Tincy Thomas Registered Nurse

1. SINUSITIS
Presented By:
Ms. Tincy Thomas
MSc N

3. INTRODUCTION:
 Sinuses are moist air spaces within the bones of the
face around the nose. Sinuses are lined with the same
mucus membrane that lines the nose and mouth.
 When a person has cold and allergies the sinus tissues
make more mucous and become swollen. The
drainage system for the sinuses get blocked and
mucous can become trapped in these sinuses.

4.  A complication of 5%-10% of URIs in children.
 Maxillary and ethmoid sinuses are most frequently
involved.
 The sinuses are hollow air-filled sacs lined by mucous
membrane. The ethmoid and maxillary sinuses are
present at birth. The frontal sinus develops during the 2nd
year and the sphenoid sinus develops during the 3rd year.

6. DEFINTION:
 Sinusitis is a condition consisting of inflammation of
the paranasal sinuses, which may or may not be as a
result of infection from bacterial, fungal, viral,
allergic or autoimmune issues.

7.  It is the inflammation of the Para nasal sinuses.
 It may be acute or chronic inflammation.
 It is an acute inflammatory process
involving one or more of the paranasal sinuses.

8. CAUSES & RISK FACTORS:
 Bacteria, Fungi, Viruses.
 Bacterial Agents are Streptococcus pneumonia,
Staphylococcus aureus, Haemophilus influenza and
Moraxella catarrhalis.
 It is possible that constant exposure to inhaled
allergens such as house dust mites, pets, mold and
cockroaches may cause chronic inflammation of the
nose and the sinuses.

9. PREDISPOSING FACTORS:
 Allergies, nasal deformities, cystic
fibrosis, nasal polyps, and HIV infection.
 Cold weather
 Using decongestant nasal sprays too much
 Structural problems such as Deviated nasal septum
 High pollen counts

10.  Adenoids, Infected tonsils or dental infections.
 Smoking.
 Infections such as small sinus Ostia, concha bullosa.
 Reinfection from siblings.

11. ETIOLOGY:
70% of bacterial sinusitis is caused by:
 Streptococcus pneumonia
 Haemophilus influenza
 Moraxella catarrhalis

12. Other causative organisms are:
 Staphylococcus aureus
 Streptococcus pyogenes,
 Gram-negative bacilli
 Respiratory viruses

13. Classification
Acute Sinusitis
Chronic Sinusitis

14. SUBJECTIVE SYMPTOMS:
 History of URI or allergic rhinitis
 History of pressure change
 Pressure, pain, or tenderness over sinuses
 Increased pain in the morning, subsiding in the
afternoon
 Malaise

15.  Low-grade temperature
 Persistent nasal discharge, often purulent
 Postnasal drip
 Cough, worsens at night
 Mouthing breathing, snoring
 History of previous episodes of sinusitis
 Sore throat, bad breath
 Headache

16. CLINICAL PRESENTATION OF
SINUSITIS:
 Periorbital edema
 Cellulitis
 Nasal mucosa is reddened or swollen
 Percussion or palpation tenderness over a sinus
 Nasal discharge, thick, sometimes yellow or green
 Postnasal discharge in posterior pharynx

17.  Difficult trans illumination
 Swelling of turbinates
 Boggy pale turbinates

18. ACUTE SINUSITIS:

19. ACUTE SINUSITIS:
 Acute inflammation of sinus mucosa is usually
precipitated by an earlier upper respiratory tract
infection.
 Most cases of acute sinusitis start with a common cold
which is caused by a virus. Colds can inflame sinuses
and cause symptoms of sinusitis. If the inflammation
produced by the cold leads to a bacterial infection.

20.  When mucous present inside the sinuses and is
unable to drain into the nose it becomes the source of
nutrients to the bacteria.
 On rare occasions acute sinusitis can results in brain
infections and other serious complications.
 The inflammation caused by the cold and nasal
problems results in swelling of the mucous
membranes of the sinuses, and this can lead to the
trapping of air and mucous behind the narrow
opening of the sinuses.

21. CLINICAL MANIFESTATIONS:
 Maxillary Sinusitis: It can cause pain or pressure in the maxillary
area (cheek, jaw, gums and teeth) and cheeks become reddened,
edematous and tender to the touch. Pain is aggravated on stooping
or coughing.
 Frontal Sinusitis: It can cause pain or pressure in the frontal sinus
cavity. Pain is localized over the forehead and the patient complains
of frontal headache. The pain is severe in the morning and gradually
subsides towards noon as the infected material get drained out from
the sinus.

