Nasal and Para nasal inflammatory disease PPT

Detailed PPT on Nasal and paranasal inflammatory disease for nursing students (Bsc+Msc)

1. Inflammatory diseases of Nose and Paranasal sinuses MATHEW VARGHESE V MSN(RAK),FHNP (CMC Vellore),CPEPC Nursing officer AIIMS Delhi 1 [email protected]

2. Related Anatomy and Physiology 2 [email protected]

3. Skeletal Framework of Nasal cavities Unpaired Bones : Ethmoid Sphenoid Frontal bone Vomer Paired Bones : Nasal Maxillary Palatine and lacrimal bones Inferior conchae 3 [email protected]

4. Regions of Nasal Cavities 4 [email protected]

5. Functions of Nasal Cavities   Main: Sense of smell (olfaction) Accessory Temperature and humidity of respired air regulation Trap and remove particulate from air Capturing foreign material in abundant mucus. Mucus normally is moved posteriorly by cilia on epithelial cells in the nasal cavities and is swallowed 5 [email protected]

6. Paranasal Sinus These are the invaginations from the nasal cavity that drain into spaces associated with the lateral nasal wall There are four paranasal air sinuses Ethmoidal sinuses Sphenoidal sinuses Maxillary sinuses Frontal sinuses Functions: skull lighter and add resonance to the voice 6 [email protected]

7. Paranasal Sinus 7 [email protected]

8. Inflammatory diseases of Nose Rhinitis Rhinitis is inflammation and swelling of the mucous membrane of the nose, characterized by a runny nose and stuffiness and usually caused by the common cold or a seasonal allergy 8 [email protected]

9. Classification Acute V/s Chronic Acute rhinitis commonly results from viral infections but may also be a result of allergies, bacteria, or other causes. Chronic rhinitis usually occurs with chronic sinusitis (chronic rhino sinusitis). Allergic V/s Non allergic 9 [email protected]

10. Allergic Rhinitis Allergic rhinitis is caused by a reaction of the body’s immune system to an environmental trigger. The most common environmental triggers include Dust Molds Pollens Grasses Trees Animals 10 [email protected]

11. Symptoms of Allergic rhinitis Itching Sneezing Runny nose Stuffiness Itchy and watery eyes Headaches and swollen eyelids Cough and wheeze. 11 [email protected]

12. Treatment of Allergic Rhinitis Avoiding the substance that triggers the allergy Nasal corticosteroid sprays decrease nasal inflammation Antihistamines help prevent the allergic reaction Nasal irrigation Antibiotics do not relieve the symptoms of allergic rhinitis. 12 [email protected]

13. Non allergic Rhinitis Acute viral rhinitis Acute viral rhinitis can be caused by a variety of viruses, usually the common cold Symptoms consist of runny nose, sneezing, congestion, postnasal drip, cough, and a low-grade fever. 13 [email protected]

14. Treatmen t Stuffiness can be relieved by taking decongestants Antihistamines help control a runny nose Antibiotics are not effective for acute viral rhinitis. 14 [email protected]

15. 2. Chronic rhinitis Chronic rhinitis is usually an extension of rhinitis caused by inflammation or a viral infection. It also may rarely occur with some other diseases. Syphilis Tuberculosis Rhinoscleroma (a skin disease characterized by very hard, flattened tissues that first appear on the nose) Rhinosporidiosis (an infection in the nose characterized by bleeding polyps) Leishmaniasis Histoplasmosis , Leprosy 15 [email protected]

16. Clinical features Chronic rhinitis causes nasal obstruction and, in severe cases, crusting, frequent bleeding, and thick, foul-smelling, pus-filled discharge from the nose. Treatment: Decongestants may relieve symptoms Treatment of underlying cause 16 [email protected]

17. 3. Atrophic rhinitis Atrophic rhinitis is a form of chronic rhinitis in which the mucous membrane thins (atrophies) and hardens, causing the nasal passages to widen (dilate) and dry out. This atrophy often occurs in older people. 17 [email protected]

18. C/F & Mnt . Crusts form inside the nose, and an offensive odor develops. People may have recurring severe nosebleeds and can lose their sense of smell ( anosmia ). Treatment is aimed at reducing the crusting, eliminating the odor, and reducing infections. 18 [email protected]

