Ch sinusitis

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This presentation describes chronic sinusitis and its management

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  • Le sinusiti sono difficili da combattere con le sole medicine, e spesso non tardano a tornare poco dopo che è stata interrotta la cura. In questi casi ricorrere alla chirurgia è il miglior compromesso.
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Ch sinusitis

  1. 1. Chronic sinusitis<br /><ul><li>Defined as inflammation of mucosal lining of paranasal sinuses of more than 3 months duration
  2. 2. Commonly follows a bout of acute sinusitis
  3. 3. Mucous membrane of sinuses are damaged irreversibly
  4. 4. Maxillary sinus is commonly involved</li></li></ul><li>Aetiology<br /><ul><li>Acute sinusitis
  5. 5. Chronic bronchitis
  6. 6. Bronchiectasis
  7. 7. Kartagener's syndrome
  8. 8. Young's syndrome</li></li></ul><li>Predisposing factors<br /><ul><li>Anatomical variations
  9. 9. Congenital
  10. 10. Hypersensitivity
  11. 11. Dental sepsis
  12. 12. Poor host resistance
  13. 13. Allergy
  14. 14. Iatrogenic – nasal packing, nasotracheal intubation</li></li></ul><li>Pathological classification<br /><ul><li>Hypertrophic sinusitis (polypoidal sinusitis)
  15. 15. Atrophic sinusitis (sclerosing / suppurative sinusitis)
  16. 16. Papillary sinusitis / Hypertrophic sinusitis
  17. 17. Follicular sinusitis – follicles are seen in the sinus mucosa
  18. 18. Glandular sinusitis – glandular elements increase in the submucosal area of the sinus mucosa</li></li></ul><li>Hypertrophic sinusitis<br /><ul><li>Inflammation mainly affects efferent vessels and lymphatics
  19. 19. Soft tissues get affected secondarily
  20. 20. Periphlebitis and perilymphangitis seen
  21. 21. Polypoidal formation of mucosa occur due to repeated attacks
  22. 22. Oedema of periosteum and rarefaction of bone is also seen</li></li></ul><li>Atrophic sinusitis<br /><ul><li>Main changes occur in the afferent vessels
  23. 23. Cellular reactions occur around arterioles and arteries
  24. 24. Endarteritis is common
  25. 25. Thrombus formation occur
  26. 26. Atrophy of mucous membrane occurs</li></li></ul><li>Papillary sinusitis<br /><ul><li>Main feature is the metaplasia of ciliated columnar epithelium into stratified squamous type
  27. 27. This causes papillary hyperplasia of the epithelium
  28. 28. Inflammatory cells are commonly seen
  29. 29. Viral infections predominantly cause this type of infection</li></li></ul><li>Clinical classification<br /><ul><li>Simple chronic infective sinusitis – Vasomotor and allergic components are absent. Usually follows attacks of acute sinusitis
  30. 30. Mixed infective and vasomotor chronic sinusitis – is usually due to vasomotor rhinitis causing seconday infection in sinus mucosa
  31. 31. Fungal sinusitis</li></li></ul><li>Symptoms<br /><ul><li>Nasal symptoms
  32. 32. Pharyngeal symptoms
  33. 33. Ear symptoms
  34. 34. Headache
  35. 35. Eye symptoms
  36. 36. Respiratory symptoms</li></li></ul><li>Signs<br /><ul><li>Anterior rhinoscopy – red congested mucosa with purulent discharge from middle meatus
  37. 37. Post nasal drip
  38. 38. Granular pharyngitis</li></li></ul><li>Investigations<br /><ul><li>Radiological
  39. 39. Routine blood tests
  40. 40. Pus for culture and sensitivity</li></li></ul><li>Management<br /><ul><li>Medical
  41. 41. Surgical</li></li></ul><li>Medical management<br /><ul><li>Antibiotics
  42. 42. Antihistamines
  43. 43. Nasal decongestants
  44. 44. Anti inflammatory drugs</li></li></ul><li>Surgical managment<br /><ul><li>Antral wash
  45. 45. Intranasal antrostomy
  46. 46. FESS
  47. 47. Caldwell Luc surgery
  48. 48. External fronto ethmoidectomy
  49. 49. Intranasal ethmoidectomy
  50. 50. External ethmoidectomy</li></li></ul><li>Complications<br /><ul><li>Orbital complications
  51. 51. Mucocele / pyocele
  52. 52. Fistulae
  53. 53. Intracranial complications
  54. 54. Osteomyelitis</li>

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