The impact of smoking on rhino sinusitis and homeopathic therapeutics

Dr Chaitra H P

ABSTRACT
Rhino sinusitis (RS) is a Multifactorial inflammatory condition which has a significant impact on health and economic. Environmental factors such as allergens and inhaled pollutants such as cigarette smoke may also play a significant role in diseases of the upper airway including asthma, otitis media, and rhino sinusitis.

INTRODUCTION
Rhino sinusitis (RS) is a Spectrum of disorders associated with inflammation of nasal and sinus mucosa, in the presence of absence of nasal polyps, for a duration at least 12 weeks. that has a significant health and economic impact. Active and passive smoking both have been associated with the risk of chronic rhino sinusitis as smoking impairs or delays the muco ciliary drainage by affecting the ciliary epithelium of the respiratory airways.

Keywords: Rhino sinusitis, paranasal sinus, tobacco smoke, sinonasal, epithelial cells, mucociliary clearance.

PATHOPHYSIOLOGIC EFFECTS OF TOBACCO SMOKE ON SINONASAL MUCOSA
Smoking causes anatomical defects in the ciliary system and increases mucus production, both of which impair mucociliary clearance. The amount of impairment varies, but heavy smokers have demonstrated prolonged lung clearance times.

Mucociliary clearance (MCC) is the primary innate defense mechanism of the lung. The functional components of the respiratory tract are the protective mucous layer, the airway surface liquid layer, and the cilia on the surface of ciliated cells. The cilia are specialized organelles that beat in metachronal waves to propel pathogens and inhaled particles trapped in the mucous layer out of the airways.

Ciliated cells in the lungs play a key role in mucociliary clearance, they clear inhaled particles out of the airways. Chronic diseases of the airways (e.g., primary ciliary dyskinesia) are the most common cause. smoking induces a physiologic nasal response including increased nasal airway resistance, nasal irritation, nasal congestion, and rhinorrhea.

Tobacco smoke extract contains a with more than 4000 noxious components, including gas and particulate substances – among them we have acrolein, formaldehyde, carbon monoxide, nicotine, nicotine; acetaldehyde, phenol and potassium cianide, and many of these components are proven toxic to the respiratory epithelium which have adverse effects on sinonasal epithelial, mucociliary clearance and innate immune function .

Smokers and quitters show similar characteristics and morbidities. At baseline (smokers and quitters) show impaired nasal muco ciliary clearance time (mean 17.6 min), significant nasal muco ciliary clearance time improvement will occur in quitters, around 65% improvement is noticed in a duration of 1 month and 85% improvement in 12 months.

          EFFECTS OF SMOKING ON RESPIRATORY TRACT

• REDUCED MUCOCILIARY CLEARANCE
• INCREASED RISK OF INFECTIONS
• AGGRAVATION OF ALLERGIC REACTIONS
• WORSENING OF CHRONIC SINUSITIS
• REDUCED RESPONSE TO TREATMENT
• IMPAIRMENT OF SENSE OF SMELL AND TASTE

CLINICAL FEATURES

1. Nasal blockages
2. Nasal discharge
3. Facial pain, tenderness around eyes ,cheeks,nose.
4. Altered sense of smell
5. Sore throat
6. Earache

DIAGNOSIS:

Diagnosis of acute cases is typically established clinically

• Imaging or Endoscopy should be considered if symptoms fail to enhance within 7 days of diagnosis or worsen during the initial management of acute bacterial rhinosinusitis.
• A clinical diagnosis of chronic sinusitis should be confirmed with objective documentation of sinonasal inflammation, which can be accomplished using anterior rhinoscopy, nasal endoscopy, or computerized tomography.

HOMEOPATHIC MANAGEMENT 

• LEMNA MINOR: used when there is an intense level of nasal blockage and anosmia or a loss of the sense of smell. tend to worsen during the wet season and can even cause a thick white discharge from the nose which has a foul smell with much sneezing.

