ENT sinusitis_2690c772d85e35c88e360d713a4921ea.pdf

Bio

1. Sinusitis
Emma Nyakuri,
ENT Nursing.
CIU

2. Sinusitis
•Sinusitis refers to inflammationof the paranasalsinusesin the face.
•This is usually accompanied by inflammation of the nasal cavity and
can be referred to as rhinosinusitis.
•It is very common.

4. Basic Anatomy
•There are four sets of paranasal sinuses:
•Frontal sinuses(above the eyebrows)
•Maxillary sinuses(either side of the nose below the eyes)
•Ethmoid sinusesa honeycomb-like in the ethmoid bone in the middle
of the nasal cavity
•Sphenoid sinuses (in the sphenoid bone at the back of the nasal cavity)

5. Basic Anatomy
•The sinuses are hollow air filled lined by mucous membrane.
•The ethmoid and maxillary sinuses are present at birth
•The frontal sinuses develop during the 2
nd
year of life
•Sphenoid sinuses develop during the 3
rd
year of life.

6. Basic Anatomy
•The paranasal sinusesare hollow spaces within the bones of the face,
arranged symmetrically around the nasal cavity.
•They produce mucous and drain into the nasal cavities via holes called
ostia.
•Blockage of the ostiaprevents drainage of the sinuses, resulting in
sinusitis.

7. Functions of the sinuses
The biological role of the sinuses is debated, but a number of possible
functions have been proposed:
•Decreasing the relative weight of the front of the skull, and especially the
bones of the face.
•Increasing resonance of the voice.
•Providing a buffer against blows to the face.
•Insulating sensitive structures like dental roots and eyes from rapid
temperature
•Humidifying and heating of inhaled air because of slow air turnover in this
region.
•Regulation of intranasal and serum gas pressures
•Immunological defense

9. Classification
Sinusitis can be classified as :
•According to duration;
•Acute(less than 12 weeks)
•Chronic(more than 12 weeks).
•According to cause
Allergic. Usually seasonal.
Viral.
Bacterial: Streptococcus pneumonia, Haemophilus influenza,β-hemolytic
streptococcus, Klebsiella pneumonia.
Iatrogenic: NGT insertion

10. Predisposing factors
•Infection due to viral URT infections.
•Hx of allergies(allergic rhinitis).
•Nonallergic rhinitis: vasometer, Aspirin intolerance
•Obstruction of drainage due to a foreign body, trauma or polyps
•Smoking.
•Patients with asthma are more likely to suffer from sinusitis.
•Medication related; topical decongestants, β-blockers, oral
contraceptives.

11. Predisposing factors
•Coexisting medical conditions;
•Pregnancy, hypothyroidism, wegner’s granulomatosis.
•Anatomic variants;
•Deviated , concha bullosa, nasal polyps, FB ant tumor.

12. Signs and symptoms
•The typical presentation of acute sinusitisfollows a recent viral URTI
presenting with;
Pressure, pain(headache), or tenderness over sinuses.
Low-grade fevers.
Malaise.
Persistent nasal discharge, often purulent.
Postnasal drip-upper airway cough syndrome. Cough worsens at night.
Snoring with mouth breathing.
Sore throat, may be associated with bad breath.
Nasal congestion.
Loss of smell.

13. Cont…d
Diagnosis
•Hx.
•P/E;
•Tenderness in the involved sinus,
•Hyperemic and edematous nasal mucosa, and
•The turbinate's are enlarged.
•X-ray examination
•Clouded sinus and fluid level is visible.
13

14. Chronic sinusitis
•Chronic sinusitisinvolves a similar presentation but with a duration of
more than 12 weeks.
•Chronic sinusitis may be associated with nasal polyps, which are
growths of the nasal mucosa.

15. Investigations
•In most cases, investigations are not necessary.
•In patients with persistent symptoms despite treatment,
investigations include:
•Nasal endoscopy( r/o CRSwNP, obtain drainage for C&S)
•CT scan( Ipsilateral sinusitis).

16. Management
•Patients with systemic infection or sepsis require admission to
hospital for emergency management.
•Delay antibiotics to patients with symptoms for up to 10 days.
•Most cases are caused by a viral infection and resolve within 2-3
weeks.

