SINUSITIS
Anatomy <ul><li>Paranasal Sinuses </li></ul>
 
Where are the sinuses? <ul><li>Four pairs of paranasal sinuses  </li></ul><ul><ul><li>Frontal-above eyes in forehead bone ...
What are the sinuses? <ul><li>The sinuses are hollow air-filled sacs lined by mucous membrane. The ethmoid and maxillary s...
What are the sinuses? (cont’d) <ul><li>Sinuses have small orifices (ostia) which open into recesses (meati) of the nasal c...
Considerations for Pediatrics <ul><li>At birth, the ethmoid, sphenoid and maxillary sinuses are tiny and cause problems in...
Sinusitis <ul><li>Inflammation of paranasal sinuses </li></ul>
What is sinusitis? <ul><li>An acute inflammatory process involving one or more of the paranasal sinuses.  </li></ul><ul><l...
How Does Sinusitis Develop ? <ul><li>Usually follows rhinitis, which may be viral or allergic. </li></ul><ul><li>May also ...
Development (cont’d) <ul><li>With inflammation, the mucosal lining of the sinuses produce mucoid drainage. Bacteria invade...
Predisposing Factors <ul><li>Allergies, nasal deformities, cystic fibrosis, nasal polyps, and HIV infection. </li></ul><ul...
Acute or Chronic Sinusitis ? <ul><li>Acute Sinusitis – respiratory symptoms last longer than 10 days but less than 30 days...
Etiology of Sinusitis <ul><li>70% of bacterial sinusitis is caused by: </li></ul><ul><li>Streptococcus pneumoniae </li></u...
Complications of Sinusitis <ul><li>Orbital cellulitis or abscess </li></ul><ul><li>Meningitis </li></ul><ul><li>Brain absc...
Subjective Symptoms  of Sinusitis <ul><li>History of URI or allergic rhinitis </li></ul><ul><li>History of pressure change...
Clinical Presentations of Sinusitis <ul><li>Periorbital edema </li></ul><ul><li>Cellulitis </li></ul><ul><li>Nasal mucosa ...
Pale, Boggy Turbinates
Diagnostic Tests <ul><li>Imaging studies, such as sinus radiographs, ultrasonograms, or CT scanning – indicated if child i...
Differential Diagnoses <ul><li>Allergic rhinitis </li></ul><ul><li>Non-allergic rhinitis </li></ul><ul><li>Infectious rhin...
Pharmacological Plan of Care <ul><li>Amoxicillin:90mg BID for 10 days or  </li></ul><ul><li>Azithromycin 12mg for 5 days  ...
Pharmacological Plan of Care <ul><li>Adults:Paracetamol 500mg Tid 5 days </li></ul><ul><li>Amoxycillin 500mg BID 10 days <...
Patient Education <ul><li>Avoid allergy triggers,antihistamine or nasal corticosteroids </li></ul><ul><li>Eat fruits & veg...
Follow Up Guidelines <ul><li>Instruct parent to call in 48 hours if condition of child has not improved. </li></ul><ul><li...
Guidelines for Referral <ul><li>Child with complications or signs of invasive infection. </li></ul><ul><li>Child needing c...
Upcoming SlideShare
Loading in...5
×

Sinusitis

4,400

Published on

0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
4,400
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
288
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Sinusitis

