Wilderness and Rescue Medicine 8th Edition

Section VI: Backcountry Medicine 205

symptoms include sinus pressure, a stuffy nose, and a clear, green or yellow nasal discharge. These are almost always a viral infection (common cold) or a local allergic reaction to something in the environment. Decongestants and antihistamines may offer some relief. Antibiotics are not helpful or necessary.

ear canal. Pain is almost immediately relieved as the pressure is released but hearing may be temporarily impaired. If no fever or other adverse symptoms develop, there is no emergency. Avoid swimming and diving and see a medical practi tioner when possible.

Middle Ear and Sinus Infection

General Principles

Middle Ear and Sinus Infection Tympanic Membrane

General Principles

Anticipate: • Pain • Spread of infection Treatment: • OTC decongestants

Middle ear

Inner ear

Inner Ear

Eustachian Tube

Middle Ear

Mechanisms: • Obstruction to infection • Water infiltration

• Inhaled steam • Saline irrigation • Antibiotics if symptoms persist

Eustachian tube

Nasal Sinuses

“… the situation can be improved with drainage.”

“Problems begin when the tube becomes obstructed and mucous accumulates.”

© 2018 WMA

© 2018 WMA

A more serious bacterial infection will cause severe pain, fever, and a bloody green nasal dis charge. Involvement of the maxillary sinus in the face can feel like a dental infection in the upper teeth, but you won’t find one specific tooth that is tender to percussion. Serious middle ear and sinus infection carries the anticipated problem of spread to adjacent structures like the skull, inner ear, and brain. As with any obstructed organ, the situation can be improved with drainage. Try to reduce the swell ing and obstruction of the eustachian tube and sinus passages with decongestant nasal spray or by having the patient breathe steam from a pot of hot water. Keeping your patient well hydrated is important. This will keep mucous from drying and becoming too thick to drain. Antibiotics are sometimes necessary for com plete treatment of more serious middle ear and sinus infections if the patient is not responding to decongestion and hydration. A middle ear infection may ultimately perforate the eardrum and drain spontaneously through the external Treatment of Middle Ear Infection and Sinusitis

Middle Ear and Sinus Infection

General Principles

Serious: • Persistent fever • Severe pain • Swelling • Altered mental status • Ataxia • Vomiting

“ Serious ear and sinus infection reflect the anticipated problem of inner ear involvement and systemic infection.”

© 2018 WMA

Treating infection of the other sinus cavities is similar except that there is no safety valve like the eardrum for perforation and drainage if neces sary. Aggressive decongestion and hydration to promote drainage through the sinus passages may improve symptoms and cure the infection. Sinus infection not responding to field treatment is best evacuated to medical care, especially if moderate pain or fever is present. Steroid and other decon gestant nasal sprays may be prescribed to reduce inflammation and swelling. Antibiotic therapy, sometimes for several weeks, is indicated in resis tant cases.