SINUSITIS    

Inflammation of the paranasal sinuses.

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

1. Primary-primary ciliary dyskinesia, cystic fibrosis, Young’s syndrome
2. Secondary-allergy, Bacterial infection

3. Immune deficiency .- primary-IgA def.,C4 def.,

                    -Secondary- HIV, Immunocompromised 

                     drugs.

3.     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

1.   Nasal obstruction
2.   Persistent mucopurulent discharge
3.   Coughing, irritaiton in throat
4.   Facial pain
5.   Hyposmia, cachosmia

Investigations

1. Nasal endoscopy
2. Swabs and antral lavage
3. Radiology- Plain x-rays   * Ct scan
4. Sinoscopy
5. Blood tests- TC,DC, ESR, Immunoglobulins

Treatment

1. Acute

   I. Medical

       a. Antibiotic

a.     Amoxycillin 500mg tds *7-10 days

b.     Azithromycin 500mg *Qid*5-7

c.     Cephalexin 500mg*OD

d.     Erythromycin  500mg qid  *7-10 dys

e.     Cotrimaxazole 960mg bd * 7-10days

f.      Doxycline 100mg bd * 7-10days

g.     Ampicillin 500mg qid * 7-10 days

h.     Cefixime 200-400mg bd *7-10dys

                                               i.     <50kg  8mg/kg

i.      Cefaclor 250-500mg tda (max 4mg/day)

ii>1month 20mg/kg/days*tds

      b. Analgesic

1.     Pcm 500mg qid or

2.     Ibruprofen 600mg tds or

3.     Nimesulide 100mg *BD

      c. Decongestant-systemic/topical

      D. Antihistamine

Antihistaminics

i.            Cetrizone 10mg to 20 mg BD

1.           Child 2-6yrs 2.5mg BD or 5mg OD

2.           >6yrs 10mg OD

ii.           Chlorpherarmine 4mg tds

1.           1-2 yrs  1mg BD

2.           2-5yrs  1mg tds (max=6mg/day)

3.           6-12yrs 2mg tds (max=12mg/day)

iii.          Fexofenadine  60mg BID

1.           >2yrs 0.23mg/kg/day (4-6)hrs

2.           2-6yrs 1mg

3.           6-12yrs 2mg

4.           >12yrs 4mg of 4-6 hrs

   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

Complications

1. Acute

Local:

•       1.Orbital-preseptal cellulitis, orbital cellulitis

       without  abscess, orbital cellulitis with 

       extraperiosteal abscess,  orbital cellulitis with

       intraperiosteal abscess,  cav. sinus thrombosis

   2. Intracranial              

   3. Bony- osteitis/osteomyelitis    4. Dental

Distant:

      Toxic shock syndrome

2. Chronic- Mucocoele/pyocoele

                   Ottitis media, adenotonsillitis, bronchitis,