Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nose > Chronic Sinusitis > Flashcards

Chronic Sinusitis Flashcards

1
Q

CHRONIC SINUSITIS

A

Sinus infection lasting for months or years is called chronic sinusitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

cause of chronic sinusitis

A

failure of acute infection to resolve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PATHOPHYSIOLOGY of CHRONIC SINUSITIS

A

Acute infection ➡️destroys normal ciliated epithelium ➡️impairing drainage from the sinus➡️ Pooling and stagnation of secretions in the sinus ➡️ infection ➡️mucosal changes, such as loss of cilia, oedema and polyp formation, thus continuing the vicious cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PATHOLOGY CHRONIC SINUSITIS

A

In chronic infections, process of destruction and attempts at healing proceed simultaneously. Sinus mucosa becomes thick and polypoidal (hypertrophic sinusitis) or under- goes atrophy (atrophic sinusitis). Surface epithelium may show desquamation, regeneration or metaplasia. Submu- cosa is infiltrated with lymphocytes and plasma cells and may show microabscesses, granulations, fibrosis or polyp formation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

BACTERIOLOGY

A

Mixed aerobic and anaerobic organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CLINICAL FEATURES

A
  • often vague and similar to those of acute sinusitis but of lesser severity
  • Purulent nasal discharge
  • Foul-smelling discharge
  • Local pain and headache
  • nasal stuffiness and anosmia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

commonest complaint

A

Purulent nasal discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Foul-smelling discharge sug- gests

A

anaerobic infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Local pain and headache are often not marked except in

A

acute exacerbations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

DIAGNOSIS

A
  • X-ray
  • X-rays after injection of contrast material
  • Computed tomography (CT) scan
  • Aspiration and irrigation:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

X-ray of the involved sinus may show

A

mucosal thickening or opacity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

X-rays after injection of contrast material may show

A

soft tissue changes in the sinus mucosa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Computed tomography (CT) scan is particularly useful in

A

ethmoid and sphenoid sinus infections and has replaced studies with contrast materials

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Aspiration and irrigation

A

Finding of pus in the sinus is confirmatory.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

TREATMENT

A
  • search for underlying aetiological factors which obstruct sinus drainage and ventilation
  • A work-up for nasal allergy
  • Culture and sensitivity of sinus discharge ➡️ proper selection of an antibiotic.
  • conservative rx ➡️antibiotics, decongestants, antihistaminics and sinus irrigations
  • surgery is required either to provide free drainage and ventilation or radical surgery to remove all irreversible diseases so as to provide wide drainage or to obliterate the sinus.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

SURGERY FOR CHRONIC MAXILLARY SINUSITIS

A

Antral puncture and irrigation
Intranasal antrostomy
Caldwell–Luc operation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Antral puncture and irrigation

A

Sinus cavity is irrigated with a cannula passed through the inferior meatus. Removal of pus and exudates helps the sinus mucosa to revert to normal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Intranasal antrostomy

A

is indicated if sinus irrigations fail to resolve infection. A window is created in the infe- rior meatus to provide aeration to the sinus and its free drainage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Caldwell–Luc operation

A

In this operation, antrum is entered through its anterior wall by a sublabial incision. All irreversible diseases are removed and a window is cre- ated between the antrum and inferior meatus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

SURGERY FOR CHRONIC FRONTAL SINUSITIS

A
  • Intranasal drainage operations
  • Trephination of frontal sinus
  • External frontoethmoidectomy (Howarth’s or Lynch operation
  • Osteoplastic flap operation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Intranasal drainage operations

A

Correction of deviated septum, removal of a polyp or anterior portion of middle turbinate, or intranasal ethmoidectomy provide drainage through the frontonasal duct. Treatment of associated max- illary sinusitis also helps to resolve chronic frontal sinusitis

22
Q 
External frontoethmoidectomy (Howarth’s or Lynch
operation)
A

The frontal sinus is entered through its floor by a curvilinear incision round the inner margin of the orbit. Diseased mucosa is removed, ethmoid cells exen- terated and a new frontonasal duct created.

23
Q

Osteoplastic flap operation

A

It may be unilateral or bilat- eral. A coronal or a brow incision is used. The anterior wall of frontal sinus is reflected as an osteoplastic flap, based inferiorly. The diseased tissues are removed and the sinus drained through a new frontonasal duct. If it is desired to obliterate the sinus, all diseased as well as healthy mucosa are stripped off and the sinus obliterated with fat

24
Q

SURGERY FOR CHRONIC ETHMOID SINUSITIS

A

Intranasal ethmoidectomy

External ethmoidectomy

25
Q

Intranasal ethmoidectomy

A

This operation is done for chronic ethmoiditis with polyp formation. The ethmoid air cells and the diseased tissue are removed between the middle turbinate and the medial wall of orbit by the intranasal route. The frontal and sphenoid sinuses can also be drained by this operation.