19. 4. Vasomotor rhinitis Vasomotor rhinitis is a form of chronic rhinitis. Nasal stuffiness, sneezing, and a runny nose—common allergic symptoms—occur when allergies do not seem to be present. Treatment of vasomotor rhinitis is by trial and error and is not always satisfactory. If inflammation of the sinus is not severe, treatment is aimed at relieving symptoms. 19 [email protected]

20. Nursing Management of rhinitis Patient education Instruct client to avoid exposure to allergens Instruct about use of medications and nasal spray Teach about steam inhalation Teach about use of nasal instillation of drugs In case of infective rhinitis teach about infection control measures including hand hygiene Provide information about influenza vaccines Give special attention to vulnerable population including Immuno compromised patients 20 [email protected]

21. Bacterial Nasal Infections 1. Nasal vestibulitis Minor infections at the opening of the nose, called nasal vestibulitis , may result in pimples at the base of nasal hairs ( folliculitis ) and sometimes crusts around the nostrils. The cause is usually the bacteria  Staphylococcus . The infection may result from nose picking or excessive nose blowing and causes annoying crusts and bleeding when the crusts slough off. Bacitracin  ointment or  mupirocin  ointment usually cures nasal vestibulitis . 21 [email protected]

22. 2 . Nasal furuncles More serious infections result in boils (furuncles) in the nasal vestibule. Nasal furuncles may develop into a spreading infection under the skin ( cellulitis ) at the tip of the nose Treatment - Antibiotics 22 [email protected]

23. Nasal polyps Polyps are common teardrop-shaped growths that form around the openings to the sinus cavities. A mature polyp resembles a peeled, seedless grape. 23 [email protected]

24. Nasal polyps 24 [email protected]

25. Symptoms Sneezing Nasal congestion Obstruction Drainage of fluid down the throat (postnasal drip) Facial pain Excessive discharge from the nose Loss of smell ( anosmia ) Reduced ability to smell ( hyposmia ) Itching around the eyes Chronic sinus infections 25 [email protected]

26. Nasal polyps Treatment Corticosteroids Sometimes surgery .Most surgical procedures are done with an endoscope. 26 [email protected]

27. Sinusitis Sinusitis is inflammation of the sinuses, most commonly caused by a viral or bacterial infection or by an allergy. It may be acute (short-lived) or chronic (long-standing). 27 [email protected]

28. Acute sinusitis Sinusitis is defined as acute if it is totally resolved in less than 30 days. In people who have a normally functioning immune system, acute sinusitis is usually caused by a viral infection. Sometimes acute sinusitis is caused by bacteria. 28 [email protected]

29. Chronic sinusitis Sinusitis is defined as chronic if it has been ongoing for more than 90 days. Causative Factors include chronic allergies, nasal polyps, and exposure to environmental irritants (such as airborne pollution and tobacco smoke). Positive family history 29 [email protected]

30. Sub acute $ Recurrent Sinusitis may also be  sub acute  (lasting from 30 to 90 days) or  recurrent  (4 or more episodes of acute sinusitis per year). 30 [email protected]

31. Symptoms Acute and chronic sinusitis have similar symptoms Yellow or green pus discharged from the nose Pressure and pain in the face Congestion and blockage in the nose Tenderness (pain when touched) and swelling over the affected sinus Reduced ability to smell ( hyposmia ) Bad breath (halitosis) A productive cough (especially at night) 31 [email protected]

32. Site specific symptoms Maxillary sinusitis  causes pain over the cheeks just below the eyes, toothache, and headache. Frontal sinusitis  causes headache over the forehead. Ethmoid sinusitis  causes pain behind and between the eyes, tearing, and headache (often described as splitting) over the forehead. Sphenoid sinusitis  causes pain that does not occur in well-defined areas and may be felt in the front or back of the head. 32 [email protected]

33. Complications of sinusitis Spread of a bacterial infection to adjacent tissue Changes in vision or swelling around the eye, Eye pain Meningitis and cause severe headache and confusion. 33 [email protected]

