ACUTE &
CHRONIC
(RHINO-)
“SINUSITIS”
Classification by duration of
symptoms
– ACUTE – lasting up to 4 weeks, with total
resolution of symptoms
– SUBACUTE – persisting more than 4 weeks, but
less than 12 weeks, with total resolution of
symptoms
– CHRONIC – 12 weeks or more of signs /
symptoms
– RECURRENT ACUTE – 4 or more episodes per
year, with resolution of symptoms between
attacks
SINO-NASAL PATHOLOGY
SYMPTOMS
PAIN
Burning
Stabbing
Throbbing
Pressure
ANOSMIA
CACOSMIA
BLOCKED DISCHARGE
Unilateral Watery/Mucoid
Bilateral
Yellow/Green
Blood
ITCHING
EPISTAXIS
PATHOPHYSIOLOGY
NASAL CAVITIES
SINUS OSTIA
MUCOSA
CILIA
VESSELS
MUCUS
CILIA
200/cell. 20 strokes/min.
“LOVE “
“HATE”
Drying
Isotonic saline
Ephedrine
Corticosteroids (1 wk)
< 10C >45C
Infection
Inflammation
Propanolol
Cocaine
Phenylephrine(>)
PREDISPOSING FACTORS
Septum deviation
Pollution
Polyps
Allergy
Tumour
Diet
Trauma
Immune supression
Dental
Endocrinological
Nose packs
Diabetis
N/G tubes
Kartegener
Foreign body
Drugs
ADENOIDITIS
GE(L)RD
Blocked nose
Common cold
10 days (35%)
Throat irritation
Watery nasal
discharge
Viral sinusitis
Symptoms > 10 days or
symptoms worsen after
5-7 days
Bacterial sinusitis
VIRAL RHINOSINUSITIS
INFLAMMATION
SINUS OSTIA OBSTRUCTION
7 sq. mm.
(secretions & mucosal oedema)
0.5 mm. oedema
3 sq. mm.
CILIARY DYSFUNCTION
2
IIr
STASIS
BACTERIAL SINUSITIS
Fever > 38C
Sinus pain: Throbbing
Bending
Coughing
Walking
Percussion ???
Dental pain
Nasal:
Discharge
Congestion
CHRONIC SINUSITIS (?)
SPECIAL INVESTIGATIONS
PUS SWABS
Absence of puss does not exclude sinusitis!!
MICROBIOLOGY
Strep.Pneumoniae
H.Influenza
M. Catarrhalis
Staph. aureus
Anaerobes
Fungi
Tuberculosis
TREATMENT OF ACUTE SINUSITIS
(See it as an abscess and treat it as such!)
Antibiotics 10 – 14 days
Drainage: Decongestant - local ( drops,spray,) systemic,??
Flushing (steam inhalations, saline)
Hypertonic saline- 1/2tsp in 250 ml
Sterile water
Prednisone
Mucolytics ??????
Anti-inflammatory
Antihistamines
‘Drying up’
SURGERY IN CHRONIC SINUSITIS
FUNCTIONAL ENDOSCOPIC SINUS SURGERY
DRUGS & THE NOSE
Symp./parasimp.
Antihistamines
Beta-blockers
Sex hormones
Corticosteroids
Cocaine/Lignocaine
Antihypertensives
Viagra/Cialis