Sinusitis

By:

Ikram khan

Introduction to sinus:

In anatomy, a sinus is a cavity within

a bone or other tissue. Most are

commonly found in the bones of the

face and connecting with the nasal

cavities.

The sinuses are lined with soft, pink

tissue called mucosa.

Normally, the sinuses are empty

except for a thin layer of mucus.

Sinusitis (rhinosinusitis)1. Sinusitis is the inflammation of the

mucous lining of the nasal passages and sinuses. The sinuses are air-filled chambers in the skull.

2. Sinusitis occurs:

Obstruction or congestion cause the paranasal sinus openings to become blocked.

When the sinus openings become blocked or too much mucus builds up in the chambers.

Bacteria and other germs can grow more easily, leading to infection and inflammation.

Causes

Viruses

(90 – 98% )acute sinusitis

Bacteria

Normally present in the nasal passages and throat and harmless.

FungiDiabetes, leukemia, AIDS, or other conditions that impair the

immune system.

Allergies, Asthma, and Immune Response

Seasonal allergic rhinitis that cause mucus blockage lead to sinusitis

Diseaseweaken the immune system e.g diabetes, AIDS.

Polyps (small benign growths) in the nasal passage block mucous drainage and restrict airflow. Result from previous sinus infections.

Acute sinusitis

Acute sinusitis (acute rhinosinusitis) causes the

cavities around your nasal passages (sinuses) to

become inflamed and swollen.

Acute sinusitis is most often caused by the

common cold. Other triggers include bacteria,

allergies and fungal infections

Duration, Less than 4 weeks

Bacterial and viral sinusitis are difficult to

distinguish. However, if symptoms last less than

10 days, it is generally considered viral sinusitis.

When symptoms last more than 10 days, it is

considered bacterial sinusitis.

Sign and Symptoms

Nasal congestion or discharge, Headache,

Facial pain

Cough or scratchy throat , Fever,

Diminished or absent sense of smell

Ear pain, dental pain, bad breath, fatigue

Drainage of a thick, yellow or greenish discharge from the nose or down the

back of the throat

Diagnosing

Diagnosing acute sinusitis usually

involves a physical exam. Your doctor

will gently tap your sinuses with his

fingers to identify an infection. The

exam may involve looking into your

nose with a light to identify

inflammation, polyps, tumors, or other

abnormalities.

Treatment of acute sinusitis Lifestyle & Home Remedies

Get plenty of rest.

Drink plenty of fluids.

Steam your sinus cavities.

Apply warm compresses to your face.

Sleep with your head elevated.

Treatment of acute sinusitis with

drugs.

Most cases of acute sinusitis don't need treatment because they are caused by viruses that cause the common cold. Self-care techniques are usually the only treatment needed to speed recovery and ease symptoms.

Treatments to relieve

symptoms

Saline nasal spray.

Decongestants.

Nasal corticosteroids.

Over-the-counter pain relievers.

Antibiotics

Antibiotics usually aren't needed to treat acute sinusitis.

Antibiotics won't help when acute sinusitis is caused by a viral or fungal infection.

Most cases of bacterial sinusitis improve without antibiotics.

Antibiotics used to treat acute sinusitis caused by a bacterial infection include amoxicillin

The combination drug trimethoprim-sulfamethoxazole(Bactrim, Septra, others).

Chronic sinusitis

Chronic sinusitis is a common condition in which the cavities around nasal passages (sinuses) become inflamed and swollen and persist despite treatment attempts.

This condition interferes with drainageand causes mucus to build up.

If you have chronic sinusitis, it may be difficult to breathe through your nose.

For sinusitis lasting more than 8 or 12 weeks

Sign and Symptoms

Nasal obstruction or congestion, causing difficulty breathing through your nose.

Pain, and swelling around your eyes, cheeks, nose or forehead

Reduced sense of smell and taste , Cough, which may be worse at night

Ear pain, Aching in your upper jaw and teeth,more significant fatigue.

Diagnosing

Nasal Endoscop

y (Rhinoscopy)

ComputerTomography

(CTscan)

X-Rays

MRI , Sinus Puncture

and Bacterial Culture

Treatment of chronic sinusitis

Antibiotics

Amoxicillin-clavulanate (Augmentin, generic) has replaced amoxicillin as the antibiotic recommended for treating chronic bacterial sinusitis in both children and adults.

For adults with sinusitis and penicillin allergies, doctors recommend either doxycycline or the fluoroquinoloneslevofloxacin or moxifloxacin.

Children should not take doxycyclinebecause it can cause tooth discoloration.

Corticosteroids

They may be helpful for patients with sinusitis (either chronic or acute) who have a history of allergic rhinitis.

Nasal spray steroids can help reduce inflammation and mucus production.

Beclomethasone ,flunisolide and budesonide ,Approved for children over age 6.

Mometasone furoate, Approved for use in patients as young as age 3.

Fluticasone ,Approved for children over age 4 year.

Decongestants

Decongestants are drugs that help

reduce nasal congestion.

Decongestants should never be used

in infants .

And children under the age of 4 years.

pseudoephedrine or phenylephrine

Naphazoline, Tetrahydrozoline

Surgery

Surgery can unblock the sinuses

when drug therapy is not effective or if

there are other complications, such as

structural abnormalities or fungal

sinusitis.

Insertion of a Drainage

Tube The simplest surgical approach is

the insertion of a drainage tube into

the sinuses followed by an infusion of

sterile water to flush them out.

Functional Endoscopic Sinus

Surgery Functional endoscopic sinus surgery

(FESS) is the standard procedure for

most patients requiring surgical

management of chronic sinusitis . The

procedure allows correction of

obstructions, including any polyp and

ventilation and drainage to aid

healing.

Adults need only a local anesthetic for

the procedure, although a general

anesthetic is needed for children.

Complications

Osteomyelitis.

One important complication is infection of the bones (osteomyelitis) of the forehead and other facial bones. In such cases, the patient usually experiences headache, fever, and a soft swelling over the bone.

Infection of the Eye Socket:

Infection of the eye socket, or orbital infection, which causes swelling and subsequent drooping of the eyelid, is a rare but serious complication of ethmoid sinusitis. In these cases, the patient loses movement in the eye.

Complications

Brain Infection: The most dangerous complication of

sinusitis, particularly frontal and sphenoid sinusitis, is the spread of infection by anaerobic bacteria to the brain, either through the bones or blood vessels. Abscesses, meningitis, and other life-threatening conditions may result.

In such cases, the patient may experience mild personality changes, headache, altered consciousness, visual problems, and, finally, seizures, coma, and death.