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Acute Sinusitis
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Acute Sinusitis

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This presentation describes acute sinusitis and its management

This presentation describes acute sinusitis and its management

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  • Cura delle sinusiti tramite intervento chirurgico:
    http://www.giuseppespinelli.it/approfondimenti/sinusiti.html
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  • 1. Sinusitis
    Dr. T. Balasubramanian
  • 2. Sinusitis
    • Can be defined as inflammation of the mucosa lining the paranasal sinuses
    • 3. Can be classified into acute and chronic
    • 4. Allergic & infective types
    • 5. Pan sinusitis is the term used to indicate inflammation of all the paranasal sinuses
    drtbalu
  • 6. Acute sinusitis
    • Acute inflammation of mucosa lining paranasal sinuses of less than 4 weeks duration
    • 7. Infection is said to be closed if the inflammatory exudate cannot escape from the sinus because of blocked ostium or viscous secretion
    • 8. Infection is said to be open if the exudate escapes from the sinuses due to normal functioning mucociliary clearence mechanism
  • Pathophysiology
    • Acute sinusitis is caused when the normal defence mechanisms like lysozymes and mucociliary clearance mechanism is breached due to viral infection.
    • 9. After the defences are breached, secondary bacterial infection follows.
  • Aetiology
    • Infections
    • 10. Swiming / bathing
    • 11. Trauma to paranasal sinuses
    • 12. As a component of general diseases
  • Infections
    • Nasal infections
    • 13. Pharyngeal infections
    • 14. Dental infections
  • Swiming / bathing
    • Infected pool / ponds
    • 15. Chemical rhinitis
    • 16. Bacterial sinusitis – due to water contamination
  • Trauma to sinuses
    • Compound fractures involving sinuses
    • 17. Foreign bodies involving sinuses
    • 18. Barotrauma - aerosinusitis
  • General diseases
  • Contributing factors
    • Unhygenic environment
    • 22. Low resistence to infections
    • 23. Over crowding
    • 24. Anatomical obstructions
    • 25. Conditions like Kartagener's syndrome
    • 26. Osteomeatal complex block
  • Importance of OMC
    • It represents an important anatomic site where the drainage channels of maxillary,frontal and ethmoidal sinuses drain
    • 27. Bounded by middle turbinate medially, basal lamella posteriorly and superiorly and lamina papyracea laterally
    • 28. It drains anteriorly and inferiorly
    • 29. Blockage in this zone causes bacterial sinusitis
  • Microbiology
    • Viruses include – Rhinovirus, Parainfluenzae I and II, Coxsackie, and Respiratory syncitial virus
    • 30. Bacteria include – Pneumococci, streptococci, staphylococci, H influenzae, E coli, Micrococcus
    • 31. Specific infections – Fungi, syphilis, tuberculosis and leprosy
  • Pathological stages
    • Catarrhal stage
    • 32. Exudative stage
    • 33. Suppurative stage
    • 34. Stage of complications
    • 35. Stage of resolution
  • Criteria to suggest bacterial sinusitis
    • Diagnosis of bacterial sinusitis requires two major / one major or two or more minor criteria
    • 36. History should be strongly suggestive of bacterial sinusitis
    • 37. Gold standard investigations would be pus culture and sensitivity
  • Major criteria
    • Facial pain / tenderness
    • 38. Facial fullness & congestion
    • 39. Nasal congestion & obstruction
    • 40. Purulent nasal discharge / post nasal drip
    • 41. Hyposmia / anosmia
    • 42. Fever
  • Minor criteria
  • Clinical types
    • Acute catarrhal type – Earliest stage. There is oedema, mucous secretion, presence of leukocytes. There is no destruction of mucous membrane lining the sinuses.
    • 48. Acute suppurative type – Inflammation is very severe. Large number of leukocytes seen. Pus could be seen accumulating due to suppuration. The mucous membrane may be necrotic and polypoidal
  • Symptoms
    • General symptoms – Malaise, headache, mild fever, facial pain, sorethroat and periorbital oedema.
    • 49. Local symptoms – Nasal block, loss of vocal resonance, reduction in sense of smell, nasal discharge, post nasal drip, cough, pain over sinus area
  • Features of pain
    • Antral pain – Occurs along the infraorbital margins, and is referred to upper teeth
    • 50. Ethmoidal pain – Over bridge of nose, and inner canthus of eye. May be referred to parietal eminence
    • 51. Frontal sinus pain – Localized to forehead. Shows classic periodicity
    • 52. Sphenoidal pain – Occipital in nature. May radiate to the neck
  • Signs
    • Swelling over cheek
    • 53. Swelling over lower eyelids / upper eyelids
    • 54. Swelling over inner canthus of eye
    • 55. Tenderness over affected sinus
    • 56. Anterior rhinoscopy – Congested nasal mucosa, sometimes discharge from middle meatus
  • Investigations
    • Radiology
    • 57. Culture sensitivity
    • 58. Routine hematology
  • Treatment
    • Purely medical
    • 59. Antibiotics
    • 60. Nasal decongestants
    • 61. Anti histamines
    • 62. Anti inflammatory drugs
    • 63. Surgery very rare – complications common. Indicated only in cases of impending complications
  • Complications
    • Osteomyelitis of the surrounding bone
    • 64. Orbital cellulitis
    • 65. Orbital abscess formation
    • 66. Intracranial complications – cavernous sinus thrombosis, meningitis, and intracranial abscess
    • 67. Ch sinusitis
    • 68. Middle ear infections
    • 69. Laryngitis, oroantral fistula, mucoceles

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