Chronic sinusitis , its symptoms and diagnosis

Sinusits a case presentation

1. SINUSITIS Presenter-Dr. Sheshadev Senapati PG PART 1 Moderator- Dr. P. Narendra (MD HOM) H.O.D Dept. of organon of medicine DR GGHMC, Gudivada

2. INTRODUCTION SINUSITIS Sinusitis is a common condition defined as inflammation of the paranasal sinuses. Sinusitis can be acute or chronic . Can be caused by an infection or growths in sinus such as nasal polyps . Can affect both adult or children .

3. Incidence Reportedly > 130 million cases in INDIA. One of the most common chronic illness 1 in every 8 Indians suffer from sinusitis

4. Sinusitis Classification Acute.  Symptoms last less than 4 weeks Subacute. Symptoms last 4 to 8 weeks Chronic.  Chronic infection happens with repeated or poorly treated acute infections. These symptoms last 8 weeks or longer. Recurrent.   3 or more episodes of acute sinusitis in a year,

5. Signs and symptoms Nasal inflammation Thick, discolored discharge from the nose (runny nose) Drainage down the back of the throat (postnasal drainage) Blocked or stuffy (congested) nose causing difficulty breathing through your nose Pain, tenderness and swelling around your eyes, cheeks, nose or forehead Reduced sense of smell and taste

6. Signs and symptoms (cont.) Ear pain Headache Aching in your upper jaw and teeth Cough or throat clearing Sore throat Bad breath Fatigue

7. Sinusitis causative Organisms Aerobic bacteria Strep. pneumoniae (30) Alpha & beta hemolytic Strep (5) Staph. aureus (5) Hemophilus influenzae (25 to 30) Escherichia coli (5) Anerobes (10 % acute, 66 % chronic) Peptostreptococcus, Propionobacterium, Bacteroides, Fungi (2 to 5) Viruses (5 to 10)

8. AETIOLOGY Growths such as Nasal Polyps, tumors Anatomical – (DNS) Allergies such as hay fever Respiratory tract infections Other systemic diseases (cystic fibrosis, HIV, diabetes, malnutrition, chemotherapy) Smoking

9. Pathogenesis 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 most commonly involved sinuses in both acute and chronic sinusitis are the maxillary and the anterior ethmoid sinuses.

10. DIAGNOSIS PHYSICAL EXAMINATION Oedematous 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

11. LAB INVESTIGATIONS Imaging tests.  Images taken using CT or MRI can show details of sinuses An allergy test.  If allergies might be triggering chronic sinusitis, an allergy skin test can be done Samples from nasal and sinus discharge (cultures).  

12. Differential Diagnosis of Sinusitis Nasopharyngitis / adenoiditis Dental abscess Tuberculosis Rhinosporidiosis Meningitis Brain abscess Nasopharyngeal cancer

13. Management Control Infection Moisten sinus cavity Use warm compression Provide relief of symptoms Evaluate and treat any predisposing conditions to prevent recurrences

14. Complications Mucocele or mucopyocele Anosmia Hyposmia Osteomyelitis of skull Facial cellulitis Orbital cellulitis Meningitis Epidural, subdural, or intracerebral abscess

15. CASE PRESENTATION

16. PRELIMINARY DATA NAME OF PT. – V. CHANDRA KIRAN AGE -26 SEX- Male ADD.- GUDIVADA OP REGD. NO- 6712

17. PRESENTING COMPLAINTS Nose blockage and coryza for 4 years One sided face pains Headache during < head bath, cold weather, >applying balm Headache for 5 years Location- temple to nape of neck < head bath , sun exposure

18. HISTORY OF PRESENTING COMPLAINTS Started before 4 years after loosing her mother due to tile falling on her. After this incident he got shocked. Got affected with covid after that incident and sinusitis after getting recovered from covid Used allopathic medicines and balms and got temporary reliefs

19. PAST HISTORY H/O Renal Calculi H/O Covid took treatment and recovered Vaccination 3 doses completed

20. FAMILY HISTORY Father- Apparently Healthy Mother- Died due to accident Siblings- Elder brother apparently Healthy

21. PERSONAL HISTORY Accommodation- own house Economic status – Middle class Diet & food habits- regular Addictions – NA Vaccination –As per schedule ,No known reactions

22. PHYSICAL GENERALS Appearance- Average Built Appetite – good Thirst - increased Desire – ice creams , spicy food, fruits Aversion – N.S Stool- soft, regular Urine-clear Sleep – refreshed Dreams- of suffering of something Perspiration – profuse on head, during eating Thermals - ambithermic

23. MENTAL GENERALS H/O grief +++ ( after sudden death of mother) Fright & shock due to that incident Anxious that something may happen Gets angry if someone does anything wrong Forgetful

24. LIFE SPACE INVESTIGATION Born through normal delivery he is the second child in the family. No h/o delayed milestones. He is a contractor by occupation. His mother died off a tile falling over her. After that incident he was shocked and depressed. He got affected with covid and after that continuously suffering with sinusitis. Anxiety . Gets angry if someone does wrong.

