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Sinusitis
(=Rhinosinusitis)
Prepared by:
Shoniwa L. Bsc. NE [C U T], RGN
definition
• Refers to the inflammation of the mucous
membrane lining the paranasal sinuses.
causes
Viruses
Common: Rhinoviruses, Coronaviruses, and Influenza viruses.
Other: Adenoviruses, Human influenza viruses.
Bacteria
Common: Streptococcus pneumoniae, Haemophillus influenzae, and
Moraxella catarrhalis.
Fungi: Aspergillus fumigatus (common in DM and HIV/AIDS.
Chemical irritants: cigarrete smoke, chlorine fumes.
Predisposing factors
• Allergic rhinitis
• Dental abscess
• Nasal polyps or nasal tumors
• Deviated nasal septum
• Immunosuppression e.g. DM or HIV/AIDS
classification
Acute sinusitis
Definition
Pathophysiology
Acute sinusitis usually follows an URTI or allergic rhinitis. The
mucosa of the nasal cavity becomes inflamed an d oedematous and
there is exudation. There is a resultant obstruction of the nasal cavities.
This creates a conducive environment for the multiplication of bacteria
in the sinuses leading to inflammation and exudation in the sinuses.
Chronic sinusitis
Definition
Refers to inflammation of the sinuses that lasts for longer than 3/52 (in
adults) or 2/52 (in children).
Pathophysiology
The openings into the sinuses are obstructed. This prevents drainage
from the sinuses. Bactria multiply in the sinuses leading to
inflammation , exudation and destruction of surrounding bone (bon
necrosis).
Clinical manifestations
Pain or pressure over the affected sinuses
(maxillary: cheek area, frontal: above the
eyes, forehead, ethmoidal: between or
behind the eyes, sphenoidal: behind the
eyes).
Fever
Nausea
Earache(=otalgia) Nasal discharge (purulent)
Dental pain Halitosis (=bad breath)
Nasal obstruction Cough
Sore throat Decreased or absence of smell (=anosmia)
Postnasal drip (in chronic sinusitis) Headache
investigations
Acute sinusitis
• Palpation and percussion over the sinuses elicits pain.
• Transillumination of the affected areas reveals a decrease in the
transmission of pain.
• Nasal swab is collected for C/S to identify the causative agent.
• NB: Imaging i.e. X-rays, CT scan or MRI are not recommended
unless complications have developed.
Chronic sinusitis
• Nasal and sinus endoscopy to allow visualization of the nasal cavity
and sinuses (a biopsy for histology or a sample for C/S may be
obtained and sent for testing).
• Imaging studies MRI,CT or X-rays of the sinuses may be done and
reveals pathology such as air-fluid levels or opacification of the
sinuses.
• Antral puncture and lavage provides material for C/S or histology.
MRI showing sinusitis
Left-sided maxillary sinusitis
Management
pharmacological
Acute sinusitis
Antibiotics
Amoxicillin PO 500mg three times a day for 3/52
Or
Clindamycin PO 600mg three time a day for 3/52
Or
Ciprofloxacin PO 500mg two times a day for 3/52
[EDLIZ, 2011]
Analgesia
NSAIDs such as Asprin or Diclofenac are administerd to relieve pain.
Management
pharmacological continued
Antihistamines
Used if allergy is suggested e.g. Chlopheniramine or Diphenhydramine
Nasal decongestants
Used to relieve swelling of the nasal mucosa leading to improvement of
drainage form the sinuses e.g. Pseudoephedrine
Management
pharmacological
Chronic sinusitis
Antibiotics
Amoxicillin PO 500mg bid. for 3/52
Or
Ciprofloxacin PO 500mg bid. for 3/52
[EDLIZ, 2011]
Analgesic, antihistamines, and nasal decongestants may also be useful.
Management
other measures
• Administer adequate amounts of oral fluids to thin the secretions and
facilitate drainage of the sinuses.
• Nasal irrigation or gurgling may help to relieve symptoms
Surgical management
Surgical management is indicated for patients who fail to respond to
medical management. There are a number of procedure that can be
done depending on the underlying pathology:
Polypectomy
Refers the removal of nasal polyps.
Correction of a deviated nasal septum.
Antrostomy
Refers to opening into the sinuses and removal of all diseased tissues
from the sinus.
complications
NB: the sinuses are in close proximity to the brain which accounts for some
serous complications.
