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    Sinusitis Sinusitis Presentation Transcript

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