sinusitis english
TRANSCRIPT
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Acute Sinusitis Diagnosis, Management, and
Complications
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Sinusitis ClassificationDefinitions
–Acuteƒ Sx & signs of infectious process < 3 weeks duration
–Subacuteƒ Sx & signs 21 to 60 days–Chronicƒ > 60 days of sx & signsƒ Or, 4 episodes of acute sinusitis each > 10 days in a single year
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General Contributors to Chronic Sinusitisƒ Resistant infectious organismsƒ Underlying systemic illness (esp.
diabetes)ƒ Immunodeficiencyƒ Irreversible mucosal changesƒ Anatomic abnormality
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SinusitisPathogenesis
ƒ Basic cause is osteomeatal complex (the middle meatal region & the frontal, ethmoid, & maxillary sinus ostia there) inflammation & infection–Sinus ostia occluded–Colonizing bacteria replicate–Ciliary dysfunction–Mucosal edema–Lowered PO2 & pH
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Development of the maxillary sinus (numbers are age in years)
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Anatomic location of the sinus ostia
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SinusitisEtiologic Organisms (& % incidence)
ƒ Aerobic bacteria–Strep. pneumoniae (30)–Alpha & beta hemolytic Strep (5)–Staph. aureus (5)–Branhamella catarrhalis (15 to 20)–Hemophilus influenzae (25 to 30)–Escherichia coli (5)
ƒ Anerobes (10 % acute, 66 % chronic)–Peptostreptococcus, Propionobacterium, Bacteroides, Fusobacterium
ƒ Fungi (2 to 5)ƒ Viruses (5 to 10)
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Acute Sinusitis Predisposing Conditions
ƒ Local–Allergic rhinitis–Nasal septal defects–Barotrauma (diving)–Nasal foreign bodies–Nasal tubes–Dental infections–Overuse of topical decongestants–Nasal polyps or tumors–Aspiration of infected water–Smoking
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Acute Sinusitis Predisposing Conditions (cont.)
ƒ Systemic–Diabetes–Immunocompromise (AIDS)–Malnutrition–Blood dyscrasias–Cystic fibrosis–Chemotherapy–Long term steroid Rx
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Normal Functions of the Components of the Sinuses
ƒ Ostia–Drain secretions from sinuses–Allow pressure equalization–Diameter 2 to 5 mm (maxillary), 1 mm (ethmoid)
ƒ Cilia–Push secretions out of sinus
ƒ Sinus secretions–Contain IgA & IgG
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Acute Sinusitis Usual Clinical Presentation
• Symptoms progress over 2 to 3 days• Nasal congestion & discharge (usually
thick & colored, not clear)• Localized pain +/- referred pain• Tenderness or pressure sensation over
sinuses• Headache• Cough due to postnasal drip• Halitosis
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Usual Physical Findings With Acute Sinusitis• Erythematous edematous nasal mucosa• Purulent secretions in middle meatal area•May be absent if ostia completely blocked
• Percussion tenderness•Over the involved sinuses•Over the maxillary molar +/- premolar teeth
• Halitosis• +/- fever
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Signs of Potentially Dangerous Complications of Acute Sinusitis
ƒ Periorbital, frontal, or cheek edemaƒ Proptosisƒ Ophthalmoplegiaƒ Ptosisƒ Diplopiaƒ Meningeal signsƒ Neuro deficits of cranial nerves II to
VI
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Acute Sinusitis Radiographyƒ Radiographic signs of sinus
pathology :–Air fluid levels–Partial or complete opacification–Bony wall displacement–4 mm or more of mucosal wall thickening
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Water’s view with air-fluid level in left maxillary sinus
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Water’s view showing air-fluid level in right maxillary sinus and mucosal thickening in left maxillary sinus
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Lateral view of normal frontal and sphenoid sinuses
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air-fluid level
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Opacification of the frontal sinuses
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Antibiotics to Consider for Rx of Sinusitis Complicationsƒ Ceftriaxone 1 gm IV q 12hƒ Cefotaxime 2 gm IV q 4hƒ Ceftizoxime 4 gm IV q 8h +
metronidazole 30 mg/Kg/dƒ Ampicillin / sulbactam 3 gm IV q
6hƒ Vancomycin 500 mg q 6h +
aztreonam 1 gm q 8h or chloramphenicol ( for PCN - allergic patients)
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https://www.youtube.com/watch?v=1GAMCCgksdg
https://www.youtube.com/watch?v=32-u6xsqLks