sinusitis and managment

1. SINUSITIS

2. Paranasal sinuses are a group of 4
paired air filled spaces that surround
the nasal cavity.
1. Frontal sinus
2. Ethmoid sinus
3. Sphenoid sinus
4. Maxillary sinus
They reduce the weight of the skull
and they humidify the inspired air.

3. Sinusitis is an inflammation of the mucus
membrane of the Paranasal sinuses.
Pansinusitisis infection of more than one
sinus.
Rhinosinusitis is referred to
inflammatory disease of the
as an
nose or
sinuses.
It is a common condition and a
complication of 5%-10% of URIs in children.

4. ON THE BASIS OF
LOCATION
ON THE BASISOF DURATION
Frontal sinusitis Acute sinusitis( infection
lasts up to 4 weeks)
Ethmoid Sinusitis Subacute sinusitis ( lasts
between 4 -12 weeks)
Maxillary sinusitis Chronic sinusitis( more
than 12 weeks)
Sphenoid sinusitis

5. Viral infection: 90% of sinusitis. Rhinovirus, coronavirus.
Bacteria: Streptococcus pneumoniae ,H Influenza
Pollutants: Chemical/irritants may trigger the build of
mucus.
Fungi: Rare.

6. URIs such as common cold
Nasal polyps
Deviated nasal septum
Dental infections
Swimming

7. Smoking and Intranasal cocaine.
Tonsillar and adenoid hypertrophy.
Pregnancy, hormonal changes with puberty.
Iatrogenic factors such as mechanical ventilation, NG
tubes, nasal packing etc.

8. Common sign and symptoms are
Fever, sore throat, headache, facial
pain and pressure, malaise.
In more advance cases the symptoms
are Anosmia, Nasal congestion and
discharge, halitosis etc.

9. 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. History taking
Physical examination
Watchful waiting: If sinusitis less than 10 days
without symptom then viral . More than 10 days
bacterial sinusitis.
X ray finding confirms the diagnosis.
CBC
CT scan.
Sinus radiography shows opacification of the
sinus, thickened mucous membrane.

11. Treatment depends on the how long
condition lasts. Most acute cases resolves
without treatment.
In most of the sinusitis antibiotics are not
recommended because viral causes.
Symptomatic treatment is given to the
patient.

12. Antibiotics are not prescribed routinely , because
many cases of sinusitis are viral.
First line therapy at most centers is amoxicillin for
14 days.
Antibiotic therapy- Amoxyclav 625 mg(Amoxycillin
500 mg + clavulamic acid 125 mg).

15. Xylometazoline nasal drops.
These are used to reduce
edema.
nasal

16. Mucolytic agents such as Guaifenesin
and Saline lavage used to decrease the
duration of sinus infections.

17. Pseudoephedrine and Phenylephrine
can be used for 10 to 14 days.
These drugs allow the restoration of
normal mucociliary function and
drainage.

19. These are used to reduce mucosal
inflammation.

20. Antihistamines are beneficial for reducing
osteomeatal obstruction in clients with
allergies and sinusitis.

21. Normal saline solution irrigations or A vaporizer
or humidifier is used to prevent nasal crusting
.These are also used to moisten secretions.

22. 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 drainage of the sinus.

23. Functional Endoscopic
sinus surgery.
Nasal antrostomy
External
sphenoethmoidectomy
Caldwell –Lue
procedure.

24. The main objective of FESS is to reestablish
the sinus ventilation and Mucociliary
clearance.
It is an outpatient surgical procedure using
local anesthesia.
Small fiberoptic endoscopes are passed
through the nasal cavity and into the sinus.
It allows the direct visualization of the
sinuses in order to remove diseased
tissue and to enlarge sinus Ostia.

26. It is a surgical procedure performed to
remove diseased mucosa from the
sphenoidal or ethmoidal sinus.
A small incision is made over the ethmoidal
sinus on the lateral nasal bridge and the
diseased mucosa is removed .
Nasal and ethmoidal packing then inserted.

27. Maxillary antrostomy is a surgical procedure
to enlarge the opening (ostium) of the
maxillary sinus. This allows for further
surgical intervention within the maxillary
sinus cavity as well as improved sinus
drainage.

28. Caldwell-luc antrostomy —also known
as Radical antrostomy— is an operation to
remove irreversibly damaged mucosa of
the maxillary sinus.
It is done when maxillary sinusitis is not
cured by medication or other non-invasive
technique.
The approach is mainly from anterior wall of
maxilla bone

30. Warm compresses apply in the sinus
area.
Increase fluid intake
Educate the patient to avoid cold
environment
Promote good oral hygiene
Avoid smoking
Avoid blowing nose.

31. For the first 24 hours after sinus surgery
,observe the client for nasal bleeding, respiratory distress,
orbital and facial edema.
Explain the client to engage in minimal physical
exercise, avoid strenuous activity.
Teach the client to sneeze only with the mouth open.
Nasal saline spray may be started 3 to 5 days after
the surgery to moisten the mucosa.
A nasal drip pad is taped beneath the nares to absorb
drainage after nasal or sinus surgery.

33. Meningitis. Osteomyelitis
Brain abscess