22.  Ethmoid Sinusitis: In ethmoid sinusitis the pain is
localized over the bridges of the nose, inner canthus and
between or behind the eyes.
 Sphenoid Sinusitis: Sphenoid Sinusitis can cause pain or
pressure behind the eyes but often refers to the vertex or
occiput of the head

23.  Malaise or tiredness
 Edema of eyelids
 Body ache
 Decreased sense of smell
 Tenderness on applying pressure
 Cough , severe at the night.
 Sore throat
 Bad breath
 Fever
 Mucopurulent nasal discharge

24. DIAGNOSTIC EVALUATION:
 History Collection
 Physical Examination
 X-ray examination of the paranasal sinuses
 Anterior and Posterior rhinoscopy reveals the
congestion of nasal mucosa and presence of mucous
in the nose.
 A Computed Tomography (CT scan).

25. MANAGEMENT:
 Antibiotic Therapy: The vast majorities of cases of acute
sinusitis are due to viral etiology and thus resolves without
antibiotics. If the symptoms are prolonged amoxicillin is a
reasonable first choice. Amoxicillin or clavulanate
(Augmentin) being indicated for the patients who fail
amoxicillin alone. Fluoroquinolones and other antibiotics
such as Clarithromycin and doxycycline are used in the
patients who are allergic to pencillin.The course of the
treatment is usually given for 10-15 days.

26.  Nasal Decongestants: Use of decongestant agents such
as pseudoephedrine and oxymetazoline helps in
relieving the nasal obstruction and mucosal swelling
thereby improving drainage of the sinuses.
Guaifenesin, a mucolytic agent may also be effective
in reducing nasal congestion.

27.  Antihistamines: - If allergy is suspected along with sinusitis,
antihistaminic drugs required to control allergies. This may
include diphenhydramine, cetirizine, fexofenadine and a
nasal steroid spray that reduces the swelling around the
sinus passages and allows the sinuses to drain.
 Steam inhalation:- Medicated steam inhalations like Tr.
Benzoin or menthol through the nose are soothing.

28.  Conservative measures: - Over the counter
medication such as acetaminophen or paracetamol
and ibuprofen can relieve some of the symptoms
associated with sinusitis such as headaches, pressure,
fatigue and pain.

29. CHRONIC SINUSITIS:

30.  In chronic sinusitis the membranes of both the
paranasal sinuses and the nose are thickened because
they are constantly inflamed for more than 8 weeks.
Chronic sinusitis is usually the result of incompletely
resolved acute sinusitis.
 Nasal polyps are grape like growths of the sinus
membranes that protrude into the sinuses or into the
nasal passages.
 Polyps make it even more difficult for the sinuses to
drain and for air to pass through the nose.

31. CLINICAL MANIFESTATIONS:
 Persistent nasal obstruction
 Nasal congestion due to the excessive nasal discharge
 Edema of the nasal mucous membrane
 Impaired mucociliary clearance
 Sore throat and dryness of throat
 Facial pain
 Headache
 Night time coughing

32.  Increase in previously minor or controlled asthma
symptoms.
 Thick green or yellow discharge
 Epitaxis
 Feeling facial fullness or tightness due to the presence of
nasal discharge.
 Aching teeth or halitosis
 Anosmia
 Reduction in the ability to smell or detect odour.
 Dental infections

33. DIAGNOSTIC EVALUATIONS:
 History Collection
 X-ray examination of the paranasal sinuses
 Anterior and Posterior rhinoscopy
 Transillumination test
 Rhino scan
 Nasal Endoscopy
 Computed Tomography
 Magnetic resonance Imaging
 Blood tests
 Biopsy of the membranes

34. MANAGEMENT:
 Treatment of chronic sinusitis aims to help in the
drainage of discharge from the sinus cavity and
remove the predisposing factors.
 Broad spectrum antibiotics are given after the culture
and sensitivity test. Amoxicillin clavulanate
(Augmentin) or ampicillin, clarithromycin and third
generation cephalosporines such as cefuroxime axetil,
cefpodoxime and cefprozil have also been effective.
 Levofloxacin a quiolone may also been used.

35.  Antibiotic therapy can be continued for 3-4 weeks.
 Use of local or systemic decongestants helps in relieving the
nasal obstruction and mucosal swelling.
 Heated mist and saline irrigation also may be effective for
opening blocked passages.
 Anti histamininic drugs and analgesics help to relieve the
symptoms. Sometimes local medication in the sinus cavity
is also instilled.

