Sinusitis (Respiratory Pathologies )

Question 1

What is Sinusitis?

Answer 1

An acute or chronic inflammation of the paranasal sinuses

Question 2

Sinuses

Answer 2

1. The nasal passages open into sinuses in the frontal, ethmoid, sphenoid and maxillary bones
2. The sinuses are air-filled continuations of the nasal passages and are lined with mucous membranes
3. Sinuses develop mostly after birth and continue to enlarge into adulthood

Question 3

Frontal Sinuses

Answer 3

1. vary from 5mm (pea sized) to larger hollows that stretch almost to the sphenoid bones
2. drain into ducts that empty
   into the top of the nasal cavity
3. appear on x-rays by the age of seven

Question 4

Ethmoid Sinuses

Answer 4

1. are a variable number of small cells that empty into the lateral portions of the nasal cavity
2. appear between two and eight years of age

Question 5

Sphenoid Sinuses

Answer 5

1. are relatively large, making the walls of the sphenoid bone itself thin
2. drain into posterior portions of the nasal cavity
3. appear after two years of age

Question 6

Maxillary Sinuses

Answer 6

Maxillary Sinuses:

1. The largest sinuses
2. The roots of the upper molars are close to the floor of the maxillary sinus
3. They drain superiorly to the nasal cavity
4. If the head is held upright, it is impossible for the sinus to drain until it is full
5. head must be horizontal to completely drain the maxillary sinus
6. are present at birth and continue to grow until 25 years of age when all the permanent teeth have erupted
7. There is inflammation and swelling the sinus mucosa
8. Sinus openings become blocked and a mucopurulent discharge is produced, which fills the affected sinus
9. Chronic sinusitis occurs as a result of persistent or recurrent infection
10. The mucosal lining thickens and may form into elongated masses called polyps
11. In rare occasions, due to the proximity of the meninges, complications of sinusitis may occur, such as meningitis or a brain abscess

Question 7

Causes of Sinusitis

Answer 7

1. Viral infection : cold virus
2. Bacterial infection: extraction of upper molars or abscess
3. Increase in pressure: airplane flight, underwater diving

Question 8

Predisposing Factors for Sinusitis

Answer 8

1. Deviation of the nasal septum: Obstructs the sinus outlets
2. Dairy and wheat products: May predispose to an overproduction of mucus in people who have sensitivities to these foods
3. Upper molar abscess: Which may spread infection to the maxillary sinus

Question 9

Medically Treating Sinusitis

Answer 9

1. Sinusitis is treated with analgesics and decongestants
2. Prolonged use or overuse of medication can lead to worsening symptoms.
3. It can damage the tissues and the mucosa may respond to overmedication by producing more mucus in a rebound effect
4. In chronic cases, surgery may be performed to add an opening to drain the sinus.
5. The mucous lining may be removed or the deviated septum corrected to open the passage

Question 10

Symptom Picture

Answer 10

Acute sinusitis:

1. Pain, often severe:

a. From frontal infections is above the eyes and the pain increases with forward flexion
b. From maxillary infections is across the cheeks

c. From sphenoid or ethmoidal infections is referral pain to the side or back of the cranium

d. Can be a headache or the sensation of a toothache

2. Tenderness over the affected sinus
3. A feeling of fullness and pressure in the affected sinus and the person has difficulty breathing through the nose
4. The person can feel ill and may have a low-grade fever
5. Nasal discharge will change from clear and runny to yellow/green and thick
6. With chronic sinusitis, pain is dull and discharge may stop as the sinuses remain blocked

Question 11

Contraindications

Answer 11

1. Massage is CI’d with a fever
2. Local lymphatic drainage is CI’d with acute infection

Question 12

Assessment

Answer 12

1. Palpation of the frontal sinuses is done by gently pressing superiorly at the medial angle of the superior orbital margin
2. Palpation of the maxillary sinuses are palpated under the zygomatic arch
3. Tenderness and possibly heat will be present
4. The lymphatic nodes in the neck may be enlarged

Question 13

Massage

Answer 13

1. Duration:

The massage should be kept to a half hour duration to avoid exhausting the client

2. Focus of treatment:

The massage will be relaxation based including unforced diaphragmatic breathing

3. Pre-treatment hydrotherapy:

A 5 min facial steam to loosen the mucus and aid in discharge-plenty of tissues and a garbage should be on hand for the client throughout the steam and massage

4. Positioning:

Prone:
a. allows draining of the bilaterally affected maxillary sinuses

b. This position is good for drainage but pressure on the affected sinuses from a face cradle may be painful

c. Treatment focus will be on relaxation massage to the shoulder and upper thoracic area

5. Positioning:

a. Side lying with the affected sinus uppermost is the best position for draining a single infected maxillary sinus

6. Positioning:

Supine:

a. may allow the other sinuses to drain

b. Lymphatic drainage can be incorporated on the neck with chronic sinusitis. This is performed for a short period of time until there is no flare-up, at that point, the time spent on lymphatic drainage will increase over several treatments until the site of infection can be included

c. Swedish techniques to the neck and pec region are performed to reduce HT

d. Petrissage strokes are used on the muscles of mastication, facial muscles, scalp and S.O.

e. Trigger points:

e1. in SCM refer across the forehead and around the eyes and ears

e2. in masseter refer into the maxilla and frontal bone
e3. in temporalis refer into the teeth and above the eyes and ears
e4. in lateral pterygoid refer into the zygoma and anterior to the ear

f. Gentle static fingertip compressions to the client’s pain tolerance are used over the affected sinuses. These compressions may give relief from the feeling of congestion

h. Light fingertip tapping may also be used

j. Passive ROM and gentle long axis traction can be performed

Question 14

Self Care

Answer 14

1. Facial steams for up to 5 days
2. Teach client how to blow their nose properly by clearing one nostril at a time