Sinusitis is the inflammation or swelling of paranasal sinuses. It is always associated with inflammation of nasal mucosa is called Rhinosinusitis. It can be due to infection, allergy or autoimmune issues. Conditions that can cause sinus blockage include the common cold, allergic rhinitis, nasal polyps, deviated septum.
TYPES
Depending upon the duration of illness :
1. Acute Sinusitis
2. Chronic Sinusitis
1. ACUTE SINUSITIS
It is define as acute inflammation in the mucus membrane of the paranasal sinuses. A sudden onset of cold-like symptoms such as runny, stuffy nose and facial pain that does not go away after 10 to 14 days. Acute sinusitis typically lasts 4 weeks or less.
PREDISPOSING FACTORS :-
A. Local Factors :
- Rhinitis
- Septal deviation
- Nasal polyps
- Hypertrophied turbinate
- Dental causes i.e. Periapical abscess, dental caries
- Benign or malignant growth in nasal cavity
- Adenoids
B. General Factors :
- Cold exposure
- Overcrowding
- Atmospheric pollution i.e. smoke, dust
- Poor general health with viral infection, DM, immune-deficiency conditions
ORGANISMS :-
Majority of causes of acute sinusitis start as viral infections followed by bacterial invasion. The most common bacteria are :
- Streptococcus pneumoniae
- H. influenza
- Streptococcus pyogens
- Staphylococcus aureus
- Anaerobic bacteria
CLINICAL FEATURES :-
- History of rhinitis i.e. running nose, nasal obstrruction
- Malaise
- Headache
- Fever, shivering
- Anorexia
- Weakness
- Other features are depends upon the involvement of an individual sinuses.
INVESTIGATIONS :-
1. X-ray of PNS
2. Blood : TC, DC, Hb%
3. Nasal discharge : Gram stain, C/S
TREATMENT :-
- Rest in bed in a warm, well-ventilated room
- Steam inhalation
- Analgesics/Antipyretics i.e. Paracetamol, Ibuprofen, Nimesulimide
- Nasal decongestant drops i.e. Ephedrine, Oxymetazoline
- Antibiotics i.e. Amoxycillin, Erythromycin, Cotrimoxazole, Doxycycline
2. CHRONIC SINUSITIS
Persistent inflammation of sinus mucosa for months or years (lasting 8 weeks or longer) is called Chronic Sinusitis.
ORGANISMS :-
Aerobic and anaerobic organisms.
CLINICAL FEATURES :-
- Purulent nasal discharge (most common symptom)
- Nasal obstruction
- Abnormalities of smell
- Headache
- Facial pain
- Halitosis
- Throat irritation, dry cough due to post-nasal discharge
INVESTIGATIONS :-
1. X-ray of PNS
2. CT scan of PNS : Ethmoid sphenoid sinuses
3. Nasal discharge : Gram stain, C/S
TREATMENT :-
A. Medical treatment :
- Antibiotics i.e. Amoxycillin, Ampicillin, Erythromycin, Co-amoxyclav, Doxycycline + Metronidazole for anaerobic bacteria.
- Nasal decongestant
- Analgesics
- Antihistaminics
- Steam inhalation
B. Surgical treatment :
- Chronic maxilary sinusitis : Antral puncture irrigation, Intranasal antrostomy, Caldwell-Luc operation
- Chronic frontal sinusitis : Intranasal drainage operation, External fronto-ethmoidectomy, Osteoplastic flap operation
- Chronic Ethmoid sinusitis : Intaranasal ethmoidectomy, External ethmoidectomy
- Chronic sphenoidal sinusitis : Sphenoidectomy
Functional Endoscopic Sinus Surgery (FESS)
COMPLICATIONS
1. Extracranial complications :-
- Mucocele
- Mucopyocele
- Osteomyelitis
- Orbital cellulitis
- Orbital absccess
- Otitis media
- Pharyngitis
- Tonsilitis
- Laryngitis
2. Intracranial complications :-
- Meningitis
- Extradural abscess
- Brain abscess
- Subdural abscess
- Cavernous sinus thrombosis
TYPES
Depending upon the duration of illness :
1. Acute Sinusitis
2. Chronic Sinusitis
1. ACUTE SINUSITIS
It is define as acute inflammation in the mucus membrane of the paranasal sinuses. A sudden onset of cold-like symptoms such as runny, stuffy nose and facial pain that does not go away after 10 to 14 days. Acute sinusitis typically lasts 4 weeks or less.