25. PHYSICAL EXAMINATIONS GENERAL EXAMINATION Consciousness- conscious Appearance- moderate Height – 5’6” Weight- 61 kg Anaemia – na Jaundice- na Cyanosis-na Oedema - na

26. VITAL SIGNS Temprature- 98.7 f Pulse- 74 bpm Respiration rate- 17/min Blood pressure- 110/70 mm of hg

27. PROVISIONAL DIAGNOSIS CHRONIC SINUSITIS

28. CASE PROCESSING Analysis of symptoms Evaluation of symptoms Hahnemann classification of disease Miasmatic analysis Selection of medicine

29. ANALYSIS OF SYMPTOMS MENTAL GENERALS Grief +++ Depressed after death of mother Anxious, Angry with wrong doings of others PHYSICAL GENERALS Desire- ice creams, spicy foods Thirst- increased , at long intervals Dreams – of suffering Perspiration- profuse , on forehead Thermals – ambithermic PARTICULARS Nose blockage alternate sides < head bath , cold weather One sided face pain, lt .>rt Headache , temple to nape of neck <head bath, sun exposure

30. EVALUATION OF SYMPTOMS Continuous grief Depression after death of mother Angry from mistakes of others Desire – ice cream Desire- spicy food Thirst – increased , at long intervals Dreams – of suffering Perspiration- profuse over head Nose blockage alternate sides <head bath, cold weather One sided face pain , Lt > rt Headache , temple to nape of neck < head bath, sun heat

31. HAHNEMANNIAN CLASSIFICATION OF DISEASE Chronic Dynamic Disease with fully developed symptoms

32. MIASMATIC ANALYSIS SYMPTOMS OF PSORIC NATURE Anxious Angry with mistakes Fright and shock after accident Desire – spicy things Headache < sunheat Nose blockage Thirst increased

33. SYMPTOMS OF SYCOTIC NATURE Continuous grief Forgetful Depression after death of mother Desire- ice cream Nose Blockage < cold weather H/O renal stones

34. SYMPTOMS OF SYPHILITIC NATURE Desire- ice cream Perspiration more on head at night PREDOMINANT MIASM Psora

35. SELECTION OF MEDICINE Non reportorial approach Miasmatic approach - as indications are clear

36. Selection Of Repertory Kent Repertory Mental symptoms are predominant Generals are predominant

37. Conversion of symptoms into rubric Mind-Grief, ailments after Mind- sadness , mental Depression Mind- Restlessness, Anxious Stomach-Desire, Fruit Stomach- Desire ice cream Perspiration -profuse eating while Nose- obstruction one sided Face- Pain (prospalgia) Head- Pain extending temples to nape of neck Head- pain < sunheat

38. REPERTORIAL RESULT Nat mur- 16/7 Ignatia- 15/8 Puls - 14/6 Calc. - 13/6 Nux-v - 12/6 Sulph- 12/6

39. Assessment Of Susceptability Moderate to high Selection of Remedy potency and dose Dated 24/05/22 Ignatia 200/ 1 dose SL for 15 days and then follow up

40. FOLLOW UP 1 Date 14/06/22 Pt little better After 1 week of medication pain reoccurred Sleeplessness for ¾ days Cough for 1 week< night Prescription- Ignatia 1M/ 1 dose , follow up after 15 days  

41. FOLLOW UP 2 Date 30/06/22 Better after medication Headache mild and nose blockage is still there Pain and stiffness of neck for 1 week (after sudden weather change) Prescription - Rhus tox 200/ 1 dose SL for 7 days and then report

42. Follow Up 3 Date- 7/7/22 Pt better Neck pain not there Headache better but nose blockage is still there One sided face pain Prescription – Ignatia 1m/ 1 dose SL for 15 days

43. FOLLOW UP 4 Date 16/08/2022 Pt better All symptoms better Cough for 1 week Prescription – SL for 15 days

44. FOLLOW UP 5 Date 15/09/22 Old symptoms reappeared Headache nose blockage for 10/15 days One sided face pain Prescription- Nat mur 200/ 1 dose SL for 15 days

45. FOLLOW UP 6 Date 14/12/2022 Pt was better after medication Headache better Pain and stiffness of neck for 7 days after getting wet in rain Prescription - Rhus tox 200/ 1 dose SL for 7 days

46. FOLLOW UP 7 Date 21/02/23 Pt is better No neck pain Headache pain from temple to face Sinusitis Prescription- Nat Mur 200/ 1 dose.

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