ACUTE & CHRONIC SINUSITIS

1. ACUTE & CHRONIC
SINUSITIS
Dr. Vijay
kumar

2. INTRODUCTION
 Sinusitis refers to the inflammation of the
mucosa of one or more paranasal
sinuses where the mucociliary clearance
function is affected as a result of
anatomical or pathological abnormalities
leading to blockage of sinus ostium.
 Depending on the site of involvement, it
can be described as- frontal,
maxillary,ethmoidal,sphenoidal.
 Pansinusitis- all sinuses are involved
which could be unilateral or bilateral.

3. PREIDSPOSING FACTORS
1. Mechanical obstruction
2. Focal infection- rhinogenic, dental,
adenotonsillitis, trauma/barotrauma.
3. Decreased mucociliary function- kartergeners
synd, Youngs synd, secondary to viral URTI
4. Allergy
5. Immunodeficiency state
6. Autonomic and hormonal imbalance
7. Granulomatous condition-Wegners ,
Amyloidosis, Sarcoidosis ,T.B, Leprosy, Syphlis.
8. Iatrogenic- asprin intolerance, rhinitis
medicomentosa, drugs-gunathidine,
neostigmine.
9. Idiopathic

4. PATHOGENESIS OF
SINUSITIS
 ACUTE STAGE- This stage usually starts
with an acute upper respiratory infection
which is followed by secondary bacterial
infection.
• Leukocytic infiltration, release of chemical
mediators, edema and vasodilatation of
submucosa, blockage of ostium.
SUBACUTE STAGE-occurs between 4wks-
12wks if not resolved completely or
inadequately treated.
• It is associated with thick sinus secretion,
infiltration with lymphocytes, proliferation of
fibroblasts, replacement of ciliated columnar
epithelium to non-ciliated(reversible).

5. CHRONIC STAGE- persistence of
infection for more than 12wks (3months).
• Persistent venous and lymphatic
obstruction.
• Thick hyperplastic proliferation of
mucosa with polypoidal changes.
• Frank polyp formation in the middle
meatus.
• Pathological obstruction in middle
meatus and stagnation of sinus
secretions setting a vicious cycle of
PATHOGENESIS OF
SINUSITIS

6. ACUTE SINUSITIS
 PREDISPOSING FACTORS
 HOST FACTORS
1. Genetic factors- immotile cilia syndrome,
cystic fibrosis, Kartergener synd. ,Youngs
synd.
2. Anatomic abnormalities- concha bullosa,
septal spur, paradoxical middle turbinate.
3. Systemic Diseases
4. Medical Tt predisposing individual to
infection.
5. Neoplasms
6. Allergic and immune disorders
7. Poor general condition

7.  PREDISPOSING FACTORS
 ENVIRONMENTAL FACTORS
1. Bacterial, viral, or fungal infection.
2. Inflammation secondary to fungal or bacterial
colonization.
3. Primary or secondary tobacco smoke
exposure.
4. Chronic or acute irritants/noxious chemicals.
 IATROGENIC FACTORS
1. Surgery
2. Medications-gunethidine, neostigmine.
3. Nasal packing
4. N-G tube placement
ACUTE SINUSITIS

8.  CAUSATIVE ORGANISMS
Viral – Rhino, Myxo, Paramyxo
Bacterial- St. pneum, H.influenze,
Strep sp, Morexella, Anaerobes,
Staph. Aureus.
Fungus- Aspergillus, Candida
ACUTE SINUSITIS

9. Mucous
becomes
more viscus
Reduced
mucociliary
transport
Infection
Inflammation/mucosal swelling
Occlusion/Obstruction of sinus ostium
Reduction in oxygen tension
Transudation of
fluid into sinus
Mucostasis
Bacterial Colonization/Infection
ACUTE
SINUSITIS(PATHOPHYSIOLOG
Y)

10.  CLINICAAL FEATURES
 General
1. Fever
2. Malaise
3. Nasal obstruction
4. Cacosmia/anosmia
 Specific
1. Headache
2. Tenderness
3. Nasal discharge
4. Orbital
ACUTE SINUSITIS

11.  MAXILLARY
 FR./bitemporal, daytime headache.
 Facial
 M.M discharge
 FRONTAL
 Frontal, early morning headache
 Forehead
 M.M discharge
 ETHMOIDAL
 Medial/Retro-orbital ache, increase with eye movement.
 Nasal bridge
 M.M/Sup.meatus
 SPHENOIDAL
 Vertex/Occipital
 PND
 Serious
ACUTE SINUSITIS

