in the text.

Asthma

• Characterized by episodes of acute airway obstruction due to bronchospasm and mucus production from exposure to various stimuli.
• More common in children, who may grow out of the condition, but may return in later years.
• Risk factors include:
  • Childhood history of asthma
  • Environmental hazards (city pollution, second-hand smoke)
  • Gastro-esophageal Reflux Disease (GERD)
  • Eczema
  • Hay fever
  • Obesity

Signs and Symptoms

• During an attack:
  • Bronchospasm traps air in the lungs
  • Diaphragm unable to relax
  • Rib cage unable to relax, intercostals unable to contract
  • Air remains in the lungs, difficulty exhaling
  • Use of accessory muscles of respiration (scalenes, SCM, upper trapezius) to expand the upper chest
• Tendency to breathe with the upper chest
• Barrel chest
• Hypertonicity of accessory muscles of respiration
• Fatigue due to decreased oxygen
• Anxiety with deep respiration

Causes

• Extrinsic:
  • Type 1 hypersensitivity reaction (histamine release)
  • External substances (dust, pollen, peanuts, emotional upset)
  • Family history
• Intrinsic:
  • Idiopathic
  • Exercise-related
  • Respiratory tract infection
  • Emotional or physical stress
  • Genetic predisposition
• Mixed:
  • Combination of extrinsic and intrinsic factors

Triggers

• Smoke
• Stress
• Respiratory infection
• Intense heat or cold
• Work-related substances (detergents, plastics, fumes)

Cardiac Asthma

• Related to congestive cardiac failure, resulting in excess fluid in the lungs

Assessment and Treatment

• Case history:
  • General health
  • Age of onset
  • Type of asthma
  • Frequency of attacks
  • Known triggers
  • Treatment received
  • Medications (inhaler)
• Aims of treatment:
  • Decrease stress and anxiety
  • Decrease tone of accessory muscles of respiration
  • Increase mobilization of thorax
  • Encourage diaphragmatic breathing
  • Remove excess secretions between attacks
  • Address postural concerns
  • Decrease severity and frequency of attacks
• Contraindications:
  • Do not massage during an attack
  • Be aware of triggers
  • Avoid stimulating work if stress or physical exertion is a trigger
  • Avoid excessive heat or cold in hydrotherapy if it is a trigger
• Frequency of treatment:
  • 1 hour/week for posture and respiratory function
  • General monthly maintenance
• Remedial exercise and self-care:
  • Encourage diaphragmatic breathing
  • General exercise
  • Treat for hyper kyphosis if indicated
  • Stretches and breathing exercises
  • Steams (with precautions)

Prognosis

• Asthma can be mild or severe, may remit in childhood, but may return in later years
• Associated with more severe cardiopulmonary complications

Cystic Fibrosis

• A disorder of the exocrine glands that affects the entire body and is ultimately fatal, usually due to pulmonary complications.
• The lungs and pancreas are the most affected organs, but the intestines and kidneys are also commonly affected.
• Not officially recognized as a COPD due to its systemic nature, but persistent coughing can lead to Bronchiectasis, which is sometimes considered a COPD.
• Life expectancy for untreated CF was less than 5 years old; with modern management, the global average is now 37 years old.
• In developed countries, it's not uncommon for CF patients to live into their 50's.

Bronchiectasis

• A permanent thickening of the bronchiole walls due to chronic infection/inflammation.
• Irreversible and prone to worsening, occasionally considered a member of the ‘COPD’ family.

History of Cystic Fibrosis

• First officially diagnosed and labeled in 1938.
• Observed historically as far back as the Middle Ages (1595).

Signs and Symptoms

• Respiratory symptoms:
  • Persistent, productive cough with thick mucus
  • Wheezing
  • Shortness of breath
  • Frequent infections of the lungs and sinuses
• Digestive symptoms:
  • Greasy, foul-smelling stool
  • Intestinal blockage and severe constipation (particularly in infants)
  • Heartburn
• Other symptoms:
  • Poor weight gain
  • Stunted growth
  • Infertility (98% of males, 20% of females)
  • Pancreatic complications (e.g., diabetes)
  • Excessive salt secretion through the skin

Causes

• Mutation of the 'Cystic Fibrosis Transmembrane Conductance Regulator' (CFTR) gene, with over 1900 known mutations.
• The gene is recessive, meaning a subject must inherit the defective gene from both parents to develop the disease.
• Possibility of being a carrier by possessing one defective gene.

Assessment

• Diagnostic testing is done during newborn screening.
• Adults can have genetic testing to determine if they are carriers.
• 'Sweat testing' measures chloride levels in sweat secretions, with a positive result being 60+ mmol/L.

Treatment

• Primary aims and treatment protocol are the same as for Chronic Bronchitis (mucus expulsion) and/or Constipation (improving transit time).
• Addressing digestive issues first allows for more comfort when placed in the appropriate respiratory drainage position.
• Techniques and contraindications are the same as for Bronchitis and Constipation.
• Remedial exercise and self-care can be applied as preventive care even if the client is not suffering from digestive problems.

Learn about sinusitis, a condition that occurs when the sinuses become inflamed, and its effects on respiratory health. Discover the purposes of the sinuses and how inflammation affects oxygen absorption.