17. Management
Symptomatic patients /no improvement after 10 days:
Antibiotic prescription, used if worsening or not improving within 7
days
•Phenoxymethylpenicillin first-line
•Amoxicillin 20-40 mg/kg q8h(>20kg, 250mg q8h)
•Augmentin 25-45 mg/kg q12h.
Or
•Cefzil15mg/kg q12h
if associated with severe pain and cough
•Antitussive : Benyllin codeine, piritex codeine

18. Cont’n…
High dose steroid nasal spray for 14 days (e.g., mometasone 200 mcg twice daily
Or Fluticasone )
•Avamys nasal spray; 2 puffs each nostril q12h
Paracetamol or NSAIDS.
•If adult with no contraindication-Caffeinated Paracetamol.
Decongestant-relieve nasal congestion.
•Oxymetazoline(0.05% & 0.1%), ephedrine ( Isoryn drops)
Antihistamine:
•Levocetrizine + montelukast( 5mg/10mg) nocte for 2/52.
•Cinnarazine; if associated with vertigo.

19. Cont’n….
•Options for chronic sinusitis are:
•Saline nasal irrigation
•Steroid nasal sprays or drops (e.g., mometasone or fluticasone)
•Functional endoscopic sinus surgery (FESS)

20. Nasal Spray Technique
•Steroid nasal sprays are often misused, which means they will not be
as effective.
•A good question to ask is, “do you taste the spray at the back of your
throat after using it?” Tasting the spray means it has gone past the
nasal mucosa and will not be as effective.
•The technique involves:
•Tilting the head slightly forward
•Using the left hand to spray into the right nostril, and vice versa (this directs
the spray slightly away from the septum)
•NOT sniffing hard during the spray
•Very gently inhaling through the nose after the spray

21. Note .
•It is worth learning and practicing how to explain the use of a
steroid nasal spray.
•You may be asked to explain how to use a steroid nasal spray in your
OSCEs. OR
•probably explain the technique to your patient at the clinic.

22. Functional Endoscopic Sinus Surgery(FESS)
•FESS involves using a small fibreoptic endoscope inserted through the
nostrils and sinuses.
•Instruments are used to remove or correct any obstructions to the
sinuses.
•Obstruction may be caused by swollen mucosa, bone, polyps or a
deviated septum (septoplasty).
•If surgery is done under local anesthesia, patient is only kept for 2-3
hours postoperatively and then discharged.
•This will promote sinus drainage and ventilation and remove diseased
tissue and also open Ostia.

23. •Balloons may be inflated to dilate the opening of the sinuses.
Note:
•A CT scan is a prerequisite before the procedure to confirm the
diagnosis and locate the diseased tissue.

24. Complication
•Cellulitis
•Meningitis
•Brain abscess

25. Often forgotten!
Pott’s Puffy Tumor,
•Life-threatening complication of infectious sinusitis the frontal bone.
•It occurs due to infection or trauma
•often seen in late childhood and adolescence.
•If left untreated for a protracted period, intracranial complications
such as
•Epidural abscess,
•Subdural empyema,
•Meningitis, and
•Cerebral abscess.

26. Nursing management.
Pre-operative teaching
•NPO for 6-8 hours before surgery
•Explain that the patient will
•Receive a sedative, feel pressure not pain during surgery
•Have a nasal pack for 24 to 48 hours after surgery
•Mustache dressing after surgery
•Have black eyes and swelling around nose and eye for 1 to 2 weeks
•Feel pressure, not pain during surgery

27. Post operative teaching
Precautions for the first week;
•After general anesthesia, position the planet in side line
•Do not blow nose at least 3 to 5 days after surgery
•Don’t blow the nose for 2 weeks
•Tell the patient to expectorate secretion instead of swallow
•Try not to sneeze, do not bent over.
•Avoid constipation.
•Maintain oral hygiene.

28. •If difficult in breathing occurs,
•Keep the head elevated.
•Sleep with an extra pillow-more comfort, decrease edema and allow better
drainage.
•Cool mist humidifier usage.
•Rest and activity
•Avoid strenuous activities.
•After a week swimming, jogging are permitted.
•If bleeding occurs, stop activity Avoid heavy lifting.
•Self monitoring .
•Report signs of infections Expect ecchymosis for 1 –2 weeks.
•Expect tarry stools from swallowed blood for a few days.
•Avoid aspirin which can cause bleeding.

29. Reference
•Logan Turner ENT textbook.