Sinusaurus
Osseous caverns and canyons rumble to the oncoming onslaught of entities of proportions unimaginable to any but those afflicted by their resounding romp. Pterodactyls on high, Ichthyosaurs in fluid media, and Brontosaurs, Triceratops, Tyrannosaurus rex, and Velociraptors on the ground, once mighty, now extinct, never inflicted carnage on a scale comparable to the 37 million annual victims of their successor, the Sinusaurus. A cold or allergy attack that fails to fossilize heralds its march on the horizon into maxillary cavities, and best defense lies in the grunts, admonitions, moldy concoctions, and surgical “clubs” of a Neanderthal descendant, your doctor.
Acute bacterial sinusitis is bacterial in nature and sometimes mastodonic in its ramifications. A cold, allergy, or environmental pollutant may inflame the sinuses and prevent their drainage of accumulated mucus into the nasal passages, leading to congestion and infection by bacterial symbionts. When attacks of sinusitis wreak annoyance, if not havoc, occur frequently, or last three months or longer, the species has most likely evolved into its chronic form. Chronic sinusitis, while docile on the symptomatic front, is likely to pounce like a saber-toothed tiger, causing damage to sinuses and cheekbones and sometimes requiring surgery to repair.
A camouflaged predator, at home in hostile surroundings, sinusitis provides false assurances by laying low or by mimicking minor annoyances like the common cold or allergies. When the time is right, nasal congestion, facial pain or pressure, and headache make their appearance. Thick, purulent or discolored nasal discharge, along with other nonspecific symptoms including cough, sneezing, and fever, bring up the rear. Add to the mix tooth pain and halitosis and Homo sapiens reverts to caveman behavioral patterns, especially when bending over or lying supine increases discomfort.
While most cases of acute sinusitis present after or in conjunction with a viral upper respiratory infection caused by rhinovirus, parainfluenza virus, or influenza virus, bacterial sinusitis complicates only 0.2 to 2% of these viral infections. That is little consolation, however, as a riot in Jurassic Park can loose the Sinusaurus on fertile neurologic terrain, and result in pain and inflammation of the eye orbits, thrombosis of cerebral veins, meningitis, and cerebral abscess. What should have amounted to a campaign of no more than 4 weeks then degenerates into a fight for survival, pitting bipeds against the forces for extinction.
Clinical history and/or setting, not the high technology of computed tomography (CT) or sinus radiography, suffices for the diagnosis of acute sinusitis. Facial or tooth pain in combination with purulent nasal discharge and persisting for more than 7 days, like the crashing of jungle trees, makes tracking the beast elementary. Chronic sinusitis, on the other hand, is a wilier creature, given to periods of stalking of greater than 12 weeks, more damaging yet less alarming to its prey, and very difficult to corner and cure. Antibiotic resistance and surgical complications form inherent parts of its defense mechanism when CT, endoscopic examination, and biopsied tissue samples for histologic examination and culture have individuated its habitat.
Oral and topical decongestants, nasal saline rinses, and intranasal steroids are brought to bear on the behemoth for 7 days. When they are found to bounce off its scales, oral amoxicillin administered in a dose of 875 mg twice a day for 10 days usually finishes the job. Not so for its chronic cousin. Surgery becomes the only recourse available when those weapons fail, providing a significant, albeit short-term, breather.
Enormous beings of thick flesh and blood ruled majestically long before the appearance of man, machine, and the Sinusaurus. When they, too, are long gone, perhaps the streptococcus and its infinitely smaller brethren will direct day to day business from thrones invisible to all but the eyes of God.
Copyright 2006, Albert M. Balesh, M.D. All rights reserved.
Inspired by June Chacon and Carina Ramirez, Ph.D.
Acute bacterial sinusitis is bacterial in nature and sometimes mastodonic in its ramifications. A cold, allergy, or environmental pollutant may inflame the sinuses and prevent their drainage of accumulated mucus into the nasal passages, leading to congestion and infection by bacterial symbionts. When attacks of sinusitis wreak annoyance, if not havoc, occur frequently, or last three months or longer, the species has most likely evolved into its chronic form. Chronic sinusitis, while docile on the symptomatic front, is likely to pounce like a saber-toothed tiger, causing damage to sinuses and cheekbones and sometimes requiring surgery to repair.
A camouflaged predator, at home in hostile surroundings, sinusitis provides false assurances by laying low or by mimicking minor annoyances like the common cold or allergies. When the time is right, nasal congestion, facial pain or pressure, and headache make their appearance. Thick, purulent or discolored nasal discharge, along with other nonspecific symptoms including cough, sneezing, and fever, bring up the rear. Add to the mix tooth pain and halitosis and Homo sapiens reverts to caveman behavioral patterns, especially when bending over or lying supine increases discomfort.
While most cases of acute sinusitis present after or in conjunction with a viral upper respiratory infection caused by rhinovirus, parainfluenza virus, or influenza virus, bacterial sinusitis complicates only 0.2 to 2% of these viral infections. That is little consolation, however, as a riot in Jurassic Park can loose the Sinusaurus on fertile neurologic terrain, and result in pain and inflammation of the eye orbits, thrombosis of cerebral veins, meningitis, and cerebral abscess. What should have amounted to a campaign of no more than 4 weeks then degenerates into a fight for survival, pitting bipeds against the forces for extinction.
Clinical history and/or setting, not the high technology of computed tomography (CT) or sinus radiography, suffices for the diagnosis of acute sinusitis. Facial or tooth pain in combination with purulent nasal discharge and persisting for more than 7 days, like the crashing of jungle trees, makes tracking the beast elementary. Chronic sinusitis, on the other hand, is a wilier creature, given to periods of stalking of greater than 12 weeks, more damaging yet less alarming to its prey, and very difficult to corner and cure. Antibiotic resistance and surgical complications form inherent parts of its defense mechanism when CT, endoscopic examination, and biopsied tissue samples for histologic examination and culture have individuated its habitat.
Oral and topical decongestants, nasal saline rinses, and intranasal steroids are brought to bear on the behemoth for 7 days. When they are found to bounce off its scales, oral amoxicillin administered in a dose of 875 mg twice a day for 10 days usually finishes the job. Not so for its chronic cousin. Surgery becomes the only recourse available when those weapons fail, providing a significant, albeit short-term, breather.
Enormous beings of thick flesh and blood ruled majestically long before the appearance of man, machine, and the Sinusaurus. When they, too, are long gone, perhaps the streptococcus and its infinitely smaller brethren will direct day to day business from thrones invisible to all but the eyes of God.
Copyright 2006, Albert M. Balesh, M.D. All rights reserved.
Inspired by June Chacon and Carina Ramirez, Ph.D.
posted by Dr. Al at
8/28/2006 11:13:00 PM
1 Comments:
Sinosaurus indeed! Great metaphor for this monstrous ailment. I've had it, and it does feel like someone is roaming the caverns with spines and scales.
By
Peg Spencer, at Saturday, September 09, 2006 10:54:00 AM
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