• SEPIA: it has marked action on sinusitis as it cover different kind of headaches vertigo, morning headache, violent congestion headaches especially when stooping, otalgia, spasmodic pain and tearing in bones of face, neuralgic pains of face, Swelling and inflammation of nose, especially at tip. Hardened mucus in nose. Anosmia, Fetid smell in nose. Dry coryza, especially of left nostril. Dry mucus, which causes an obstruction in nose.

• KALIUM BICHROMICUM: Snuffles of children, especially fat, chubby babies. Pressure and pain at root of nose, and sticking pain in nose. Septum ulcerated; round ulcer. Fetid smell. Discharge thick, ropy, greenish-yellow. Tough, elastic plugs from nose; leave a raw surface. Inflammation extends to frontal sinuses, with distress and fullness at root of nose. Dropping from posterior nares . Loss of smell. Much hawking. Inability to breathe through nose. Dryness. Coryza, with obstruction of nose, Violent sneezing.

• HYDRASTIS CANADENSIS: Thick, tenacious secretion from posterior nares to throat. Watery, excoriating discharge. Ozæna, with ulceration of septum. Tends to blow nose all the time.

• STICTA PULMONARIA: Dull heavy pressure in the forehead and at the root of nose. Stuffed up feeling in nose and frontal sinuses, Worse at night and better in the open air. Constant need to blow nose, but no discharge. Mucus membranes are dry and painful.
• HEPAR SULPH : Hepar sulph is sometimes indicated in acute sinusitis, especially where it comes on after exposure to cold air.  Nasal discharge is thick and yellow, and the nostrils are often sore and inflamed.  There may be an offensive odour from the nose, and the nose and face are sensitive to touch.  If there is a headache, there will often be a pressing, boring pain in the forehead and root of nose.  The scalp is typically sore and sensitive to touch.

• PHOSPHORUS: complains of having a stuffed nose one moment and fluent nasal discharges the next. These symptoms often come with a feeling of dullness in the head and a sore throat. Hoarseness often follows. The mucus from the nose is typically profuse, greenish, yellow and blood- streaked.

CONCLUSION
Rhino sinusitis is a true chronic disease which has a strong miasmatic background that starts with Psora and evolves to sycosis.

• the Psoric features include recurrent infections and episodes of rhinorrhea sneezing etc.
• sycotic phase is characterized by loss of cilia, goblet cell hypertrophy and inflammatory exudates and development of polyps etc.

But smoking when it becomes a maintaining cause, the cause Should be removed in order to reverse the pathology of the condition , “These states of ill-health, which persons bring upon themselves disappear spontaneously” , This was a statement made by Dr Samuel Hahnemann in his of Organon of Medicine.

REFERENCES

• Dalhamn, Tore. “In vivo and in vitro ciliotoxic effects of tobacco smoke.” Archives of Environmental Health: An International Journal 21.5 (1970): 633-634.
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• Krause J William, Krause’s Essentials of Human Histology for Medical Students;Universal Publishers,2005, 3^rd edition,320 pages.
• Ralston, S., Strachan, M., Britton, R., Penman, I. and Hobson, R., 2018. Davidson’s Principles & Practice Of Medicine. 23rd ed. Edinburgh: Elsevier.
• Hwang PH, Irwin SB, Griest SE, Caro JE, Nesbit GM. Radiologic correlates of symptom-based diagnostic criteria for chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2003 Apr;128(4):489-96. doi: 10.1016/S0194-59980223295-7. PMID: 12707650.
• Boericke W., 9th Edition, New Manual of Homoeopathic Materia Medica and Repertory; Augmented, B. Jain Publisher (P) Ltd., New Delhi, (2000)
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Dr Chaitra H Pawar
PG Scholar,Department of Practice of Medicine
Father Muller Homoeopathic Medical College, Deralakatte, Mangalore, Karnataka
Under the guidance of Dr G RAJACHANDRA
Email id- Chaitra.pawar13@gmail.com