2. Sinusitis –
1. Inflammation of mucosa of one or more
Para Nasal Sinuses
2. Pan Sinusitis – all sinuses involved
3. Multi Sinusitis – more than one sinus
involved
• MOST COMMON– Maxillary sinusitis
• 2nd – Ethmoid, Frontal and Sphenoid
(rare alone, mainly as pan sinusitis)
3. ⦁ Open Sinusitis – drainage of secretions,
patent ostia
⦁ Closed Sinusitis – no drainage, blocked
ostia, more severe
• Acute Sinusitis – if < 4 weeks
• Subacute Sinusitis – 4 weeks to 3 months
• Chronic Sinusitis – persistent for > 3
months due to incomplete resolution of
acute stage, destruction of respiratory
epithelium (cilia) – inadequate drainage
of secretions – mucosal oedema –
polypoidal changes
4. ⦁ Infection – Nasal infection,
adenotonsillitis, dental infection
(maxillary sinus) – upper molar and
premolar
⦁ Persistant infection – chronic sinusitis
⦁ Most Common cause – viral infection
initially (Rhinovirus, Parainfluenza virus),
followed by becterial infection
(H.Influenzae -most common,
pneumococci, streptococci)
7. ⦁ Immunodeficiency and nutritional
deficiency
⦁ Environmental –
⦁ cold and wet climate
⦁ Smoke & dust
⦁ swimming and bathing in pond with
high chlorine content
⦁ Contaminated pond
⦁ Idiopathic
8. ⦁ CLINICAL FEATURES –
⦁ localized headache
⦁ Pain over cheeks radiating to teeth,
aggravating on bending forward
⦁ straining, chewing, coughing – Maxillary
Sinusitis
⦁ Pain between and behind the eyes,
over bridge of nose aggravated by
movement of eye ball - Ethmoidal sinusitis
9. ⦁ Frontal headache starts in the
morning, peaks in the afternoon then
subsides (office headache) to again
increase at time of sleep (diurnal)
- Frontal Sinusitis
⦁ Pain over the vertex or occiput
radiating to the temporal/mastoid
region
–Sphenoidal sinusitis
⦁ Purulent nasal discharge in middle
meatus – anterior sinuses/
superior meatus – posterior
sinuses/ foul smelling – dental
infection
10. ⦁ Nasal blockage
⦁ Loss of smell
⦁ Affects vocal resonance
⦁ Fever, general malaise, bodyache
⦁ Post nasal discharge
⦁ Nocturnal cough – children
⦁ Children – ethmoidal sinusitis more
common as relatively large ethmoids,
swelling of cheeks
⦁ Altered taste
11. ⦁ Signs:
⦁ Flushing and swelling of cheeks and lower
eyelid – Maxillary sinusitis
⦁ Oedema of lids – puffy and swollen,
swelling of inner canthus – Ethmoidal
sinusitis
⦁ Swelling of upper eyelid and orbital
swelling – Frontal sinusitis
⦁ Tenderness – canine fossa (maxillary),
inner canthus (ethmoidal), floor or anterior
wall of frontal bone (frontal)
12. • Associated dental infection - maxillary
• Postural test –
• on bending down discharge in nose –
frontal
• on bending head to the opposite side -
maxillary
13. ⦁ Diagnosis:
⦁ DNE – oedema of middle turbinate,
OMC blockage
⦁ X Ray PNS –
⦁ fluid level, opacity – Waters view,
Caldwel view, Pierre view
⦁ CT Scan : OMC/PNS
⦁ Trans illumination tests
16. Treatment:
⦁ Medical
⦁ Bed rest
⦁ Treat the dental infection
⦁ Antibiotics –
