EAR, NOSE, THROAT, AND DENTAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 207

acting decongestants such as phenylephrine. Decongestant sprays should probably be re-
served for the times when they are needed most, such as at night to permit restful sleep.
Whenfirstadministered,adecongestantusuallyrelievesobstructionbyreducingtheswell-
ing of the mucous membrane over the more prominent portions of the nasal passages. A
second spray five to ten minutes later may be necessary to reach the recesses of the nasal
cavity. Swelling in these areas should be relieved to promote drainage and reduce the risk
ofbacterial sinusitis. Asystemic decongestant oracombined decongestant andantihistam-
ine taken orally may be beneficial.
Antibiotics have no effect on the viruses that cause colds and for most individuals
should not be administered. The rare serious complications of colds may require antibiotic
therapy, but such therapy should not be given until the conditions actually develop. Pro-
phylactic antibiotic therapy should be avoided, even at high altitudes, because the bacteria
producing any subsequent infection could become resistant to the antibiotics. However,
the uncommon individuals who almost invariably develop a bacterial bronchitis or bron-
chopneumonia following a cold should be considered exceptions to this rule.
Sinusitis
Sinusitis is an infection of one or more of the paranasal sinuses ( Fig. 16-1 ) , air-filled
spaceswithinthebonesofthefacethatarelinedbyathinmucousmembranesimilartothat
of the nose and are connected with the nose by narrow canals. The sinuses serve to make
the skull lighter in weight than it would be if these areas were occupied by solid bone.
Sinusitis most commonly results from obstruction of the canals that drain the sinuses,
usually caused by swelling of the mucous membrane around the opening due to a cold or
allergy. Mucous collects within the sinus, becomes infected, and the infection spreads to
the surrounding tissues.
Sinusitis, although accompanied by a headache, is rarely disabling by itself. Complica-
tions do occur, and spread of the infection to the bones of the skull or to the brain itself can
result in chronic osteomyelitis, meningitis, or a brain abscess. However, these potentially
lethalcomplicationsusuallyfollowprolongedchronicsinusitis,whichshouldbeeradicated
before an extended wilderness outing.
Acute sinusitis sometimes accompanies or follows a cold or hay fever. The most prom-
inent symptom is headache, which may be located in the front of the head, “behind the
eyes,” or occasionally in the back of the head. A purulent discharge frontal frequently
drains into the nose and back into the throat—so-called postnasal drip—where it may be
swallowed.