Acute Sinusitis

6,888 views

Published on

This presentation describes acute sinusitis and its management

Published in: Health & Medicine
1 Comment
9 Likes
Statistics
Notes
  • Cura delle sinusiti tramite intervento chirurgico:
    http://www.giuseppespinelli.it/approfondimenti/sinusiti.html
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total views
6,888
On SlideShare
0
From Embeds
0
Number of Embeds
18
Actions
Shares
0
Downloads
350
Comments
1
Likes
9
Embeds 0
No embeds

No notes for slide

Acute Sinusitis

  1. 1. Sinusitis<br />Dr. T. Balasubramanian<br />
  2. 2. Sinusitis<br /><ul><li>Can be defined as inflammation of the mucosa lining the paranasal sinuses
  3. 3. Can be classified into acute and chronic
  4. 4. Allergic & infective types
  5. 5. Pan sinusitis is the term used to indicate inflammation of all the paranasal sinuses</li></ul>drtbalu<br />
  6. 6. Acute sinusitis<br /><ul><li>Acute inflammation of mucosa lining paranasal sinuses of less than 4 weeks duration
  7. 7. Infection is said to be closed if the inflammatory exudate cannot escape from the sinus because of blocked ostium or viscous secretion
  8. 8. Infection is said to be open if the exudate escapes from the sinuses due to normal functioning mucociliary clearence mechanism</li></li></ul><li>Pathophysiology<br /><ul><li>Acute sinusitis is caused when the normal defence mechanisms like lysozymes and mucociliary clearance mechanism is breached due to viral infection.
  9. 9. After the defences are breached, secondary bacterial infection follows.</li></li></ul><li>Aetiology<br /><ul><li>Infections
  10. 10. Swiming / bathing
  11. 11. Trauma to paranasal sinuses
  12. 12. As a component of general diseases</li></li></ul><li>Infections<br /><ul><li>Nasal infections
  13. 13. Pharyngeal infections
  14. 14. Dental infections</li></li></ul><li>Swiming / bathing<br /><ul><li>Infected pool / ponds
  15. 15. Chemical rhinitis
  16. 16. Bacterial sinusitis – due to water contamination</li></li></ul><li>Trauma to sinuses<br /><ul><li>Compound fractures involving sinuses
  17. 17. Foreign bodies involving sinuses
  18. 18. Barotrauma - aerosinusitis</li></li></ul><li>General diseases<br /><ul><li>Influenza
  19. 19. Measles
  20. 20. Whooping cough
  21. 21. Pneumonia</li></li></ul><li>Contributing factors<br /><ul><li>Unhygenic environment
  22. 22. Low resistence to infections
  23. 23. Over crowding
  24. 24. Anatomical obstructions
  25. 25. Conditions like Kartagener's syndrome
  26. 26. Osteomeatal complex block</li></li></ul><li>Importance of OMC<br /><ul><li>It represents an important anatomic site where the drainage channels of maxillary,frontal and ethmoidal sinuses drain
  27. 27. Bounded by middle turbinate medially, basal lamella posteriorly and superiorly and lamina papyracea laterally
  28. 28. It drains anteriorly and inferiorly
  29. 29. Blockage in this zone causes bacterial sinusitis</li></li></ul><li>Microbiology<br /><ul><li>Viruses include – Rhinovirus, Parainfluenzae I and II, Coxsackie, and Respiratory syncitial virus
  30. 30. Bacteria include – Pneumococci, streptococci, staphylococci, H influenzae, E coli, Micrococcus
  31. 31. Specific infections – Fungi, syphilis, tuberculosis and leprosy</li></li></ul><li>Pathological stages<br /><ul><li>Catarrhal stage
  32. 32. Exudative stage
  33. 33. Suppurative stage
  34. 34. Stage of complications
  35. 35. Stage of resolution</li></li></ul><li>Criteria to suggest bacterial sinusitis<br /><ul><li>Diagnosis of bacterial sinusitis requires two major / one major or two or more minor criteria
  36. 36. History should be strongly suggestive of bacterial sinusitis
  37. 37. Gold standard investigations would be pus culture and sensitivity</li></li></ul><li>Major criteria<br /><ul><li>Facial pain / tenderness
  38. 38. Facial fullness & congestion
  39. 39. Nasal congestion & obstruction
  40. 40. Purulent nasal discharge / post nasal drip
  41. 41. Hyposmia / anosmia
  42. 42. Fever</li></li></ul><li>Minor criteria<br /><ul><li>Headache
  43. 43. Halitosis
  44. 44. Fatigue
  45. 45. Cough
  46. 46. Dental pain
  47. 47. Ear fullness / ear pain</li></li></ul><li>Clinical types<br /><ul><li>Acute catarrhal type – Earliest stage. There is oedema, mucous secretion, presence of leukocytes. There is no destruction of mucous membrane lining the sinuses.
  48. 48. Acute suppurative type – Inflammation is very severe. Large number of leukocytes seen. Pus could be seen accumulating due to suppuration. The mucous membrane may be necrotic and polypoidal</li></li></ul><li>Symptoms<br /><ul><li>General symptoms – Malaise, headache, mild fever, facial pain, sorethroat and periorbital oedema.
  49. 49. Local symptoms – Nasal block, loss of vocal resonance, reduction in sense of smell, nasal discharge, post nasal drip, cough, pain over sinus area</li></li></ul><li>Features of pain<br /><ul><li>Antral pain – Occurs along the infraorbital margins, and is referred to upper teeth
  50. 50. Ethmoidal pain – Over bridge of nose, and inner canthus of eye. May be referred to parietal eminence
  51. 51. Frontal sinus pain – Localized to forehead. Shows classic periodicity
  52. 52. Sphenoidal pain – Occipital in nature. May radiate to the neck</li></li></ul><li>Signs<br /><ul><li>Swelling over cheek
  53. 53. Swelling over lower eyelids / upper eyelids
  54. 54. Swelling over inner canthus of eye
  55. 55. Tenderness over affected sinus
  56. 56. Anterior rhinoscopy – Congested nasal mucosa, sometimes discharge from middle meatus</li></li></ul><li>Investigations<br /><ul><li>Radiology
  57. 57. Culture sensitivity
  58. 58. Routine hematology</li></li></ul><li>Treatment<br /><ul><li>Purely medical
  59. 59. Antibiotics
  60. 60. Nasal decongestants
  61. 61. Anti histamines
  62. 62. Anti inflammatory drugs
  63. 63. Surgery very rare – complications common. Indicated only in cases of impending complications</li></li></ul><li>Complications<br /><ul><li>Osteomyelitis of the surrounding bone
  64. 64. Orbital cellulitis
  65. 65. Orbital abscess formation
  66. 66. Intracranial complications – cavernous sinus thrombosis, meningitis, and intracranial abscess
  67. 67. Ch sinusitis
  68. 68. Middle ear infections
  69. 69. Laryngitis, oroantral fistula, mucoceles</li>

×