Download to read offline
Uploaded byDr Varsha Dhage
Sinusitis / Dr.Varsha Dhage
1) Sinusitis is inflammation of the paranasal sinuses, the air-filled cavities around the nose. The four main sinus cavities are the maxillary, frontal, ethmoid, and sphenoid sinuses. 2) Acute sinusitis is caused by viral or bacterial infection following a cold or allergy. Symptoms include facial pain, nasal congestion, and discolored nasal discharge. Maxillary sinusitis commonly involves pain in the cheek. 3) Treatment involves antibiotics, nasal decongestants, pain relievers, and surgery if symptoms persist. Surgical treatments include antral puncture to drain pus from the maxillary sinus or functional endoscopic sinus surgery. Comp
More Related Content
Similar to Sinusitis / Dr.Varsha Dhage
Sinusitis / Dr.Varsha Dhage
- 1. SINUSITIS Presented by- DR.VARSHA DHAGE,M.S. Shalakya-ENT Ass. Professor, Dept. Of Shalakyatantra SNKDCT’s Nallasopara Ayurved Medical College,dist.Palghar
- 3. PNS The spacesin certain skull bones which are filled up with air, lined by pseudostratified ciliated columner epithelium and are related to the nose by their opening in the nasal cavity , are called Paranasal sinuses.
- 4. Sr.n o. Name of sinusSite of sinus capacity shape drainage 1 Maxillary sinus Occupies maxillary bone 15cc pyramidal In middle meatus 2. Frontal Sinus Frontal Bone 7cc pyramidal In middle meatus 3. Ant.ethmoidal sinus Ant.part of lateral mass of ethmoid bone variable Ethmoidal sinuses look like wings of s butterfly In middle meatus 4, post.ethmoidal sinus Posteior part of lateral mass of ethmoid bone variable In sup.meatus 5. Sphenoidal sinus Body of sphenoid bone 7cc spherical In sup.meatus
- 5. TYPES OF PNS Four pairs of paranasal sinuses – Frontal-above eyes in forehead bone Maxillary-in cheekbones, under eye Ethmoid-between eyes and nose Sphenoid-in center of skull, behind nose and eyes
- 6. FUNCTION OF PNS Decreasing the relative weight of the skull Increasing the resonance of the voice Providing a buffer against facial trauma Insulating sensitive structures from rapid temperature fluctuations in the nose Humidifying and heating inspired air
- 7. PATHOPHYSIOLOGY Usually followsrhinitis, which may be viral or allergic. May also result from abrupt pressure changes (air planes, diving) or dental extractions or infections. Inflammation and edema of mucous membranes lining the sinuses cause obstruction. This provides for an opportunistic bacterial invasion.
- 8. With inflammation,the mucosal lining of the sinuses produce mucoid drainage. Bacteria invade and pus accumulates inside the sinus cavities. Postnasal drainage causes obstruction of nasal passages and an inflamed throat. If the sinus orifices are blocked by swollen mucosal lining, the pus cannot enter the nose and builds up pressure inside the sinus cavities.
- 9. PREDISPOSING FACTORS • Allergies,nasal deformities, cystic fibrosis, nasal polyps, and HIV infection. • Cold weather • High pollen counts • Smoking in the home • Reinfection from siblings
- 10. Acute Sinusitis– respiratory symptoms last longer than 10 days but less than 30 days. Sub acute sinusitis – respiratory symptoms persist longer than 30 days without improvement. Chronic sinusitis – respiratory symptoms last longer than 120 days.
