ACUTE & CHRONIC (RHINO-)

“SINUSITIS”

Classification by duration of symptoms

– ACUTE – lasting up to 4 weeks, with total resolution of symptoms

– SUBACUTE – persisting more than 4 weeks, but less than 12 weeks, with total resolution of symptoms

– CHRONIC – 12 weeks or more of signs / symptoms

– RECURRENT ACUTE – 4 or more episodes per year, with resolution of symptoms between attacks

PAIN

Burning

Stabbing

Throbbing

Pressure

BLOCKED

Unilateral

Bilateral

DISCHARGE

Watery/Mucoid

Yellow/Green

Blood

ANOSMIA

CACOSMIA

ITCHING EPISTAXIS

SINO-NASAL PATHOLOGYSYMPTOMS

PATHOPHYSIOLOGY

NASAL CAVITIES

SINUS OSTIA

MUCOSA

CILIA

VESSELS

MUCUS

Drying

< 10C >45C

Infection

Inflammation

Propanolol

Cocaine

Phenylephrine(>)

Isotonic saline

Ephedrine

Corticosteroids (1 wk)

“LOVE “ “HATE”

200/cell. 20 strokes/min.

CILIA

PREDISPOSING FACTORS

Septum deviation Pollution

Polyps Allergy

Tumour Diet

Trauma Immune supression

Dental Endocrinological

Nose packs Diabetis

N/G tubes Kartegener

Foreign body Drugs

ADENOIDITIS

GE(L)RD

Common cold10 days (35%)

Viral sinusitis

Symptoms > 10 days or

symptoms worsen after 5-7 days

Blocked nose

Throat irritation

Watery nasal discharge

Bacterial sinusitis

VIRAL RHINOSINUSITIS

INFLAMMATION

(secretions & mucosal oedema)

SINUS OSTIA OBSTRUCTION

CILIARY DYSFUNCTION

STASISIIr2

7 sq. mm.

0.5 mm. oedema

3 sq. mm.

BACTERIAL SINUSITIS

Fever > 38C

Sinus pain: Throbbing

Bending

Coughing

Walking

Percussion ???

Dental pain

Nasal: Discharge

Congestion CHRONIC SINUSITIS (?)

SPECIAL INVESTIGATIONS

PUS SWABS

Absence of puss does not exclude sinusitis!!

Strep.Pneumoniae

H.Influenza

M. Catarrhalis

Staph. aureus

Anaerobes

Fungi

Tuberculosis

MICROBIOLOGY

TREATMENT OF ACUTE SINUSITIS

(See it as an abscess and treat it as such!)

Antibiotics 10 – 14 days

Drainage: Decongestant - local ( drops,spray,) systemic,??

Flushing (steam inhalations, saline)

Hypertonic saline- 1/2tsp in 250 ml

Sterile water

Prednisone

Mucolytics ??????

Anti-inflammatory

Antihistamines

‘Drying up’

FUNCTIONAL ENDOSCOPIC SINUS SURGERY

SURGERY IN CHRONIC SINUSITIS

DRUGS & THE NOSE

Symp./parasimp.

Antihistamines

Beta-blockers

Sex hormones

Corticosteroids

Cocaine/Lignocaine

Antihypertensives

Viagra/Cialis