  1. 1. SINUSITIS
  2. 2. Anatomy <ul><li>Paranasal Sinuses </li></ul>
  3. 4. Where are the sinuses? <ul><li>Four pairs of paranasal sinuses </li></ul><ul><ul><li>Frontal-above eyes in forehead bone </li></ul></ul><ul><ul><li>Maxillary-in cheekbones, under eyes </li></ul></ul><ul><ul><li>Ethmoid-between eyes and nose </li></ul></ul><ul><ul><li>Sphenoid-in center of skull, behind nose and eyes </li></ul></ul>
  4. 5. What are the sinuses? <ul><li>The sinuses are hollow air-filled sacs lined by mucous membrane. The ethmoid and maxillary sinuses are present at birth. The frontal sinus develops during the 2 nd year and the sphenoid sinus develops during the 3 rd year. </li></ul>
  5. 6. What are the sinuses? (cont’d) <ul><li>Sinuses have small orifices (ostia) which open into recesses (meati) of the nasal cavities. </li></ul><ul><li>Meati are covered by turbinates (conchae). </li></ul><ul><li>Turbinates consist of bony shelves surrounded by erectile soft tissue. </li></ul><ul><li>There are 3 turbinates and 3 meati in each nasal cavity (superior, middle, and inferior). </li></ul>
  6. 7. Considerations for Pediatrics <ul><li>At birth, the ethmoid, sphenoid and maxillary sinuses are tiny and cause problems in infants and toddlers. </li></ul><ul><li>Frontal sinuses develop between 4-7 years of age, causing problems in school aged children and adolescents. </li></ul>
  7. 8. Sinusitis <ul><li>Inflammation of paranasal sinuses </li></ul>
  8. 9. What is sinusitis? <ul><li>An acute inflammatory process involving one or more of the paranasal sinuses. </li></ul><ul><li>A complication of 5%-10% of URIs in children. </li></ul><ul><li>Persistence of URI symptoms >10 days without improvement. </li></ul><ul><li>Maxillary and ethmoid sinuses are most frequently involved. </li></ul>
  9. 10. How Does Sinusitis Develop ? <ul><li>Usually follows rhinitis, which may be viral or allergic. </li></ul><ul><li>May also result from abrupt pressure changes (air planes, diving) or dental extractions or infections. </li></ul><ul><li>Inflammation and edema of mucous membranes lining the sinuses cause obstruction. </li></ul><ul><li>This provides for an opportunistic bacterial invasion. </li></ul>
  10. 11. Development (cont’d) <ul><li>With inflammation, the mucosal lining of the sinuses produce mucoid drainage. Bacteria invade and pus accumulates inside the sinus cavities. </li></ul><ul><li>Postnasal drainage causes obstruction of nasal passages and an inflamed throat. </li></ul><ul><li>If the sinus orifices are blocked by swollen mucosal lining, the pus cannot enter the nose and builds up pressure inside the sinus cavities. </li></ul>
  11. 12. Predisposing Factors <ul><li>Allergies, nasal deformities, cystic fibrosis, nasal polyps, and HIV infection. </li></ul><ul><li>Cold weather </li></ul><ul><li>High pollen counts </li></ul><ul><li>Day care attendance </li></ul><ul><li>Smoking in the home </li></ul><ul><li>Reinfection from siblings </li></ul>
  12. 13. Acute or Chronic Sinusitis ? <ul><li>Acute Sinusitis – respiratory symptoms last longer than 10 days but less than 30 days. </li></ul><ul><li>Sub acute sinusitis – respiratory symptoms persist longer than 30 days without improvement. </li></ul><ul><li>Chronic sinusitis – respiratory symptoms last longer than 120 days. </li></ul>
  13. 14. Etiology of Sinusitis <ul><li>70% of bacterial sinusitis is caused by: </li></ul><ul><li>Streptococcus pneumoniae </li></ul><ul><li>Haemophilus influenzae </li></ul><ul><li>Moraxella catarrhalis </li></ul><ul><li>Other causative organisms are: </li></ul><ul><li>Staphylococcus aureus </li></ul><ul><li>Streptococcus pyogenes, </li></ul><ul><li>Gram-negative bacilli </li></ul><ul><li>Respiratory viruses </li></ul>
