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SINUSITIS AND ITS MANAGEMENT       DR NAUSHEEN QURESHI       ASSISTANT PROFESSOR             ENT DEPT               HFH
Anatomy of sinuses
• Where are the  sinuses?• Four pairs of  paranasal sinuses  – Frontal-above eyes    in forehead bone  – Maxillary-in    c...
EMBRYOLOGICAL DEVELOPMENT • The sinuses are hollow air-filled   sacs lined by mucous membrane. • The ethmoid and maxillary...
EMBRYOLOGICAL DEVELOPMENT • At birth, the ethmoid, sphenoid   and maxillary sinuses are tiny   and cause problems in infan...
Inflammation of paranasal sinuses
DEFINATION AND INCIDENCE • An acute inflammatory process   involving one or more of the   paranasal sinuses. • A complicat...
PATHOGENESIS: • Usually follows rhinitis, which may be   viral or allergic. • May also result from abrupt pressure   chang...
PATHOGENESIS: • With inflammation, the mucosal lining   of the sinuses produce mucoid   drainage. Bacteria invade and pus ...
PREDISPOSING FACTORS • Allergies, nasal deformities,   cystic fibrosis, nasal polyps, and   HIV infection. • Cold weather ...
AETIOLOGY • 70% of bacterial sinusitis is   caused by:     • Streptococcus pneumoniae     • Haemophilus influenzae     • M...
SYMPTOMS: • History of URI or allergic rhinitis • History of pressure change • Pressure, pain, or tenderness over sinuses ...
CLINICAL FEATURES: • Periorbital edema • Cellulitis • Nasal mucosa is reddened or swollen • Percussion or palpation tender...
DIAGNOSTIC TESTS: • Imaging studies, such as sinus   radiographs, ultrasonograms, or   CT scanning – indicated if child is...
DIFFERENTIAL DIAGNOSIS •   septum deviation) •    Nasal foreign body Allergic rhinitis •    Non-allergic rhinitis •    Inf...
MEDICAL TREATMENT • Acetaminophen or ibuprofen to   relieve pain • Decongestants • Antihistamines • Nasal saline
ANTIBIOTIC TREATMENT: • Antimicrobials-treat for 10-14   days, depending upon severity,   with one of the following: • Amo...
TREATMENT• SEPTRAN: CO-  TRIMOXAZOLE+TRIMETHOPRIM• CEFACLOR:500MG:1 *TDS• STEAM INHALATION
FOLLOW UP INSTRUCTIONS     Humidifier to relieve the drying of       mucous membranes associated       with mouth breathin...
PATIENT EDUCATION: • Child should not dive. • Child should not travel by airplane. • Urge parent to eliminate triggers in ...
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Acute sinusitis

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Transcript of "Acute sinusitis"

  1. 1. SINUSITIS AND ITS MANAGEMENT DR NAUSHEEN QURESHI ASSISTANT PROFESSOR ENT DEPT HFH
  2. 2. Anatomy of sinuses
  3. 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. 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. 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. 6. Inflammation of paranasal sinuses
  7. 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. 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. 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. 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. 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. 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. 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. 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. 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. 16. MEDICAL TREATMENT • Acetaminophen or ibuprofen to relieve pain • Decongestants • Antihistamines • Nasal saline
  17. 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. 18. TREATMENT• SEPTRAN: CO- TRIMOXAZOLE+TRIMETHOPRIM• CEFACLOR:500MG:1 *TDS• STEAM INHALATION
  19. 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. 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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