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Acute and Chronic sinusitis.pptx
- 1. ACUTE AND CHRONIC SINUSITIS &ITS COMPLICATIONS
- 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)
- 5. ⦁ Mechanical obstruction– 1. DNS 2. Hypertrophied turbinates 3. nasal polyp 4. Tumours 5. nasal packing ⦁ Decreased mucociliary clearance – 1. cystic fibrosis 2. kartagener’s syndrome 3. young’s syndrome
- 6. ⦁ Iatrogenic – 1.rhinitis medica mentosa 2. aspirin intolerance 3. drug induced ⦁ Granulomatous diseases- ⦁ Tuberculosis, leprosy, syphilis, rhinoscleroma, rhino-sporidiosis ⦁ Hormonal – ⦁ pregnancy, puberty, menstruation, honeymoon, emotions, stress ⦁ Allergic rhinitis – chronic sinusitis ⦁ Trauma - Fracture or penetrating injuries
- 7. ⦁ Immunodeficiency andnutritional 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 headachestarts 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: ⦁ Flushingand 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 dentalinfection - 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
- 14. ⦁ D/D – 1.TM Neuralgia (Costen’s syndrome) 2. Trigeminal neuralgia 3. Dental neuralgia (caries) 4. Migraine 5. Temporal arteritis 6. Herpetic neuralgia 7 . Neoplasms 8. Brain stem lesions
- 15. ⦁ Complications – 1.Chronic sinusitis 2. middle ear 3 . pharyngeal infections 4. osteomyelitis 5. orbital cellulitis 6. optic nerve damage
- 16. Treatment: ⦁ Medical ⦁ Bedrest ⦁ Treat the dental infection ⦁ Antibiotics – ⦁ Ampicillin, Amoxycillin, Erythromycin,Doxycycline, Amoxyclav (for H.influenzae) , metronidazole ( for anaerobes) for 10 – 21 days
- 17. ⦁ Nasal decongestantdrops and systemic decongestants ⦁ Steam inhalation with inhalant capsules ⦁ Nasal irrigation with saline ⦁ Analgesics and anti inflammatory ⦁ Hot fomentation
- 18. ⦁ Surgical ⦁ Minimalrole – 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 oftaste ⦁ Reduced sense of smell ⦁ Post nasal discharge – hawking sensation ⦁ Nasal bleed ⦁ Halitosis
- 21. ⦁ Signs ⦁ Tendernesspresent ⦁ 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: ⦁ ETobstruction ⦁ pharyngitis ⦁ dryness of throat ⦁ cough ⦁ hoarseness of voice ⦁ Treatment: ⦁ Medical ⦁ Steroid nasal spray ⦁ Alkaline nasal douching ⦁ Antibiotics – rare
- 24. Surgical: ⦁ FESS –middle meatal antrostomy (maxillary), anterior/ posterior ethmoidectomy, frontal recess clearance, sphenoidectomy ⦁ Intra nasal antrostomy – maxillary sinus ⦁ Caldwel luc surgery – maxillary sinus ⦁ Intranasal/ External ethmoidectomy – ethmoidal sinus
- 25. ⦁ External frontoethmoidectomy (Howarth’s surgery) – frontal sinus ⦁ Osteoplastic flap procedure – frontal sinus ⦁ Spheniodotomy – sphenoid sinus ⦁ NOTE – ISOLATED FRONTAL, SPHENOIDAL SINUSITIS IS 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 FungalSinusitis: ⦁ 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 invasivesinusitis: ⦁ 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 spreadsinto 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
- 31. ⦁ INTRACRANIAL ⦁ Meningitis ⦁Encephalitis ⦁ Brain abscess, Subdural abscess, Extradural abscess ⦁ Cavernous Sinus Thrombophlebitis ⦁ Ant PNS complications – mucocele, pyocele, osteomyelitis, orbital, intracranial ⦁ Post PNS complications – CST, Supraorbital fissure syndrome, Orbital apex syndrome, optic neuritis
- 32. ⦁ Chronic epitheliallined, 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 ofacute 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 seenin 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 ⦁ Extraduralabscess ⦁ 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: ⦁ Infectionof 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 ⦁ Abruptonset 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 betweenoral 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 – ⦁ passageof 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
- 41.