Brain complications
• Meningitis
• Brain abscess
Orbital complications
• Periorbital cellulitis
• Subperiosteal abscess
• Orbital cellulitis
• Orbital abscess
Osteomyelitis of the maxillary or frontal bones
Nursing management

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Sinusitis

  • 2. definition • Refers to the inflammation of the mucous membrane lining the paranasal sinuses.
  • 3.
  • 4. causes Viruses Common: Rhinoviruses, Coronaviruses, and Influenza viruses. Other: Adenoviruses, Human influenza viruses. Bacteria Common: Streptococcus pneumoniae, Haemophillus influenzae, and Moraxella catarrhalis. Fungi: Aspergillus fumigatus (common in DM and HIV/AIDS. Chemical irritants: cigarrete smoke, chlorine fumes.
  • 5. Predisposing factors • Allergic rhinitis • Dental abscess • Nasal polyps or nasal tumors • Deviated nasal septum • Immunosuppression e.g. DM or HIV/AIDS
  • 6. classification Acute sinusitis Definition Pathophysiology Acute sinusitis usually follows an URTI or allergic rhinitis. The mucosa of the nasal cavity becomes inflamed an d oedematous and there is exudation. There is a resultant obstruction of the nasal cavities. This creates a conducive environment for the multiplication of bacteria in the sinuses leading to inflammation and exudation in the sinuses.
  • 7. Chronic sinusitis Definition Refers to inflammation of the sinuses that lasts for longer than 3/52 (in adults) or 2/52 (in children). Pathophysiology The openings into the sinuses are obstructed. This prevents drainage from the sinuses. Bactria multiply in the sinuses leading to inflammation , exudation and destruction of surrounding bone (bon necrosis).
  • 8. Clinical manifestations Pain or pressure over the affected sinuses (maxillary: cheek area, frontal: above the eyes, forehead, ethmoidal: between or behind the eyes, sphenoidal: behind the eyes). Fever Nausea Earache(=otalgia) Nasal discharge (purulent) Dental pain Halitosis (=bad breath) Nasal obstruction Cough Sore throat Decreased or absence of smell (=anosmia) Postnasal drip (in chronic sinusitis) Headache
  • 9. investigations Acute sinusitis • Palpation and percussion over the sinuses elicits pain. • Transillumination of the affected areas reveals a decrease in the transmission of pain. • Nasal swab is collected for C/S to identify the causative agent. • NB: Imaging i.e. X-rays, CT scan or MRI are not recommended unless complications have developed.
  • 10. Chronic sinusitis • Nasal and sinus endoscopy to allow visualization of the nasal cavity and sinuses (a biopsy for histology or a sample for C/S may be obtained and sent for testing). • Imaging studies MRI,CT or X-rays of the sinuses may be done and reveals pathology such as air-fluid levels or opacification of the sinuses. • Antral puncture and lavage provides material for C/S or histology.
  • 13. Management pharmacological Acute sinusitis Antibiotics Amoxicillin PO 500mg three times a day for 3/52 Or Clindamycin PO 600mg three time a day for 3/52 Or Ciprofloxacin PO 500mg two times a day for 3/52 [EDLIZ, 2011] Analgesia NSAIDs such as Asprin or Diclofenac are administerd to relieve pain.
  • 14. Management pharmacological continued Antihistamines Used if allergy is suggested e.g. Chlopheniramine or Diphenhydramine Nasal decongestants Used to relieve swelling of the nasal mucosa leading to improvement of drainage form the sinuses e.g. Pseudoephedrine
  • 15. Management pharmacological Chronic sinusitis Antibiotics Amoxicillin PO 500mg bid. for 3/52 Or Ciprofloxacin PO 500mg bid. for 3/52 [EDLIZ, 2011] Analgesic, antihistamines, and nasal decongestants may also be useful.
  • 16. Management other measures • Administer adequate amounts of oral fluids to thin the secretions and facilitate drainage of the sinuses. • Nasal irrigation or gurgling may help to relieve symptoms
  • 17. Surgical management Surgical management is indicated for patients who fail to respond to medical management. There are a number of procedure that can be done depending on the underlying pathology: Polypectomy Refers the removal of nasal polyps. Correction of a deviated nasal septum. Antrostomy Refers to opening into the sinuses and removal of all diseased tissues from the sinus.
  • 18. complications NB: the sinuses are in close proximity to the brain which accounts for some serous complications. Brain complications • Meningitis • Brain abscess Orbital complications • Periorbital cellulitis • Subperiosteal abscess • Orbital cellulitis • Orbital abscess Osteomyelitis of the maxillary or frontal bones