Simply Described in nursing aspect only

1. SINUSITIS
PREPARED BY:
SHRUTHI SASI
REGISTERED NURSE
CLINIC 2

2. OBJECTIVES
At the end of this session,participants will be able to:
1.Evaluate a patient with sinusitis
2.Define sinusitis
3.Enlist the classification,etiology,pathophysiology,clinical
Manifestations,diagnosis and treatment and complication of sinusitis.
4.Explain the nursing management of patients with sinusitis.

3. DEFINITION
 Sinusitis is an inflammation of the mucus membrane of
paranasal sinuses.
 Paranasal sinuses are group of 4 paired air filled spaces
that around the nasal cavity.
They reduce the weight of the skull and they humidify the
inspired air.

4. ANATOMY OF SINUSES

5. CLASSIFICATION

6. • Bacterial : from streptococcus pneumonia, klebsiella, staphylococcus aureus…
• Viral infection : 90% of sinusitis occurs due to rhinovirus.
• Pollutants : chemical/irritants may trigger the build of mucus(pollen,dust etc)
• Fungi : rare
• RISK FACTORS
 Swimming and diving : infected water enters to the sinuses through ostium.
 Trauma : compound fractures or penetrating injuries.
 Dental infections :bacteria may cause the bone decay and breakdown,allowing the
infection to spread
 Obstruction to sinus ventilation and drainage(dns,polyp,neoplasm)
 Stasis of secretions in nasal cavity. (Cystic fibrosus, enlarged adenoids)
 Smoking
 Iatrogenic factors such as mechanical ventilation, NG tubes,nasal packing etc
ETIOLOGY

7. NASAL POLYP
ADENOID HYPERTROPHY

8. PATHOPHYSIOLOGY

9. CLINICAL MANIFESTATIONS
• Maxillary sinusitis : pain in the upper jaw.
• Frontal sinusitis : pain in the forehead.
• Ethmoid sinusitis : pain over nasal bridge.
• Sphenoid sinusitis : pain over the occiput or vertex.

10. CLINICAL MANIFESTATIONS
cont..
 Facial pressure and pain
 Headache
 Nasal congestion and nasal block
 Cough with phlegm
 Nasal and post nasal discharge
 Yellow or green mucus from nose
 In advance -halitosis, anosmia.
 Fever

11. DIAGNOSTIC TESTS
• History collection- allergens,cold environment,chemical exposure etc..
• Physical examination- DNS,polyp,allergic mucosa,tenderness
• CBC/CRP-elevated
• X-ray PNS-shows opacification of sinus, thickened mucus membrane.
• CT maxillofacial area scan.
• Nasal endoscopy
• Culture and sensitivity test.

12. CT-SCAN FINDINGS

13. TREATMENT
Medical management
Treatment depends on the how long the conditions lasts. Most acute cases are
managed without treatment.
In most of the sinusitis ,antibiotics are not recommended because viral causes.
Symptomatic treatment is given to the patient .
In any rhinoviral illness improves within 7 – 10 days.
Bacterial sinusitis requires the persistences of symptoms for longer than 10
days.
A 7 – 10 days of watchful waiting before antibiotics are prescribed.

14. TREATMENT (cont..)
• Treatment of symptoms with analgesics, antipyretics.
• Nasal Decongestants (xylometazoline nasal drops used to reduce
nasal edema & are preferred to as initial strategy )
• Antihistamines -for reducing osteomeatal obstruction in clients with allergies.
• Mucolytic agents such as Guaifenesin and saline lavage used to decrease the
duration of sinus infection.
• Corticosteroid nasal spray :To reduce mucosal inflammation(fluticasone)
• Humidification : Normal saline solution irrigations/humidifier is used to prevent
nasal crusting
• Steam inhalation
• Antibiotics (amoxicillin as first line)

15. ANTRAL IRRIGATION OR SINUS
LAVAGE
• Antral lavage is a surgical procedure in which a cannula is inserted into the
opening of the maxillary sinus via the inferior meatus to allow irrigation and
drainageof the sinus.

