This document discusses sinusitis, including its definition, types, causes, symptoms, and treatments. It defines sinusitis as inflammation of the sinus mucous membranes. There are four main types based on the affected sinus: maxillary, ethmoidal, frontal, and sphenoidal. Sinusitis can be acute (<3 weeks), subacute (3-8 weeks), or chronic (>8 weeks). Common causes are bacterial, viral, or fungal infections which cause obstruction, impaired cilia function, or excessive mucus. Symptoms include facial pain, congestion, discharge, and headaches. Treatment involves medications to reduce swelling and drainage, as well as surgery in severe cases.

2. Definition:
Inflammation of the lining
mucous membrane of a sinus.
But
since the mucosal lining
of nose & sinuses are continuous.
Therefore
Newer Nomenclature for it is:
•RHINOSINUSITIS

4. 1. LOCATION:
• Maxillary Sinusitis-
involvement of Maxillary sinus.
• Ethmoidal Sinusitis-
involvement of the Ethmoid Sinus.
• Frontal Sinusitis-
involvement of Frontal sinus.
• Sphenoidal Sinusitis-
involvement of Sphenoid Sinus.

5. MAXILLARY SINUSITIS

6. ANTERIOR ETHMOIDAL
SINUSITIS

7. POSTERIOR ETHMOIDAL
SINUSITIS

8. FRONTAL SINUSITIS

9. SPHENOIDAL SINUSITIS

10. 2. No. of sinuses involved:
Multi Sinusitis
• Involvement of
more than one sinus.
Pan sinusitis
• Involvement of all the sinuses.
RIGHT LEFT
BILATERAL

11. MULTI SINUSITIS

12. PANSINUSITIS

13. PAN SINUSITIS

14. 3. DURATION OF SYMPTOMS:
• Acute = < 3 Weeks.
• Sub acute = 3 Weeks- 8 Weeks.
• Chronic = > 8 Weeks.
• Agency for Healthcare Research & Quality 1999.

15. 4. PATHOGENIC ORGANISMS:
•Bacterial.
•Viral.
•FUNGAL.

16. 5. DRAINAGE:
• Open Sinusitis:
Ostium of infected sinus is patent
Drainage of excess discharge occurs
Severe symptoms of sinusitis
do not develop.
• Closed Sinusitis:
Ostium of infected sinus is blocked
Drainage of excess discharge does not occur
Severe symptoms of sinusitis develop.

17. PATHOPHYSIOLOGY
• Related to 3 factors:
• 1. Obstruction of Sinus Drainage
Pathways. (Sinus Ostia):
• Caused by:
• Anatomical variants like
• Concha bullosa
• (Pneumatized middle turbinate)
• Oedema, Inflammation, Polyp,
• tumour, trauma, Scarring etc.
• Nasal instrumentation, Packing, N/G tube etc.

18. PATHOPHYSIOLOGY(Contd.)
• 2. Ciliary impairment:
• Poor ciliary function
accumulation of mucous
• Results from loss of ciliated
ep.cells, cold air, high airflow,
viral, bacterial or
environmental ciliotoxins,
infl. mediators, contact b/w mucosal
surfaces, scars & Primary ciliary dyskinesia.

19. PATHOPHYSIOLOGY(Cond.)
• 3. Quality & Quantity of Mucous:
• Decrease in Water content of
Mucous blanket impairs the
ciliary motality.
• Overproduction of
mucous overwhelms the
Mucociliary clearance system.

21. VIRAL URTI
EDEMA
AROUND
SINUS OSTIA
PARALYSIS OF
CILIA
STASIS OF MUCOUS SECRETION
SECONDARY BACTERIAL INFECTION

22. ETIOLOGICAL MICROORGANISMS
Commonest:
• Streptococcus pneumoniae.
• Haemophilus influenzae.
• Streptococcus pyogenes.
• Staphyllococcus aureus.
• E. Coli.
• Less commonly:
• ANAEROBES.
• Klebsiella.
• Stretococcus faecalis.

23. PREDISPOSING FACTORS
Anatomical, Physiological or Pathological :
• D.N.S.
• Concha bullosa.
• Trauma/fractures.
• Diving.
• Pre existing Rhinitis.
• Polyps.
• Infections spreading from
dental source.(10%)

24. SYMPTOMS
• Facial pressure /pain.
• Hyposmia./ anosmia.
• Nasal congestion.
• Nasal discharge.
• Postnasal drip.
• Fever.
• Cough.
• Fatigue.
• Maxillary dental pain.
• Ear fullness/pressure.

25. PAIN
• Location:
• Maxillary>
• Cheek or Upper Teeth.
• Frontal>
Forehead/Below eyebrows.
• Ethmoidal/Sphenoidal>
Retro bulbar/ vault pain.

26. PAIN
• Nature:
• Occurs due to stretching of nerve
fibers in the walls of dilated
blood vessels.
• Throbbing in character.
• Made worse by straining,
strooping or coughing.