36. SURGICAL MANAGEMENT:
 When medicine fails surgery may be the only
alternative for treating chronic sinusitis. The goal of
surgery is to improve sinus drainage and reduce
blockage of the nasal passages. During surgery which
is usually done through the nose, the surgeon enlarges
the natural openings of the sinuses removes any
polyps and correct significant anatomic deformities
that contribute the obstruction.

37.  Antrum Puncture: In this procedure the trochar and
cannula put under the inferior turbinate about half
inch from the anterior end of the turbinate. After
piercing nasoantral wall the trochar entered into
antral cavity. The trochar is removed and the cannula
is placed properly in the sinus cavity. This procedure
is done to irrigate sinus cavity with sterile nasal
saline. The discharge comes out through the natural
ostium of the sinus. After the procedure local
medication is instilled, cannulla is withdrawn and
nose is cleaned.

38.  Intranasal Antrostomy: This is the drainage
operation performed on the maxillary sinus to create
a permanent window near the floor of antrum to
facilitate drainage of discharge.
 Caldwell –Luc Radical Antrostomy: Incision in the
upper gum opening in the anterior wall of antrum
removal of the entire diseased maxillary sinus mucosa
and drainage is allowed into inferior or middle
meatus by creating a large window in the lateral
nasal wall.

39.  Balloon Sinuplasty: This method similar to balloon
angioplasty used to unclog arteries of the heart, utilizes
balloons in an attempt to expand the openings of the
sinuses in a less invasive manner.
 Functional Endoscopic Sinus Surgery: The normal
clearance from the sinus is restored by removing the
anatomical and pathological obstructive variations that
predispose to sinusitis. The benefit of FESS is its ability to
allow for a more targeted approach to the affected sinuses,
reducing tissue disruption and minimizing post operative
complications.

40. NURSING MANAGEMENT:
 Encourage the client to get plenty of bed rest. Lying
down can make sinuses feel more stopped up , so try
lying on the side that lets you breathes the best. You
can prompt yourself with a pillow.
 The nurse instructs the patient about the methods to
promote drainage such as inhaling steam (steam bath,
hot shower), increasing fluid intake and applying
local heat.

41.  Apply moist heat such by holding a warm, wet towel
against face or breathing in steam through a cloth or
towel. This will relieve sinus pressure and helps to
open sinuses.
 Encourage the patient to avoid bending, lifting heavy
objects and stooping.

42.  Talk with the doctor before using an over the counter
cold medicine. Some cold medicines can make
symptoms worse or cause other problems.
 Don’t use a nasal spray with a decongestant in it for
more than 3 days. If using it for than 3 days, the
swelling in the sinuses may get worse when you stop
using the medications.

43. PREVENTION:
 Keep the nose moist as possible with frequent use of nasal saline
sprays.
 Avoid upper respiratory tract infections.
 Use a humidifier if necessary. If the air in the home is dry such
as it is if you have forced hot air heat, adding moisture to the
air may help to prevent sinusitis. Be sure the humidifier stays
clean and free of mold with regular thorough cleaning.
 Avoid very dry indoor environments. But be aware that if
allergic to molds, house dusts mites, cockroaches; a humid
environment may also create problems.

44.  Avoid exposure to irritants such as cigarette smoking,
strong odors from chemicals. Tobacco smoke and air
contaminants can irritate and inflame your lungs and
nasal passages. Avoid alcohol which can worsen
swelling in the sinuses.
 Avoid long periods of swimming pools treated with
chlorine, which irritates the lining of the nose and the
sinuses.
 Avoid water diving which forces water into the
sinuses from the nasal passages

45. PATIENT EDUCATION:
 Avoid allergy triggers, antihistamine or nasal
corticosteroids
 Eat fruits & vegetables,
 Reduces stress,
 Wash hands and maintain hygiene.
 Avoid smoke and pollution hydration.

46. GUIDELINES FOR REFERRAL:
 Child with complications or signs of invasive
infection.
 Child needing control of allergic rhinitis.
 Child with chills and fever.
 Child with persistent headache.
 Child with edema of forehead, eyelids.
 Child with orbital cellulites

47. REFERENCES:
 Lewis's textbook of Medical Surgical Nursing 3 rd
edition, Volume- 1 page no: 440-442.
 Javeed Ansari Textbook of Medical Surgical Nursing
PV Books page no: 101- 106.
 Joycee M Black, Hokanson Hawks Textbook of
Medical surgical Nursing Volume 1 &7th Edition
Elsevier Publications Page No 1797-1799.