SINUSITIS
Aetiology
1. Allergy
2. Infection
Acute-Bact.- Strept., Staph., H. influenzae, N.
sp., anaerobes.
Viral-Rhinovirus, Inf. Virus,parainfl.
Chronic – Specific-Fungal-Aspergillus
- Non-specific
3. Structural e.g.. OMC-DNS,
HIT
Contributing factors
1. Anatomical
varience -DNS, Concha bullosa,
enlarged ethmoidal bulla, everted uncinate
process,
paradoxical MT.
2. Mucociliary abnormalities
•Primary-primary ciliary dyskinesia, cystic fibrosis, Young’s
syndrome
•Secondary-allergy, Bacterial infection
3. Immune deficiency .- primary-IgA def.,C4 def.,
-Secondary- HIV, Immunocompromised
drugs.
4. Allergy
Clinical Features
Acute sinusitis
Symptoms
1. Acute
Maxillary sinusitis: Pain over the cheek® frontal
region, teeth, in the morning increased
by straining & bending forward
2.
Acute Frontoethmoidal: Pain about the eye & frontal
3. Acute . Sphenoid: Rare,
Pain over retro-orbital® vertex,
temple or occiput.
SIGNS
1. Hyperamic nasal mucosa, mucopus in Middle Meatus ,
2. Tenderness over paranasal sinus
3. Post Nasal drip
4. Redness, swelling
of cheek® eyelids
CHRONIC SINUSITIS-
Symptoms
• Nasal obstruction
• Persistent mucopurulent discharge
• Coughing, irritaiton in throat
• Facial pain
• Hyposmia, cachosmia
Investigations
•Nasal endoscopy
•Swabs and antral lavage
•Radiology- Plain x-rays * Ct scan
•Sinoscopy
•Blood tests- TC,DC, ESR, Immunoglobulins
•
Treatment
1. Acute
I.
Medical
a. Antibiotic
b. Analgesic
c. Decongestant-systemic/topical
II.
Supportive
Steam inhalation
2. Chronic- same
- Steroids- topical spray
SURGICAL TREATMENT OF SINUSISTIS
•Maxillary sinusitis: Antral lavage
Caldwell-luc
operation
•Frontal sinusitis: Trephining-Acute sinusistis
•Ethmoid
sinusitis: Intranasal/external/transantral
ethmoidectomy
• Functional Endoscopic Sinus Surgery
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