26
Q

External ethmoidectomy

A

In this operation, ethmoid sinuses are approached through medial orbital incision. Access can also be obtained to sphenoid and frontal sinuses and the operation is called fronto-spheno-ethmoidectomy.

27
Q

SURGERY FOR CHRONIC SPHENOIDITIS SINUSITIS

A

Sphenoidotomy. Access to the sphenoid sinus can be obtained by removal of its anterior wall. This is accomplished by external ethmoidectomy or trans-septal approach, usu- ally the former, because of the coexistence of ethmoid dis- ease with chronic sphenoiditis.

28
Q

FUNGUS CAUSING SINUSITIS

A

Aspergillus, Alternaria, Mucor or Rhizopus

They may involve single or multiple sinuses.

29
Q

Fungal ball is due to

A

implantation of fungus into an otherwise healthy sinus which on CT shows a hyperdense area with no evidence of bone erosion or expansion

30
Q

most commonly involved sinus in Fungal ball

A

Maxillary sinus >sphenoid>ethmoid >frontal

31
Q

Treatment for Fungal ball

A

surgical removal of the fungal ball and adequate drainage of the sinus. No antifungal therapy is required

32
Q

Allergic fungal sinusitis

A

allergic reaction to the causative fungus

33
Q

Presentation of Allergic fungal sinusitis

A

presents with sinunasal polyposis and mucin

34
Q

mucin of Allergic fungal sinusitis contains

A
  • eosinophils
  • Charcot- Leyden crystals
  • fungal hyphae
35
Q

CT scan of Allergic fungal sinusitis shows

A

mucosal thickening with hyperdense areas

36
Q

How many sinus are involved in Allergic fungal sinusitis

A

There is no invasion of the sinus mucosa with fungus. Usually more than one sinus are involved on one or both sides.

37
Q

Treatment of Allergic fungal sinusitis

A

endoscopic surgical clearance of the sinuses with provision of drainage and ventilation. This is combined with pre and postoperative systemic steroids.

38
Q

Chronic invasive sinusitis

A

Here the fungus invades into the sinus mucosa. There is bone erosion by fungus

39
Q

In Chronic invasive sinusitis Patient presents with

A

chronic rhinosinusitis

40
Q

CT scan of Chronic invasive sinusitis shows

A

thick- ened mucosa with opacification of sinus and bone erosion. Patient may have intracranial or intraorbital invasion.

41
Q

Histopathology of Chronic invasive sinusitis shows

A

fungal invasion of submucosa and granulomatous reaction with multinucleated giant cells.

42
Q

Treatment for Chronic invasive sinusitis

A

surgical removal of the involved mucosa, bone and soft tissues followed by antifungal ther- apy

43
Q

antifungal ther- apy for Chronic invasive sinusitis

A

i.v. amphotericin B. Up to a total of 2–3 g of the drug is given. followed by itraconazole therapy for 12 months or more monitored by serial CT or MRI scans.

44
Q

Fulminant fungal sinusitis

A

It is an acute presentation and is mostly seen in immunocompromised or dia- betic individuals.

45
Q

Common fungal species for Fulminant fungal sinusitis

A

Mucor

Aspergillus

46
Q

Mucor causes which disease

A

rhinocerebral disease

47
Q

How does mucor causes black eschar of inferior turbi- nate, palate or the sinus

A

invasion of the blood vessels, mucor fungus causes ischaemic necro- sis presenting as a black eschar, involving inferior turbi- nate, palate or the sinus

48
Q

Where does mucor spreads to

A

face, eye, skull base and the brain

49
Q

Treatment for mucor

A

Treatment is surgical debridement of necrotic tissue and i.v. amphotericin B.

50
Q

Aspergillus infection can also cause

A

acute fulminant sinusitis with tissue invasion.

51
Q

acute fulminant sinusitis due to Aspergillus presentation

A

acute sinusitis and develop sepsis and other sinus com- plications. Unlike Mucor infection, there is no black eschar.

52
Q

For for acute fulminant sinusitis due to Aspergillus presentation

A

antifungal therapy and surgery.

Nose (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions