ACUTE AND CHRONIC SINUSITIS.lecture [Autosaved].pptx

This slide contains details of the etiology, predisposing factors, signs and symptoms as well as management of Acute and Chronic sinusitis

1. ACUTE AND CHRONIC SINUSITIS BY DR ASOEGWU CHINYERE NKIRUKA

2. OUTLINE Introduction/Definition Surgical anatomy Pathophysiology Etiology Risk factors/Causes Clinical features/Complications Investigation Treatment

3. INTRODUCTION/DEFINITION Inflammation of the mucosal lining of the nose and paranasal sinuses – rhinosinusitis Blocks the ostia and impedes the drainage of mucus from the sinuses This usually follows common cold

4. Classification Clinical/ duration Acute sinusitis: <4weeks Subacute sinusitis: 4weeks to 12 weeks Recurrent acute: 4 or more episodes per year Chronic sinusitis: >12weeks Cause Allergic or Non-allergic Non-Allergic: Infection/ Inflammatory/Anatomic

5. SURGICAL ANATOMY 4 pairs of sinuses namely maxillary, ethmoid, frontal and sphenoid. They open into the lateral and posterior superior wall of the nose via the ostia Lateral wall of the nose have 3 turbinates namely; inferior, middle & superior Under each turbinate is a corresponding meatus Inferior turbinate originate from the maxilla while middle and superior originate from the ethmoid bone

6. Continued Nasolacrimal duct drains into the inferior meatus The maxillary, anterior ethmoidal and frontal sinuses drains into the middle meatus also called the osteomeatal complex The posterior ethmoid and sphenoid sinuses drain into the superior meatus

7. Continued Lining- Respiratory pseudostratified epithelium made up of 4 cells namely -Ciliated columnar cells -Nonciliated columnar cells -Goblet mucous cells - Basal cells Attached to the periosteum to form mucoperiosteum

8. Continued

9. Anatomy continued

10. Physiologic function of sinuses Phonetic: Resonance, protection from bone conduction of own speech Respiratory: Humidification, buffer pressure changes, local immunologic defense Olfactory: Olfactory mucosa, air reservoir of stimuli Static: Reduce skull weight Mechanical: Trauma protection Thermal: Heat insulation

11. Pathophysiology Three major factors are implicated namely: Narrow sinus ostia from inflammation & mechanical obstruction Bacterial colonization and multiplication Hypoxia in the sinus, negative pressure & secretion retention ii) Dysfunction of ciliary apparatus iii) Viscous sinus secretions –impairs ciliary movement

12. Pathophysiology Disturbed host and microbial factors -Immune defence + Mucociliary clearance -Mucosal oedema and pathology leads to reduced ostial patency -Disturbed cellular metabolism (metabolic acidosis), inflammation and gross mucosal pathology + polyps -Multiplication of colonized bacteria

13. Etioology Infectious: Viral, bacteria, fungal Local factors: Nasal obstruction Choanal atresia, adenoid, rhinitis, polyps, FB, tumours , septal deviation, concha bullosa, ciliary dyskinesia Systemic factors: Asthma, cystic fibrosis, allergic fungal sinusitis Immune deficiencies: HIV/AIDS, organ transplant, chemotherapy Environmental factors: Air pollution, cigarette smoke

14. Infective Etiology Infection- viral, bacterial & fungal Viral causes acute sinusitis Types of virus- Rhinovirus, Coronavirus, Influenza virus, Adeno virus, Human parainfluenza virus, Human respiratory syncytial virus Last 7 – 10days

15. continued Bacterial Causes include -Streptococcus pneumonia -Haemophilus influenza -Moraxella catarrhalis -Staphylococcus aureus -Anaerobic bacteria -Gram negative enteric organisms Fungal causes- Aspergillus, Candida

16. Continued Allergy - Inflammation Anatomic variation –deviated septum, concha bullosa leading to nasal obstruction Nasal tumour /polyps/enlarged adenoid Cystic fibrosis- dysfunctional ciliary apparatus & viscous secretion Immunocompromise -HIV, uncontrolled DM

17. CLINICAL FEATURES Rhinorrhea anterior and posterior Nasal congestion/obstruction Facial pain/tenderness Ear pressure/ear pain Headache Tooth ache Snoring

18. Continued Sore throat Hyposmia /Anosmia (Reduced sense of smell and taste) Cough, which might be worse at night Bad breath (halitosis) Fatigue Fever

19. Allergy symptoms Sneezing in paroxysms Itching of the nose, ears, throat and eyes Alternating nasal obstruction Watery copious rhinorrhea initially

20. Factors associated with diagnosis of Rhinosinusitis Major Symptoms Minor symptoms Facial /pressure Headache Facial congestion/fullness Halitosis Purulent nasal discharge Fatigue Hyposmia /anosmia Dental pain Fever Cough Purulence in nasal cavity Ear pain

21. Nasal mucosa colour / oedematous / Rhinorrhea colour /consistency/ odour Inferior turbinate engorgement Septal deviation/spurs Middle meatus rhinorrhea/ oedema /polyp/granuloma Facial tenderness Ophthalmic examination Ear examination Throat examination –post nasal drip

22. COMPLICATIONS Mucocoel Meningitis Brain abscess Chronic sinusitis Pharyngitis/ laryngitis Osteomyelitis –Pott’s puffy tumour Orbital Cellulitis/ Ophthalmitis Cavernous sinus thrombosis/Blindness Otitis media with effusion

23. INVESTIGATION Nasal endoscopy- middle meatal pathologies e.g. discharge, mucosal oedema , polyp/ polypoid mucosa X ray paranasal sinuses Computed Tomography Scan of paranasal sinuses- intraluminal sinus pathology, anatomic variations, obstruction of the ostia MRI- Intracranial complications FBC Swab for M/C/S Allergy studies

24. TREATMENT Antibiotics/ Glucocorticoids/Surgery Rest Appropriate antibiotics Decongestants topical/oral Steam inhalation/humidifier Antihistamines Analgesics Antifungal Saline nasal spray/ irrigation Nasal corticosteroid spray Surgery endoscopic FESS/ESS