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Acute Sinusitis

Acute Sinusitis



This presentation describes acute sinusitis and its management

This presentation describes acute sinusitis and its management



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    Acute Sinusitis Acute Sinusitis Presentation Transcript

    • Sinusitis
      Dr. T. Balasubramanian
    • Sinusitis
      • Can be defined as inflammation of the mucosa lining the paranasal sinuses
      • Can be classified into acute and chronic
      • Allergic & infective types
      • Pan sinusitis is the term used to indicate inflammation of all the paranasal sinuses
    • Acute sinusitis
      • Acute inflammation of mucosa lining paranasal sinuses of less than 4 weeks duration
      • Infection is said to be closed if the inflammatory exudate cannot escape from the sinus because of blocked ostium or viscous secretion
      • 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.
      • After the defences are breached, secondary bacterial infection follows.
    • Aetiology
      • Infections
      • Swiming / bathing
      • Trauma to paranasal sinuses
      • As a component of general diseases
    • Infections
      • Nasal infections
      • Pharyngeal infections
      • Dental infections
    • Swiming / bathing
      • Infected pool / ponds
      • Chemical rhinitis
      • Bacterial sinusitis – due to water contamination
    • Trauma to sinuses
      • Compound fractures involving sinuses
      • Foreign bodies involving sinuses
      • Barotrauma - aerosinusitis
    • General diseases
      • Influenza
      • Measles
      • Whooping cough
      • Pneumonia
    • Contributing factors
      • Unhygenic environment
      • Low resistence to infections
      • Over crowding
      • Anatomical obstructions
      • Conditions like Kartagener's syndrome
      • Osteomeatal complex block
    • Importance of OMC
      • It represents an important anatomic site where the drainage channels of maxillary,frontal and ethmoidal sinuses drain
      • Bounded by middle turbinate medially, basal lamella posteriorly and superiorly and lamina papyracea laterally
      • It drains anteriorly and inferiorly
      • Blockage in this zone causes bacterial sinusitis
    • Microbiology
      • Viruses include – Rhinovirus, Parainfluenzae I and II, Coxsackie, and Respiratory syncitial virus
      • Bacteria include – Pneumococci, streptococci, staphylococci, H influenzae, E coli, Micrococcus
      • Specific infections – Fungi, syphilis, tuberculosis and leprosy
    • Pathological stages
      • Catarrhal stage
      • Exudative stage
      • Suppurative stage
      • Stage of complications
      • Stage of resolution
    • Criteria to suggest bacterial sinusitis
      • Diagnosis of bacterial sinusitis requires two major / one major or two or more minor criteria
      • History should be strongly suggestive of bacterial sinusitis
      • Gold standard investigations would be pus culture and sensitivity
    • Major criteria
      • Facial pain / tenderness
      • Facial fullness & congestion
      • Nasal congestion & obstruction
      • Purulent nasal discharge / post nasal drip
      • Hyposmia / anosmia
      • Fever
    • Minor criteria
      • Headache
      • Halitosis
      • Fatigue
      • Cough
      • Dental pain
      • Ear fullness / ear pain
    • 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.
      • 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.
      • 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
      • Ethmoidal pain – Over bridge of nose, and inner canthus of eye. May be referred to parietal eminence
      • Frontal sinus pain – Localized to forehead. Shows classic periodicity
      • Sphenoidal pain – Occipital in nature. May radiate to the neck
    • Signs
      • Swelling over cheek
      • Swelling over lower eyelids / upper eyelids
      • Swelling over inner canthus of eye
      • Tenderness over affected sinus
      • Anterior rhinoscopy – Congested nasal mucosa, sometimes discharge from middle meatus
    • Investigations
      • Radiology
      • Culture sensitivity
      • Routine hematology
    • Treatment
      • Purely medical
      • Antibiotics
      • Nasal decongestants
      • Anti histamines
      • Anti inflammatory drugs
      • Surgery very rare – complications common. Indicated only in cases of impending complications
    • Complications
      • Osteomyelitis of the surrounding bone
      • Orbital cellulitis
      • Orbital abscess formation
      • Intracranial complications – cavernous sinus thrombosis, meningitis, and intracranial abscess
      • Ch sinusitis
      • Middle ear infections
      • Laryngitis, oroantral fistula, mucoceles