  14. 15. Complications of Sinusitis <ul><li>Orbital cellulitis or abscess </li></ul><ul><li>Meningitis </li></ul><ul><li>Brain abscess </li></ul><ul><li>Intractable wheezing in children with asthma </li></ul><ul><li>Cavernous sinus thrombosis </li></ul><ul><li>Subdural empyema </li></ul>
  15. 16. Subjective Symptoms of Sinusitis <ul><li>History of URI or allergic rhinitis </li></ul><ul><li>History of pressure change </li></ul><ul><li>Pressure, pain, or tenderness over sinuses </li></ul><ul><li>Increased pain in the morning, subsiding in the afternoon </li></ul><ul><li>Malaise </li></ul><ul><li>Low-grade temperature </li></ul><ul><li>Persistent nasal discharge, often purulent </li></ul><ul><li>Postnasal drip </li></ul><ul><li>Cough, worsens at night </li></ul><ul><li>Mouthing breathing, snoring </li></ul><ul><li>History of previous episodes of sinusitis </li></ul><ul><li>Sore throat, bad breath </li></ul><ul><li>Headache </li></ul>
  16. 17. Clinical Presentations of Sinusitis <ul><li>Periorbital edema </li></ul><ul><li>Cellulitis </li></ul><ul><li>Nasal mucosa is reddened or swollen </li></ul><ul><li>Percussion or palpation tenderness over a sinus </li></ul><ul><li>Nasal discharge, thick, sometimes yellow or green </li></ul><ul><li>Postnasal discharge in posterior pharynx </li></ul><ul><li>Difficult transillumination </li></ul><ul><li>Swelling of turbinates </li></ul><ul><li>Boggy pale turbinates </li></ul>
  17. 18. Pale, Boggy Turbinates
  18. 19. Diagnostic Tests <ul><li>Imaging studies, such as sinus radiographs, ultrasonograms, or CT scanning – indicated if child is unresponsive to 48 hours of antibiotics and if the child has a toxic appearance, chronic or recurrent sinusitis, and chronic asthma. </li></ul><ul><li>Laboratory studies, such as culture of sinus puncture aspirates. </li></ul>
  19. 20. Differential Diagnoses <ul><li>Allergic rhinitis </li></ul><ul><li>Non-allergic rhinitis </li></ul><ul><li>Infectious rhinitis </li></ul><ul><li>Drug-induced rhinitis </li></ul><ul><li>Nasal polyps </li></ul><ul><li>Dental abscess </li></ul><ul><li>Carcinoma of sinus </li></ul><ul><li>Cluster headache </li></ul><ul><li>Structural defects (septum deviation) </li></ul><ul><li>Nasal foreign body </li></ul>
  20. 21. Pharmacological Plan of Care <ul><li>Amoxicillin:90mg BID for 10 days or </li></ul><ul><li>Azithromycin 12mg for 5 days (penicillin allergy). </li></ul><ul><li>Paracetamol 15mg every 6 hrs </li></ul><ul><li>Salt water gargle. </li></ul>
  21. 22. Pharmacological Plan of Care <ul><li>Adults:Paracetamol 500mg Tid 5 days </li></ul><ul><li>Amoxycillin 500mg BID 10 days </li></ul><ul><li>Ofloxacin 400mg BID for 10 days </li></ul><ul><li>(penicillin allergy) </li></ul><ul><li>Salt water gargle </li></ul>
  22. 23. Patient Education <ul><li>Avoid allergy triggers,antihistamine or nasal corticosteroids </li></ul><ul><li>Eat fruits & vegetables, </li></ul><ul><li>Reduces stress, </li></ul><ul><li>Wash hands and maintain hygiene. </li></ul><ul><li>Avoid smoke and pollution hydration </li></ul>
  23. 24. Follow Up Guidelines <ul><li>Instruct parent to call in 48 hours if condition of child has not improved. </li></ul><ul><li>Instruct parent to bring child in for a recheck in 2 weeks. </li></ul>
  24. 25. Guidelines for Referral <ul><li>Child with complications or signs of invasive infection. </li></ul><ul><li>Child needing control of allergic rhinitis. </li></ul><ul><li>Child with chills and fever. </li></ul><ul><li>Child with persistent headache. </li></ul><ul><li>Child with edema of forehead, eyelids. </li></ul><ul><li>Child with orbital cellulitis </li></ul>
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×