⦁ Ampicillin, Amoxycillin,
Erythromycin,Doxycycline, Amoxyclav (for
H.influenzae) , metronidazole ( for
anaerobes) for 10 – 21 days
17. ⦁ Nasal decongestant drops and
systemic decongestants
⦁ Steam inhalation with inhalant capsules
⦁ Nasal irrigation with saline
⦁ Analgesics and anti inflammatory
⦁ Hot fomentation
18. ⦁ Surgical
⦁ Minimal role – only if medical treatment
fails
⦁ Drainage of pus
⦁ Antral lavage – maxillary sinusitis
⦁ Trephination of frontal sinus – frontal
sinusitis – 2 cm horizontal incision
supero medial aspect of eyebrow
⦁ Perforation of anterior wall of sphenoid
sinus
– sphenoidal sinusitis
19. ⦁ Etiology – allergy, dusty enviroment, fungal
infection
⦁ Clinical Features:
⦁ Less severe headache, dull but
persistant/ heavy head
⦁ Nasal obstruction – persistant and more
at night – polypoidal changes
⦁ Foul smelling purulent nasal discharge/
viscid mucoid
nasal discharge/ mucopurulent
20. ⦁ Loss of taste
⦁ Reduced sense of smell
⦁ Post nasal discharge – hawking
sensation
⦁ Nasal bleed
⦁ Halitosis
21. ⦁ Signs
⦁ Tenderness present
⦁ Discharge in middle meatus/ superior
meatus
⦁ Posterior rhinoscopy – discharge in
middle/ superior meatus
⦁ Excoriation of nasal vestibule skin
⦁ Crusting, hypertrophied turbinates
⦁ Congestion of middle meatus (localised)
22. ⦁ Diagnosis:
⦁ DNE, CT Scan, X Ray PNS, antroscopy
(maxillary sinus)
⦁ X Ray PNS – opacity, thickened mucosa
⦁ DNE – Discharge, polyp, accessory ostia
23. ⦁ Complications:
⦁ ET obstruction
⦁ pharyngitis
⦁ dryness of throat
⦁ cough
⦁ hoarseness of voice
⦁ Treatment:
⦁ Medical
⦁ Steroid nasal spray
⦁ Alkaline nasal douching
⦁ Antibiotics – rare
26. ⦁ Aspergillus (mc) – fumigatus/ niger/ flavus
⦁ Alternaria
⦁ Mucor
⦁ Rhizopus
⦁ Common in immunocompromised and those with
trauma (#)
⦁ Predisposing factors – dry and hot climate
⦁ Types
⦁ Invasive - chronic invasive, fulminant fungal
sinusitis
⦁ Non invasive – fungal ball, allergic fungal
sinusitis
27. ⦁ Fungal ball/Mycetoma:
⦁ Implantation of fungi into healthy
sinus
⦁ No bone erosion
⦁ MC – Maxillary Sinus, Sphenoidal
(2nd), Ethmoidal, Frontal
⦁ Thick greenish discharge visualised
⦁ Diagnosis – Histopathology, CT
⦁ Treatment – Surgical removal
⦁ NO ROLE OF ANTI FUNGAL THERAPY
28. ⦁ Allergic Fungal Sinusitis:
⦁ Allergic reaction to fungi
⦁ Seen in young adults
⦁ h/o asthma
⦁ Sino nasal polyps
⦁ Pan sinusitis
⦁ Nasal secretions – mucin – contains
eosinophils, charcot leyden crystals, fungal
hyphae
⦁ No invasion of sinuses, bony erosion by
pressure
⦁ Treatment – FESS with pre op and post
op systemic steroids
29. ⦁ Chronic invasive sinusitis:
⦁ Invades sinus mucosa
⦁ Bone erosion by fungi
⦁ Intracranial and intraorbital invasion
⦁ Treatment
⦁ Surgical removal of invaded mucosa
⦁ Anti fungal therapy – Amphotericin B
IV, Itraconazole oral
30. ⦁ Infection spreads into or beyond the bony
walls of PNS
⦁ EXTRA CRANIAL
⦁ Mucocele
⦁ Pyocele
⦁ Osteomyelitis
⦁ Orbital – Orbital cellulitis and abscess
