rhinitis-sinusitis Flashcards
which sinus is present at birth
ethmoid
maxillary
when does frontal sinus develop
2nd year
when does spenoid sinus develop
3rd year
function of paranasal sinuses
Humidifying and warming inspired air Regulation of intranasal pressure Lightening the skull Resonance Absorbing shock Contribute to facial growth
define acute, subacute, chronic
Acute stage – signs and symptoms may last (1-3) weeks
Subacute stage – 3weeks to 3 months
Chronic stage – lasting longer than 3 months
Recurrent episode – repetitive acute bouts of more than 4 bouts in a year
causative organisms in sinusitis viral
Viral - Rhinovirus , Reovirus , Myxovirus, Paramyxovirus , Coxsachivirus , ECHOvirus
causative organisms bacteria
Bacterial - Streptococcus pneumonia, Strept.haemolyticus, Staph. aureus, Haemophilus influenzae, Neiseria catarrhalis.
Mode of infection
Rhinogenic
Odontogenic
Haematogenic
Traumatic
pathophysiology of acute rhinosinusitis
inflammation leads to
increased vascular permeability and mucosal edema
impaired mucociliary function
increased mucus production
predisposing factors
Cold weather Smoking and Fumes Allergies Nasal deformities Nasal polyps Cystic fibrosis HIV infection
symptoms
- Headache, Fever, Malaise, Halitosis
- Nasal obstruction, Heaviness in the head,
- Rhinorrhoea - Mucoid - Mucopurulent - Haemorrhagic mucupurulent.
- Nasal irritation .
- Facial pains and tenderness
Localisation of pain in sinusitis
a, Maxillary - Frontal headache, Infra orbital pain.
b, Frontal - Frontal headache, Sopra orbital pain.
c, Ethmoid - Intra-canthal pain on the bridge of the nose.
d, Sphenoid - Occipital headache, Retro-ocular pain.
Investigations
- Radiological- X ray paranasal sinuses i. e. Water’s (Occipito-mental) view.
Computerized tomography. (CT Scan). - Haematological- Full blood count (FBC).
- Microbiology - Culture and Sensitivity test of Nasal swab .
Management of acute sinusitis
- Broad spectrum antibiotics.
- Analgesic / antipyretics .
- Nasal decongestant . a. Topical - b. Systemic-
- Steam inhalation with Menthol, or (TBC) Tincture of Benzoin Compound.
- Physiotherapy - Short wave therapy.
how does physiotherapy work?
Physiotherapycan assist in acute and especially in chronicsinusitisthrough means of reducing the inflammation in the linings, reducing the viscosity of the secretions and aiding in clearing the passages by increasing the rate of drainage from thesinuscavities.
which of the sinuses is more prone to inflammation
maxillary
since it drains against gravity
microbes implicated in chronic sinusitis
bacteria
Gram negatives - Proteus vulgaris Pseudomonas aureginosa Escherechia coli.
Gram positives - Streptococcus spp. Staphylococcus aureus, Neiseria catarrhalis.
most common inciting agent in chronic sinusitis
viral URI
Pathogenesis of chronic sinusitis
Ostia obstruction creates increasingly hypoxic environment within sinus
Retention of secretion results in inflammation and bacterial infection
Secretion stagnate, obstruction increases, cilia and epithelial damage become more pronounced
symptoms of chronic
- Offensive yellowish or greenish mucopurulent discharge .
- Nasal obstruction and Irritation.
- Discomfort ( Heaviness ) in the area of the involved sinus.
- Halitosis .
management of chronic
- Medical -
- Surgical - a. Antral wash- out . b.Antral wash-out & Antrostomy. c. Radical antrostomy - Caldwell Luc Operation.
instrument used in antral lavage
Lilwitz trocar and cannula
difference between allergic and infective sinusitis
Nostril - Allergy is usually bilateral while infective sinusitis is usually unilateral.
Rhinorrhoea - Allergy is mucoid ( watery ) while infective sinusitis is mucopurulent.
Halitosis - eminent in infective sinusitis.
Complications of sinusitis
Local- Fronto- ethmoidal mucocoele. Nasal and Antrochoanal polyps. Hypertrophic nasal turbinates. Epistaxis.
Distant- Pharyngitis, Tonsillitis, Laryngitis, Orbital cellulitis - abscess, Otitis media.
Intra-cranial-Meningitis, Cerebral abscess, Cavernous sinus thrombosis.