12.  INVESTIGATIONS
1. Transillumination
2. X-ray
3. C.T scan
4. Sinus endoscopy
5. Pus c/s
6. Histopathology
 TREATMENT
 Antibiotics
 Analgesics
 Decongestants systemic/local
 Surgery
ACUTE SINUSITIS

13. CHRONIC SINUSITIS
 Persistence of symptoms and signs for 12 weeks or more.
 Chronic rhinosinusitis is defined as inflammation of the nose
and paranasal sinuses characterised by two or more of the
following-
1. Blockage/congestion
2. Discharge:anterior/posterior(discoloured)
3. Facial pain/pressure
4. Reduction or loss of smell
Plus either
 Endoscopic signs of
 Polyps;
 Mucopurulent discharge from middle meatus;
 Or oedema/ mucosal obstruction primarily in middle
meatus;
and /or
 Computed Tomography(CT) changes:
 Mucosal changes within ostiomeatal complex and or
sinuses

14. PATHOGENESIS
CHRONIC SINUSITIS

15. MUCOSAL PATHOLOGY
INFLAMMATION
ALTERED
MUCOCILIARY
FUNCTION
OSTIAL
OBSTRUCTION

16.  MUCOSAL PATHOLOGY
1. Hypertrophic- due to increased
vascular permeability.
2. Atrophic-due to endarteritis.
 BACTERIOLOGY
The bacteria found in ch. sinusitis are
same as those causing acute
sinusitis, with the addition of gram –
ve bacteria, and low virulence
streptococcus viridans.
CHRONIC SINUSITIS

17.  BACTERIOLOGY
Common bacteria found in chronic
sinusitis include:
1. H.influnze
2. S.pneumoniae
3. S.aureus
4. M.catarrhalis
5. P.aeruginosa
6. Gram –ve bacteria
7. S.viridans
CHRONIC SINUSITIS

18.  Clinical Features
1. Blockage/congestion
2. Discharge:anterior/posterior(discolou
red)
3. Facial pain/pressure
4. Reduction or loss of smell
CHRONIC SINUSITIS

19. MAXILLARY FRONTAL ETHMOID SPHENOID
AGE After 8yrs Adults Children Any age
Route Nose
Trauma
Nose
Trauma
Nose Nose
Headache Forehead
Bitemporal
Frontal
Early morning,
on
forward bending
Medial
Retroocular
Vertex
Occipital
Tenderness Facial Frontal Nasal bridge
--
Nasal
Discharge
M.M(ant) M.M(ant) M.M, S.M PND
X-ray Water’s view –
fluid, swelling
Water’s view-
swelling
Oblique view-
haziness
Lateral view-
Fluid
Treatment Medical, Surgical Medical, Surgical Medical Medical,
Surgical
Complicatio
n
Local Local ,
intracranial
Intracranial Intracranial

20.  INVESTIGATIONS
1. Transillumination
2. X-ray
3. C.T scan
4. Sinus endoscopy
5. Pus c/s
CHRONIC SINUSITIS

21.  TREATMENT
1. Allergen avoidence
2. Removal of pridisposing factors
3. Medical Tt
4. Surgical Tt.
CHRONIC SINUSITIS

22. COMPLICATIONS OF
SINUSITIS
 NASAL
1. POLYPOSIS
2. CH.RHINITIS
3. ATROPHIC RHINITIS
 ORBITAL
1. CELLULITIS
2. ABSCESS
3. RETROBULBAR NEURITIS
4. SUP.ORBITAL FISSURE SYNDROME
5. ORBITAL APEX SYNDROME
 EAR
1. M.E EFFUSION/ASOM
2. CSOM

23.  PHARYNGEAL/LARYNGEAL
1. Granular pharyngitis
2. Lat.wall pharyngitis
3. Ch.laryngitis
4. Tonsillitis
 INTRACRANIAL
1. Meningitis
2. Extra/subdural abscess
3. Frontal lobe abscess
4. Cavernous sinus thrombosis
5. encephalitis
 BONY
1. osteomylitis
 MISC.
1. Mucocoel
2. Pyocoel
3. Oroantral fistula
COMPLICATIONS OF
SINUSITIS