16. SURGICAL
MANAGEMENT
• FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS)
 the main objective of fess is to re-establish the sinus ventilation and
mucocilliary clearance.
 FESS is a minimally invasive procedure that is performed using an endoscope, a
thin, rigid tube with a camera on the end. The endoscope is inserted through the
nostrils, allowing the surgeon to visualize the inside of the nasal passages and
sinuses. The surgeon can then remove any tissue or obstruction that is blocking the
sinuses, such as swollen or infected tissue.
It is doing only after all non-surgical treatment options such as antibiotics, topical
nasal corticosteroids, and nasal lavage with saline solutions have been exhausted.
Possible complications include nasal bleeding, pain, scar formation.
After fess nasal packing may be inserted to minimize nasal bleeding.

17. SURGICAL
MANAGEMENTcont..
 The endoscopic approach to FESS is a less invasive method than open sinus
surgery, which allows patients to be more comfortable during and after the
procedure. Entering the surgical field via the nose, rather than through an
incision in the mouth as in the previous Caldwell-Luc method, decreases risk
of damaging nerves which innervate the teeth.

18. FINE ENDOSCOPIC SINUS
SURGERY

19. SURGICAL MANAGEMENTcont
NASALANTROSTOMY
• Maxillary antrostomy is a surgical procedure to enlarge the opening of the maxillary sinus.
• This allows for improved sinus drainage.
CALDWELL-LUC PROCEDURE
• It is to remove irreversibly damaged mucosa of the maxillary sinus via canine fossa
EXTERNAL SPHENO-ETHMOIDECTOMY
• It is performed to remove diseased mucosa from the sphenoidal or ethmoidal sinuses.
• A small incision is made over the ethmoidal sinus on the lateral nasal bridge and the
diseased mucosa is removed

20. • .
SURGICAL MANAGEMENTcont..
CALDWELL-LUC PROCEDURE
EXTERNAL SPHENO-ETHMOIDECTOMY

21. NURSING MANAGEMENT
• Apply warm compresses in the sinus area.
• Increase fluid intake to loosen the secretions.
• Educate patient to avoid cold environment.
• Promote good oral hygiene.
• Avoid smoking.
• Explain the client to engage in minimal physical exercise, avoid strenuous
activity.
• Elevate the head when lying down to relieve the stuffy feeling.

22. NURSING
MANAGEMENT
POST OPERATIVE NURSING MANAGEMENT
Breath through the mouth after surgery,because of the prsence of nasal pack.
Use luke warm water ,not hot water.
Avoid swimming for 6 weeks.
Avoid sawdust,chemicals and excessive dust for 4 weeks.
Donot blow the nose.
Donot put anything into nose.
For sneezing,open mouth and sneeze naturally.

23. NURSING MANAGEMENT
cont..
• SALINE NASAL WASH :is the practice of moving a saline (saltwater) solution
through your nasal passages to clear out mucus and flush out debris and allergens.
Irrigation devices, such as neti pots, squeeze bottles and rubber nasal bulbs, push the
water through one nostril and out the other.
Use saline nasal wash to keep the nasal passages open and wash out mucus and
dried blood
Proper follow up with doctor is required to clear the nasal passage.
For the first 24 hours after sinus surgery observe the client for nasal bleeding,
respiratory distress, orbital and facial edema.

24. NURSING DIAGNOSIS
• Ineffective airway clearance related to the obstruction and presence of thickened
secretions.
• Acute pain(head,throat sinus) related to inflammation of nose.
• Hyperthermia related to inflammation process.
• Disturbed sleeping pattern related to obstruction of the nose.
• Risk for infection related to disease process.
• Anxiety related to lack of knowledge about disease and medical procedures.
• Altered comfort related to facial fullness and nasal discharge.

25. COMPLICATIONS
A. LOCAL
 Mucocele/pyocele : mucus containing cystic lesion
 mucus retension cyst
 Osteomyelitis (frontal bone and maxilla)
B.ORBITAL
 Orbital cellulitis : eyelid edema and erythema,proptosis and chemosis,no limited extraoccular
movement.
 Orbital abcess : significant exophthalmos,chemosis,ophthalmoplegia and visual impairement.
 Subperiosteal absecss : proptosis and impaired extraoccular muscle movement
C.INTRACRANIAL
 Meningitis
 Extradural/subdural abscess : headache, fever,altered mental status,ct shows hypodense
collection.
 Cavernous sinus thrombosis : bilateral orbital pain,chemosis,ophthalmoplegia

26. REFERENCES
• http://en.wikipedia.org
• https://slideshare.net

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