ACUTE SINUSITIS

1. DR SHEETAL RAI ASST PROF DEPT OF ENT YENEPOYA MEDICAL COLLEGE ACUTE SINUSITIS

2. SPECIFIC LEARNING OBJECTIVES • To know the etiology, clinical features and management of :- • Maxillary sinusitis • Frontal sinusitis • Ethmoid sinusitis • Sphenoid sinusitis

3. CLASSIFICATION

4. AETIOLOGY EXCITING CAUSES : • Nasal infections • Swimming/diving • Trauma • Dental infections

5. AETIOLOGY PREDISPOSING CAUSES: I)LOCAL • Obstruction to sinus ventilation & drainage • Stasis of secretions • Previous attacks of sinusitis

6. AETIOLOGY PREDISPOSING CAUSES: II) GENERAL • Environmental • Poor general health

7. BACTERIOLOGY • Usually viral >>>>>>>>>>bacterial • S.pneumoniae • H.influenza • Moraxellacatarrhalis • Strept. pyogenes • S.aureus • Kleb.pneumoniae 2. Dental origin ………anaerobic organisms

8. PATHOLOGY Acute inflammation ...... • Hyperaemia and exudation of fluid • Increased neutrophils • Increased activity of serous & mucous glands Ostium block…retained secretions…empyema Decreased mucociliary clearance Destruction of bony walls ….. complications

9. ACUTE MAXILLARY SINUSITIS

10. AETIOLOGY • Dental infection …….. Most important • Viral …..bacterial invasion • Swimming in contaminated water • Trauma to the sinus

11. CLINICAL FEATURES • Headache • Facial pain …. Increases on stooping forwards ….referred to gums and teeth • Tenderness over the canine fossa • Edema and redness of cheek & lower eyelid • Mucopus in middle meatus • Edematous mucosa • Post nasal drip

12. CLINICAL FEATURES

13. X RAY PNS WATER’S VIEW

14. CT NOSE AND PNS Normal CT PNS B/L maxillary sinusitis

15. TREATMENT MEDICAL : • Antibiotics • Nasal decongestants – drops/spray/oral • Analgesics • Steam inhalation • Hot fomentation SURGICAL : • FESS • ANTRAL LAVAGE

16. ANTRAL LAVAGE

18. TECHNIQUE OF ANTRAL LAVAGE

19. COMPLICATIONS • Acute ….. Subacute…. Chronic sinusitis • Frontal sinusitis • Osteitis/osteomyelitis of maxilla • Orbital cellulitis

20. ACUTE FRONTAL SINUSITIS

21. CLINICAL FEATURES • Frontal headche ….. OFFICE HEADACHE • Tenderness over superomedial aspect of the orbit • Edema of upper eyelid • Mucopus in middle meatus

22. X RAY PNS WATER’S VIEW

23. TREATMENT MEDICAL : same as maxillary sinusitis SURGICAL : • TREPHINATION • FESS

24. TREPHINATION

25. COMPLICATIONS • Orbital cellulitis • Osteomyelitis of frontal bone /fistula formation • Meningitis • Chronic frontal sinusitis

26. ACUTE ETHMOID SINUSITIS

27. AETIOLOGY • Associated with infection of other sinuses. • Infants and young children……more often.

28. CLINICAL FEATURES • Pain over the bridge of the nose and medial to the eye. • Tenderness …… medial to medial canthus. • Edema of the eyelids. • Nasal discharge anterior ethmoids ….. Middle meatus posterior ethmoids …. Superior meatus

29. TREATMENT • MEDICAL : Same as that of maxillary sinusitis • SURGICAL : In case of orbital abscess ….. Reduced vision and exopthalmos…………….EXTERNAL ETHMOIDECTOMY

30. EXTERNAL ETHMOIDECTOMY

31. COMPLICATIONS • Orbital cellulitis and abscess • Optic nerve involvement ….. Reduced vision and blindness • Cavernous sinus thrombosis • Meningitis, extradural abscess, brain abscess

32. ACUTE SPHENOID SINUSITIS

33. AETIOLOGY Often associated with • Pansinusitis • Posterior ethmoid sinusitis • Isolated sphenoid sinusitis is rare

34. CLINICAL FEATURES • Headache ….. Occipital / vertex • Post nasal discharge …….roof and posterior wall of nasopharynx/above posterior end of middle turbinate.

35. X RAY PNS • Water’s view with open mouth

36. TREATMENT • MEDICAL : same as that for acute infection of other sinuses. • SURGICAL : FESS

37. SUMMARY • Sinusitis is a very common ENT condition. • May lead to intracranial and orbital complications. • Most often amenable to medical line of management. • When medical management fails or in case of complications, surgery is indicated.

38. All images have been derived from Google image search THANK YOU