- 11. ETIOLOGY OF SINUSITIS 70% of bacterial sinusitis is caused by: • Streptococcus pneumoniae • Haemophilus influenzae • Moraxella catarrhalis Other causative organisms are: • Staphylococcus aureus • Streptococcus pyogenes, • Gram-negative bacilli • Respiratory viruses
- 12. COMPLICATIONS OF SINUSITIS Intra-orbital Orbital cellulitis Orbital abscess Cutaneous fistula Mucocele Intra-cranial Extra-dural abcess Sub-dural abscess Meningitis Encephalitis Brain abscess Otitic hydrocephalus
- 13. DIFFERENTIAL DIAGNOSES • Allergicrhinitis • Non-allergic rhinitis • Infectious rhinitis • Drug-induced rhinitis • Nasal polyps • Dental abscess • Carcinoma of sinus • Cluster headache • Structural defects (septum deviation) • Nasal foreign body
- 14. EXAMINATIONN OF SINUSES Transillumination test-in a dark room. A low voltage small lamp with long and narrow handle, is kept in the mouth the lips closed.a cherry red glow appears on both sides of faces and pupils.absence of glow indicates presence of pus or mucosal thickening. Posture test- In standing postion-if pus appears in midle meatus-frontal sinusitis If pus appears after the head is bent forward – maxillary sinus
- 15. RADIOLOGICAL EXAMINATION Standard viewsFor visualisation of 1. Occipitomental(water’s view) Maxillary sinus 2. Fronto-occipital Frontal & ethmoidal sinus 3. Lateral view Frontal & sphenoidal sinus 4. Submento-vertical Sphenoidal sinus 5. lt,.oblique & rt. oblique Ethmoid sinus
- 16. SINUSITIS Inflammation ofmucosal lining of the para nasal sinuses is called sinusitis. If all sinuses are affected ,then it is called Pan-Sinusitis. Commenest type –maxillary sinusitis
- 17. ACUTE MAXILLARY SINUSITIS Predisposing factor- Spread of nasal infection Trauma Spread of dental infection-premolar and molar teeth Causative organism- viral.bacterial
- 18. CLINICAL FEATURES Painin maxillary region radiateing to eyes Tenderness over the canine fossa Headache,fever,malaise Nasal discharge-initially mucoid,later on purulent due to secondary infection.may b blood stained. Foul smelling dicharge indicates dental infection Dicharge may be seen trickling down from the middle meatus.
- 19. DIAGNOSIS X rayPNS water’s view-hazziness or complete opacity CT scan
- 20. TREATMENT ANTIBIOTICS NASALDECONGESTANTS STEAM INHALATION ANALGESICS ANTIHISTAMINES SURGICAL TREATMENT-ANTRAL PINCTURE/INTRANASAL ANTROSTOMY RADICAL ANSTROTOMY
- 21. RADICAL ANTROSTOMY UnderGA, A large opening is made in maxillary antrum through the canine fossa. The wall of canine fossa is opened with hammer,gouge and then opening is enlarged with punch forcep. Now pus,diseased mucosa and polyps are removed,leaving normal mucosa undisturbed.
- 22. ANTRAL PUNCTURE/LAVAGE UnderLA, trochar with cannula is inserted into maxillary sinus through inf.meatus about ½ inch from its ant.border. Saline water is then pumped into the sinus which flows out through natural ostium.
- 23. ACUTE FRONTAL SINUSITIS Symptoms Dull pain occurs in supraorbital area.starts in morning and increases till midday and tends to disappear in late afternoon. Photophobia,lacrimatio n Nasal discharge Fever,malaise Signs Tenderness over floor of sinus Selling over eyelid and eyebrow On rhinoscopy, local changes are seen
- 24. TREATMENT Conservative treatment Surgical treatment- Frontal trephine-an opening is made in the floor of sinus by giving a small incision just below the medial end of eyebrow.after drainage, 2 plastic tubes are inserted into sinus through the wond and fixed by suturing.tubes are removed after complete cure Functional endoscopic sinus surgery
- 25. ETHMOIDAL SINUSITIS-ANT. &POST. Pain behind the eyes Unilateral nasal obstruction Mucopurulent/purulent nasal discharge fever,headache,malaise Tenderness just below inner canthus Swelling of skin over nasal bone Treatment- Intranasal approach Frontal ethmoidal approach Transantral ethmoidal approach
- 26. SPHENOIDAL SINUSITIS Usuallyoccurs in association with post.ethmoidal sinusitisor may occur as a part of generalized sinus infection(pansinusitis) Pain is deep in the centre of head Pus may seen in sup.meatus on post.rhinoscopy Ant.rhinoscopy-normal Treatment- conservative Intranasal surgical opening of the sphenoidal sinus in chronic stage.
- 27.