PREDISPOSING FACTORS :-
A. Local Factors :
- Rhinitis
- Septal deviation
- Nasal polyps
- Hypertrophied turbinate
- Dental causes i.e. Periapical abscess, dental caries
- Benign or malignant growth in nasal cavity
- Adenoids
B. General Factors :
- Cold exposure
- Overcrowding
- Atmospheric pollution i.e. smoke, dust
- Poor general health with viral infection, DM, immune-deficiency conditions
ORGANISMS :-
Majority of causes of acute sinusitis start as viral infections followed by bacterial invasion. The most common bacteria are :
- Streptococcus pneumoniae
- H. influenza
- Streptococcus pyogens
- Staphylococcus aureus
- Anaerobic bacteria
CLINICAL FEATURES :-
- History of rhinitis i.e. running nose, nasal obstrruction
- Malaise
- Headache
- Fever, shivering
- Anorexia
- Weakness
- Other features are depends upon the involvement of an individual sinuses.
INVESTIGATIONS :-
1. X-ray of PNS
2. Blood : TC, DC, Hb%
3. Nasal discharge : Gram stain, C/S
TREATMENT :-
- Rest in bed in a warm, well-ventilated room
- Steam inhalation
- Analgesics/Antipyretics i.e. Paracetamol, Ibuprofen, Nimesulimide
- Nasal decongestant drops i.e. Ephedrine, Oxymetazoline
- Antibiotics i.e. Amoxycillin, Erythromycin, Cotrimoxazole, Doxycycline
2. CHRONIC SINUSITIS
Persistent inflammation of sinus mucosa for months or years (lasting 8 weeks or longer) is called Chronic Sinusitis.
ORGANISMS :-
Aerobic and anaerobic organisms.
CLINICAL FEATURES :-
- Purulent nasal discharge (most common symptom)
- Nasal obstruction
- Abnormalities of smell
- Headache
- Facial pain
- Halitosis
- Throat irritation, dry cough due to post-nasal discharge
INVESTIGATIONS :-
1. X-ray of PNS
2. CT scan of PNS : Ethmoid sphenoid sinuses
3. Nasal discharge : Gram stain, C/S
TREATMENT :-
A. Medical treatment :
- Antibiotics i.e. Amoxycillin, Ampicillin, Erythromycin, Co-amoxyclav, Doxycycline + Metronidazole for anaerobic bacteria.
- Nasal decongestant
- Analgesics
- Antihistaminics
- Steam inhalation
B. Surgical treatment :
- Chronic maxilary sinusitis : Antral puncture irrigation, Intranasal antrostomy, Caldwell-Luc operation
- Chronic frontal sinusitis : Intranasal drainage operation, External fronto-ethmoidectomy, Osteoplastic flap operation
- Chronic Ethmoid sinusitis : Intaranasal ethmoidectomy, External ethmoidectomy
- Chronic sphenoidal sinusitis : Sphenoidectomy
Functional Endoscopic Sinus Surgery (FESS)
COMPLICATIONS
1. Extracranial complications :-
- Mucocele
- Mucopyocele
- Osteomyelitis
- Orbital cellulitis
- Orbital absccess
- Otitis media
- Pharyngitis
- Tonsilitis
- Laryngitis
2. Intracranial complications :-
- Meningitis
- Extradural abscess
- Brain abscess
- Subdural abscess
- Cavernous sinus thrombosis
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