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Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
Acute sinusitis
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Acute sinusitis

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ENT

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  • 1. SINUSITIS AND ITS MANAGEMENT DR NAUSHEEN QURESHI ASSISTANT PROFESSOR ENT DEPT HFH
  • 2. Anatomy of sinuses
  • 3. • 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
  • 4. EMBRYOLOGICAL DEVELOPMENT • 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
  • 5. EMBRYOLOGICAL DEVELOPMENT • 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.
  • 6. Inflammation of paranasal sinuses
  • 7. DEFINATION AND INCIDENCE • 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
  • 8. PATHOGENESIS: • 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
  • 9. PATHOGENESIS: • 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.
  • 10. PREDISPOSING FACTORS • Allergies, nasal deformities, cystic fibrosis, nasal polyps, and HIV infection. • Cold weather • High pollen counts • Day care attendance • Smoking in the home • Re-infection from siblings
  • 11. AETIOLOGY • 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
  • 12. SYMPTOMS: • 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
  • 13. CLINICAL FEATURES: • 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
  • 14. 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.
  • 15. DIFFERENTIAL DIAGNOSIS • septum deviation) • Nasal foreign body Allergic rhinitis • Non-allergic rhinitis • Infectious rhinitis • Drug-induced rhinitis • Nasal polyps • Dental abscess • Carcinoma of sinus • Cluster headache • Structural defects
  • 16. MEDICAL TREATMENT • Acetaminophen or ibuprofen to relieve pain • Decongestants • Antihistamines • Nasal saline
  • 17. ANTIBIOTIC TREATMENT: • Antimicrobials-treat for 10-14 days, depending upon severity, with one of the following: • Amoxicillin:20-40mg/kg/d in 3 divided doses(>20kg, 250mg tid) • CLAVUNATED AMOXICILLIN:25- 50mg/kg/d in 2 divided doses, Use suspension if child is less than 40kg.
  • 18. TREATMENT• SEPTRAN: CO- TRIMOXAZOLE+TRIMETHOPRIM• CEFACLOR:500MG:1 *TDS• STEAM INHALATION
  • 19. FOLLOW UP INSTRUCTIONS Humidifier to relieve the drying of mucous membranes associated with mouth breathing • Increase oral fluid intake • Saline irrigation of the nostrils • Moist heat over affected sinus • Prolonged shower to help promote drainage
  • 20. PATIENT EDUCATION: • Child should not dive. • Child should not travel by airplane. • Urge parent to eliminate triggers in the home (dust, smoking) • Have all members of the family treated, if indicated. • 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.

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