27. PAIN
• Periodicity:
Usually worse on waking>
subsides as upright posture
reduces Nasal congestion.
• Frontal sinusitis produces
“Crescendo” Pain which is
worse at mid day & subsides
by the evening.

28. SIGNS
• Purulent Nasal secretions.
• Purulent posterior pharyngeal secretions
• Mucosal erythema.
• Peri orbital edema.
• Tenderness over the affected
sinuses.
• Air-fluid levels on
Trans illumination of the sinuses.
• Facial erythema.

29. Goal of therapy:
TO IMPROVE MUCOCILIARYFUNCTION
TREATMENT
TO CONTROL
INFECTION

30. TREATMENT (Contd.)
• Medical:
• Rest.
• Steam inhalation.
• Analgesics.
• Decongestants –
Local / systemic.
• Antibiotics.

31. TREATMENT (contd.)
Surgical:
Maxillary sinusitis:
• Antrum Washout (Proof puncture)
• Intranasal antrostomy.
Frontal sinustis:
• Trephine.
Sphenoid Sinusitis:
• Anterior Sphenoidotomy.
Ethmoid sinusitis:
• No surgery usually needed.

33. CHRONIC SINUSITIS
• How from Acute?
• Duration.
• The typical symptoms of
Acute sinusitis i.e. FEVER
&
FACIAL PAIN
are usually absent in chronic.

34. ETIOLOGICAL ORGANISMS
• Aerobic organisms:
• Staphyllococcus aureus.
• H. inluenzae
• M. catarrhalis.
• S. pneumoniae.
• Streptococcus intermedius.
• Pseudomonas aeruginosa.
• Nocardia.

35. ETIOLOGICAL ORGANISMS (Contd.)
• Anaerobic organisms:
• Peptostreptococcus.
• Prevotella.
• Porphyromonas.
• Bacteroids.
• Fusobacterium.

36. PREDISPOSING FACTORS
• Anatomical abnormalities of
ostiomeatal complex.
• Allergic rhinitis.
• Nasal polyps.
• Non Allergic Rhinitis.
• Nasotracheal intubation.
• Nasogastric intubation.

37. PREDISPOSING FACTORS (Contd.)
• Tumoral obstruction.
• Immunological disorders.
• Cystic fibrosis.
• Environmental pollution &
Smoking.
• Repeated URTI.
• GERD.

38. Nasal stuffiness.
Nasal discharge.
Postnasal drip.
Facial fullness,
Discomfort & Headache.
Chronic unproductive cough.
Hyposmia.
Sore throat.
Fetid breath.
SYMPTOMS:

39. Malaise.
Exacerbation of Asthma.
Dental Pain.
Visual disturbances.
Sneezing.
Stuffy ears.
Unpleasant taste.
P.U.O.
SYMPTOMS (Contd.)

40. SIGNS:
Tenderness over the affected sinuses.
Oropharyngeal erythema
purulent secretion.
Dental caries.
• Rhinological findings:
Mucosal edema, erythema
Nasal obstruction due to D.N.S., H.Ts., &
Polyposis.
Purulent secretions.

41. COMPLICATIONS:
Ophthalmological:
• Extraperiosteal Abscess.
• Orbital cellulitis.
• Cellulitis of eyelids.

42. Bony:
Osteomyelitis
of
Frontal
&
Maxillary bones.
COMPLICATIONS (Contd.)

43. COMPLICATIONS (Contd.)
Intracranial:
Meningitis.
Encephalitis.
Extradural abscess.
Subdural abscess.
Intracerebral abscess.
Cavernous sinus thrombosis.

44. EVALUATION:
Anterior Rhinoscopy.
Posterior Rhinoscopy.
Palpation over sinus areas.
Transillumination Test.
Postural test.
Radiography.
Proof Puncture.
Biopsy.

45. TREATMENT
Medical therapy:
• Reducing edema of sinus tissues.
• Facilitating drainage of
sinus secretions.
• Controlling predisposing factors.
• Treating concomitant infections.
• Adjunct to surgical treatment.

46. TREAMENT (Cond.)
Surgical therapy:
MAXILLARY SINUSITIS:
• Antrum Washout (Proof puncture)
• Intranasal antrostomy.
• Caldwel Lucs operation.
FRONTAL SINUSITIS:
• Trephine.
• External Fronto ethmoidectomy
(Howarth’s operation)
• Osteoplastic flap procedure
(Mac Beth’s operation)

47. TREATMENT (Contd.)
ETHMOID SINUSITIS:
• Intranasal Ethmoidectomy.
• External Fronto ethmoidectomy.
• Trans antral Ethmoidectomy.
(Horgan’s operation)
SPHENOID SINUSITIS:
• Anterior Sphenoidotomy.
• External Fronto Spheno Ethmoidectomy.

48. RECENT ADVANCE