Download - ACUTE & CHRONIC ( RHINO-) “SINUSITIS”
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ACUTE & CHRONIC (RHINO-)
“SINUSITIS”
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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
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PAIN
Burning
Stabbing
Throbbing
Pressure
BLOCKED
Unilateral
Bilateral
DISCHARGE
Watery/Mucoid
Yellow/Green
Blood
ANOSMIA
CACOSMIA
ITCHING EPISTAXIS
SINO-NASAL PATHOLOGYSYMPTOMS
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PATHOPHYSIOLOGY
NASAL CAVITIES
SINUS OSTIA
MUCOSA
CILIA
VESSELS
MUCUS
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Drying
< 10C >45C
Infection
Inflammation
Propanolol
Cocaine
Phenylephrine(>)
Isotonic saline
Ephedrine
Corticosteroids (1 wk)
“LOVE “ “HATE”
200/cell. 20 strokes/min.
CILIA
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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
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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
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VIRAL RHINOSINUSITIS
INFLAMMATION
(secretions & mucosal oedema)
SINUS OSTIA OBSTRUCTION
CILIARY DYSFUNCTION
STASISIIr2
7 sq. mm.
0.5 mm. oedema
3 sq. mm.
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BACTERIAL SINUSITIS
Fever > 38C
Sinus pain: Throbbing
Bending
Coughing
Walking
Percussion ???
Dental pain
Nasal: Discharge
Congestion CHRONIC SINUSITIS (?)
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SPECIAL INVESTIGATIONS
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PUS SWABS
Absence of puss does not exclude sinusitis!!
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Strep.Pneumoniae
H.Influenza
M. Catarrhalis
Staph. aureus
Anaerobes
Fungi
Tuberculosis
MICROBIOLOGY
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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’
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FUNCTIONAL ENDOSCOPIC SINUS SURGERY
SURGERY IN CHRONIC SINUSITIS
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DRUGS & THE NOSE
Symp./parasimp.
Antihistamines
Beta-blockers
Sex hormones
Corticosteroids
Cocaine/Lignocaine
Antihypertensives
Viagra/Cialis