34. Diagnosis History P/E PNS – X ray CT Sinus fluid culture by nasal endoscope 34 [email protected]

35. Treatment Treatment of sinusitis is aimed at improving sinus drainage and curing the infection Steam inhalation Hot, wet towels over the affected sinuses and hot beverages may help relieve the swollen membranes and promote drainage. Nasal irrigation or using a Saline nasal spray also can help symptoms. 35 [email protected]

36. Antibiotics For acute sinusitis that is severe (3 or more days of symptoms such as fever of 102.2º F (39º C) or higher and severe pain) or persistent (for 10 or more days), antibiotics such as amoxicillin/ clavulanate  or  doxycycline  are given. People who have chronic sinusitis take the same antibiotics but for a longer period of time, typically 4 to 6 weeks. 36 [email protected]

37. Surgery When antibiotics are not effective, surgery may be performed either to wash out the sinus and obtain material for culture or to improve sinus drainage, which allows the inflammation to resolve. Nasal obstruction that interferes with drainage may also require surgery. 37 [email protected]

38. What is sinus surgery? Sinus surgery is a procedure that aims to open the pathways of the sinuses and clear blockages. This is an option for people with ongoing and recurrent sinus infections, for people with abnormal sinus structure, or abnormal growths in the sinus 38 [email protected]

39. Functional endoscopic sinus surgery (FESS) FESS is carried out with a tool called an endoscope. This is an illuminated, thin fiber-optic tube. The endoscope is inserted into the nose to reach the openings of the sinuses. Micro-telescopes and surgical instruments can then be passed down the endoscope and used to carry out the procedure. The surgeon will use these tools to remove obstructive tissues and other blockages to clear the sinuses. 39 [email protected]

40. FESS The entire procedure is carried out through the nostrils and leaves little to no scarring. Some swelling may occur, but it will disappear quite quickly. A person who has this surgery will usually only feel mild discomfort for a short period of time. FESS can be performed frequently. It can also be carried out on an outpatient basis. 40 [email protected]

41. Image-guided surgery Image-guided endoscopic surgery is a newer procedure that may be recommended for severe forms of sinus blockages or after previous sinus surgeries. In addition to using an endoscope, this type of surgery uses a near-three-dimensional mapping system to show the surgeon the position of the surgical instruments. This is done using CT scans and infrared signals 41 [email protected]

42. Caldwell-Luc operation This procedure is less common and more invasive. It tends to be carried out when there is a growth present inside the sinus cavity. The Caldwell-Luc operation aims to remove growths and improve sinus drainage. It creates a pathway between the nose and the cavity beneath the eye called the maxillary sinus. This window then aids drainage. 42 [email protected]

43. Nursing Management of sinusitis For the post op patient: assess for profuse nasal bleeding, respiratory distress, ecchymosis , and orbital and facial edema for the first 24 hours. Apply ice compresses to the nose and cheek to minimize edema and control bleeding Semi-High flowler’s position for 24-48 hours Remove nasal packing the am after surgery. Mild analgesics as necessary Teach clients to increase fluid intake to thin secretions, avoid blowing the nose for 7-10 days ( snif or spit), sneeze with mouth open, limit strenuous activity for ~ 2 weeks. Nasal sprays may be started 3-5 days after surgery to moisten the nasal mucosa. 43 [email protected]

44. Fungal Sinus Infections Fungus balls  are overgrowths of Aspergillus fungi in healthy people. Symptoms include sinus pain, pressure, nasal congestion, and drainage of fluids. Surgery is needed to open the affected sinus and remove the fungal debris. 44 [email protected]

45. Invasive fungal sinusitis  is a very serious disorder that develops most often in people whose immune system is impaired by chemotherapy or by diseases such as poorly controlled diabetes, leukemia, lymphoma, multiple myeloma, or AIDS. It may spread rapidly. Symptoms include pain, fever, and discharge of pus from the nose. Treatment is surgery and antifungal drugs 45 [email protected]

46. Allergic fungal sinusitis  is a chronic sinusitis in which fungi cause an allergic reaction characterized by marked nasal congestion and the formation of nasal and sinus polyps Surgery is typically required to open up the sinuses and to remove the fungal debris. Long-term treatment is also required with corticosteroids and antifungal drugs 46 [email protected]

