Rhinosinusitis

1,975 views

Published on

Published in: Education

Rhinosinusitis

  1. 1. Definitiongroup of disorders characterized by inflammation of the mucosa of the nose and paranasal sinuses.Nasal congestionNasal dischargeSneezingNasal itchiness
  2. 2. PathophysiologyViral infection nose and sinuses, anatomical abnormalities sinus Ostia obstruction reducedmucociliary clearence stasis of secretion Secondary bacterial infection.
  3. 3. Factors causing RhinosinusitisAnatomical factors  Mucociliary clearance  Agar nasi cells Primary  Over pneumatized bulla  Kartagener’s ethmodalis syndrome  Young’s syndrome  Paradoxical turbinate  Cystic fibrosis  Concha bullosa  Secondary  DNS  Allergy  Haller cells  Infection  @HA_COP  trauma
  4. 4. OrganismsAc rhinosinusitis Strepto pneumonia H influenza M cattarahalisCh rhinosinusitis Bacteria causing ac rhinosinusitis + pseudomonas anaerobes
  5. 5. Acute Rhinosinusitis - Symptoms1 Proceeding URTI or Dental infection2Constitutional symptoms  Fever , malaise3Headache/ facial pain  Maxillary –maxillary region, aggravated on stooping ,coughing and chewing heache frontal  Frontal – Office headache at frontal  Ethmoidal- bridge of the nose  Sphenoidal -vertex4 Nasal discharge , nasal obstruction5 Redness and oedema frontal-upper eylid maxillary-same region plus lowe eye lid
  6. 6. Acute Rhinosinusitis - SignsFeverCongested nasal mucosaLocal tendernessMucopus in nose or nasopharynxDental caries
  7. 7. InvestigationRadiological study X-ray : water’s view and lateral views opacity or fluid level at affected sinus CT scan: coronal view nose and pns preferred MRI – recent• Nasal swab• Diagnostic nasal endoscopy• Mucosal biposy
  8. 8. Radiological studies
  9. 9. Medical RxAntibiotics x 2 weeks Amoxicillin Augmentin CefuroximeNasal decongestants – 0.1% xylometazoline drop or sprayAntihistaminesAnalgesics and antipyretics• Medicated steam inhalation• Hot fomentation
  10. 10. surgicalAntral lavage esp for maxillary also in fronatal to rule out max co-infectionTrephination of frontal sinus indication1 (both )Persistane symptoms after 48 hrs of medical therapy2 Threatened orbital complication
  11. 11. Chronic Rhinosinusitis Symptoms SignsUsually less - no pain n Mucopus in the meati headacheNasal obstruction Nasal mucosa congestedNasal/Post nasal purulent X-ray show fluid level or discharge opacityhyposmia / anosmia
  12. 12. Task force criteria 2 major criteria or 1 major and 2 minor criteria Major criteria Minor criteriaFacial pain/pressure HeadacheFacial congestion/fullness HalitosisNasal obstruction/blockage FatigueNasal discharge/purulence Dental painHyposmia /anosmia CoughPurulence on nasal Ear pain/pressure/ examination fullnessFever (acute RS only) Fever (nonacute) @CDEF2H2
  13. 13. Investigations (similar)
  14. 14. CRS RxMedical management Antibiotic Corticosteroid Antihistamine Nasal decongestants
  15. 15. Chronic Sinusitis - TreatmentSurgical Open-depends on the site  Antral puncture , intranasal antrostomy, Caldwell- Luc Operation- maxillary  Intranasal/external ethmoidectomy.  Trephination of frontal sinus, Osteoplastic flap operation, external frontoethmoidectomy Endoscopic-FESS
  16. 16. FESSFunctional Endoscopic Sinus Surgery? Funtional resume the normal function of sinus  drainage  ventilation
  17. 17. FESS-complicationLocal  Bleeding  Adhesion  Mucocele  Stenosis  RecurrenceOrbital  Orbital haematoma  Diplopia  BlindingIntracranial  CSF leakage  Meningitis
  18. 18. END

×