⦁ Descending infections – ASOM,CSOM,
Pharyngitis, Tonsillitis, Laryngitis,
Bronchitis
⦁ Focal infections – Polyarthritis,
Tenosynovitis, skin diseases
⦁ Distant infections – Septicaemia, TSS
32. ⦁ Chronic epithelial lined, oval cystic swelling of PNS
containing mucus occurs as a complication of chronic
sinusitis
⦁ Etiology
⦁ Due to permanent/chronic obstruction of sinus
ostium
⦁ Due to obstruction of ducts of mucus/minor salivary
glands of sinus mucosa
⦁ Leading to expansion of sinus and erosion of bony
wall or collection of secretions in the sinus leading to
retention cyst without wall erosion
⦁ Any age group, mc 40-60 years
⦁ Frontal (mc), Ethmoid (2nd mc), Maxillary, Sphenoid
33. ⦁ Complication of acute sinusitis
⦁ Infection of mucocele
⦁ Pain and fever
⦁ Ethmoidal pyocele – seen in children
⦁ Treatment – evacuation of pus and excision
of diseased mucosa
⦁ IV broad spectrum antibiotics
34. ⦁ Commonly seen in ethmoid sinus infections as
closely related to orbit by lamina papyracea
⦁ 2nd – frontal sinus infections
⦁ Can lead to orbital cellulitis, subperiosteal
abscess, intra orbital abscess
⦁ Inflammatory oedema of eyelids – upper lid
(frontal), lower lid (maxillary), both (ethmoidal)
⦁ Proptosis
⦁ Lid oedema
⦁ Chemosis of conjuctiva
⦁ Exophthalmos
⦁ Ophthalmoplegia
35. ⦁ Osteitis – infection of compact bone
⦁ Osteomyelitis – infection of cancellous/diploic bone,
infection of bone marrow
⦁ Involves – Frontal Sinus (mc), Maxillary sinus (2nd mc)
⦁ Etiology:
⦁ Suppurative sinusitis (acute infection)
⦁ Trauma
⦁ Surgery
⦁ Thrombophlebitis of infected bone
⦁ Staph aureus, streptococci, pneumococci, anaerobes
⦁ F>M
36. ⦁ Meningitis
⦁ Extradural abscess
⦁ Subdural abscess
⦁ Cerebral abscess
⦁ CST
⦁ Etiology
⦁ Sinusitis – Destruction of roof of frontal,
ethmoidal, sphenoidal sinus – anterior cranial
fossa
⦁ Otitis Media
⦁ Treatment – IV antibiotics and anti convulsive
therapy
37. ⦁ Etiology:
⦁ Infection of PNS – posterior ethmoid and
sphenoid
⦁ Orbital complications of sinusitis
⦁ Furunculosis of nose, infection of vestibule
⦁ Due to valveless nature of veins of
cavernous sinus – easy spread of infection
38. ⦁ C/F
⦁ Abrupt onset with B/L involvement
⦁ High grade fever 105 F with chills and
rigor
⦁ Swollen eyelids and proptosis of eyeball
⦁ Ophthalmoplegia with retinal congestion
⦁ Diminished vision
⦁ Dilated and fixed pupil
⦁ Papilloedema and chemosis of conjuctiva
⦁ Treatment
⦁ IV antibiotics/ anticoagulant therapy
⦁ Drainage of infected sinus
⦁ Orbital decompression
39. ⦁ Communication between oral cavity and
maxillary sinus
⦁ Etiology:
⦁ Dental extraction – upper premolar and
molar
⦁ Malignancy
⦁ Granulomatous disorders
⦁ Complication of acute maxillary sinusitis
⦁ Trauma
⦁ Surgery – Caldwel Luc Surgery
40. C/F –
⦁ passage of food and fluids from oral cavity
to nose
⦁ Blow of air from nose to oral cavity
⦁ Treatment
⦁ Antibiotics
⦁ Large fistula – surgery with flaps – palatal
and buccal flaps