47. Chronic Inflammatory Disease of Nasal Cavity and Paranasal Sinuses Rhino sinusitis Inflammation of the paranasal sinuses and nasal cavity Rhinosinusitis may present in the acute or chronic form, and chronic rhinosinusitis (CRS) may present with or without nasal polyps. The most common symptoms of CRS are nasal obstruction, nasal congestion, discharge, fatigue, headache, facial pressure, and dysosmia , which may also show worsening in certain seasons, such as winter CRS frequently occurs in conjunction with nasal polyps and asthma, presenting as a complex allergic entity 47 [email protected]

48. CRS The mainstay in the treatment of CRS is nasal corticosteroids, both in the presence and absence of nasal polyps . Other predominant treatment options in the absence of nasal polyps are nasal wash, nasal decongestants, and systemic corticosteroids. 48 [email protected]

49. Sinonasal Inflammatory Polyp Inflammatory nasal polyps are inflammatory, polypoidalsinonasal mucous tissues that arise in response to inflammatory stimuli, such as allergy and infections, or as a component of a systemic process such as aspirin intolerance or cystic fibrosis . The mainstay in the medical treatment of sinonasal polyps is nasal corticosteroids. 49 [email protected]

50. Paranasal Nasal Sinus Mucocele Mucoceles are defined as benign cystic lesions limited by the mucosa of the paranasal sinus itself and occurring most frequently in the paranasal sinus Surgical excision is the standard treatment for these lesions, with the endoscopic approach being the gold standard 50 [email protected]

51. Bacterial Infections Rhinoscleroma is a chronic granulomatous disease of the nasal cavity, nasopharynx, and paranasal sinuses caused by Klebsiellarhinoscleromatis 51 [email protected]

52. Leprosy Leprosy is caused by Mycobacterium leprae and is characterized by involvement of the skin and peripheral nerves. Depression of the nasal bridge is a characteristic feature of leprosy. The nasal mucosa is the main point of entry and exit of the bacteria . 52 [email protected]

53. Protozoal Mucocutaneousleishmaniasis Mucocutaneousleishmaniasis is caused by Leishmaniabrasiliensis . Almost 40% of patients develop mucocutaneous involvement, with the typical early symptoms being nasal obstruction associated with a nodule or polyp at the inferior turbinate. The disease eventually progresses to destroy the nasal septum and destroy the nose and mouth if not controlled. 53 [email protected]

54. Viral Infection Herpes Herpes simplex is caused by herpes simplex virus (HSV) type I or II and manifests as painful blisters or ulcers around the nose and mouth . Oral lesions are generally caused by HSV type I. Tingling, itching, or burning may be experienced before the appearance of the blisters . 54 [email protected]

55. Nursing Process related to Nasal and paranasal diseases Assessment Take proper health history Take in detailed symptom analysis on OLDCARTS format Onset Location Duration Characteristics Aggravating factors Relieving factors Time Setting 55 [email protected]

56. Assessment Take history of allergy and allergens Proper physical examination using all 4 techniques Inspection Percussion Palpation Auscultation 56 [email protected]

57. Nursing diagnoses Ineffective airway clearance related excessive mucus production secondary to inflammation Acute pain related to nasal mucosal irritation Impaired verbal communication related to nasal cavity obstruction secondary to polyps Altered body temperature ,hyperthermia related to inflammation Knowledge deficit related to management and home care of nasal and paranasal inflammatory disease r/t lack of exposure 57 [email protected]

58. Nursing Interventions Maintaining a patent airway  The breath sounds must be assessed every 2 hourly. Asess RR, Rhythm,pattern ABG results must be interpreted to determine the degree of oxygenation provided by the ventilators or oxygen. Assess for cough and swallow reflexes Use an oral artificial airway to maintain patency Nasal and oral care is provided to keep the upper airway free of accumulated secretions debris 58 [email protected]

59. Maintaining a patent airway Position on alternate sides 2-4 hrs to prevent secretions accumulating in the airways on one side. Maintain the neck in a neutral position Oronasopharyngeal suction may be necessary to aspirate secretions.. Chest percussion and postural drainage may be prescribed to assist in the removal of tenacious sections Dentures are removed 59 [email protected]

