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Sinusitis
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  • 1. SINUSITIS
  • 2. Anatomy
    • Paranasal Sinuses
  • 3.  
  • 4. 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
  • 5. 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.
  • 6. 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).
  • 7. 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.
  • 8. Sinusitis
    • Inflammation of paranasal sinuses
  • 9. 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.
  • 10. 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.
  • 11. 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.
  • 12. 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
  • 13. 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.
  • 14. 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
  • 15. Complications of Sinusitis
    • Orbital cellulitis or abscess
    • Meningitis
    • Brain abscess
    • Intractable wheezing in children with asthma
    • Cavernous sinus thrombosis
    • Subdural empyema
  • 16. 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
  • 17. 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
  • 18. Pale, Boggy Turbinates
  • 19. 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.
  • 20. 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
  • 21. 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.
  • 22. 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
  • 23. Patient Education
    • Avoid allergy triggers,antihistamine or nasal corticosteroids
    • Eat fruits & vegetables,
    • Reduces stress,
    • Wash hands and maintain hygiene.
    • Avoid smoke and pollution hydration
  • 24. 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.
  • 25. 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