60. Acute pain related to nasal mucosal irritation Perform a comprehensive assessment. Assess location, characteristics, onset, duration, frequency, quality and severity of pain. Observe for nonverbal indicators of pain: moaning, guarding, crying, facial grimace Accept patient’s description of pain Obtain vital signs. Assess the client’s current use of medications. 60 [email protected]

61. Pain Management Anticipate the need for pain management Provide a quiet environment Use nonpharmacological pain relief methods (relaxation exercises, breathing exercises, music therapy). Provide optimal pain relief by administering prescribed pain relief medication. Review patient’s medication records and flow sheet. 61 [email protected]

62. Patient Education Prevention of upper airway infections Emphasize frequent handwashing When to contact health care provider Need to complete antibiotic treatment regimen Annual influenza vaccine for those at risk 62 [email protected]

63. Anxiety and Depression Allow asking of questions and provide information. Permit verbalization of feelings. Interventions to reduce anxiety and promote comfort Reassuring manner. Stay with the patient during episodes of anxiety. Relaxation techniques 63 [email protected]

64. Conclusion These are the common acute and chronic inflammatory diseases of nasal and paranasal sinuses. Understanding and proper knowledge regarding this disease will enable nurses to manage their client in proper way without complication. 64 [email protected]

65. References 1. Riechelmann H; Europäischen Akademie für Allergie und Klinische Immunologie (EAACI) under European Rhinologic Society (ERS). [Chronic Rhinosinusitis - EPOS 2012 Part I]. Laryngorhinootologie . 2013; 92: 193-201. 2. Gorbach SL, Falagas M. The 5-Minute Infectious Diseases Consult. Boston: Wolters Kluwer . 2001. 3. Passali D, Cingi C, Cambi J, Passali F, Muluk NB. A survey on chronic rhinosinusitis : opinions from experts of 50 countries. Eur Arch Otorhinolaryngol . 2016;. 4. Robinson, Robert. Nose, Paranasal Sinuses, and Nasopharynx. In: Head and Neck Pathology: Atlas for Histologic and Cytologic Diagnosis. Philadelphia: Lippincott Williams & Wilkins. 2012; 142. 5. Stamm AC, Draf W, editors. Micro-endoscopic sinus surgery in children. In: Micro-endoscopic Surgery of the Paranasal Sinuses and the Skull Base. Berlin: Springer. 2012; 363. 6. Hssaine K, Belhoucha B, Rochdi Y, Nouri H, Aderdour L, et al. Paranasal sinus mucoceles : About 32 cases. Rev Stomatol Chir Maxillofac Chir Orale . 2015; 00188-00183. 65 [email protected]

66. References . Scangas GA, Gudis DA, Kennedy DW. The natural history and clinical characteristics of paranasal 24 www.avidscience.com 25 Chronic Inflammatory Diseases Chronic Inflammatory Diseases www.avidscience.com sinus mucoceles : a clinical review. Int Forum Allergy Rhinol . 2013; 3: 712-717. 8. Lee TJ, Li SP, Fu CH, Huang CC, Chang PH. Extensive paranasal sinus mucoceles : a 15-year review of 82 cases. Am J Otolaryngol . 2009; 30: 234- 238. 9. Grammer , Leslie, Paul Greenberger. Radiologic Evaluation of Allergic and Related Diseases. In: Patterson’s Allergic Diseases. 7th edn . Baltimore: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2009; 165. 10. Meltzer EO, Hamilos DL, Hadley JA, Lanza DC, Marple BF. Rhinosinusitis : developing guidance for clinical trials. J Allergy Clin Immunol . 2006; 118: S17-61. 11. http://www.avidscience.com/wp-content/uploads/2016/04/CID-16-01 12.https:// www.msdmanuals.com /home/ear,-nose,-and-throat-disorders/nose-and-sinus-disorders/introduction-to-nose-and-sinus-disorders 13. http://www.scielo.br/pdf/rboto/v74n2s0/en_a02.pdf 14. http:// www.mariobussi.com /en/diseases-of-major-interest/diseases-of-nose-and-paranasal- sinuses.html 15. https://www.slideshare.net/kapradh/diseases-of-the-paranasal-sinuses 66 [email protected]

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