Rhinosinusitis

1. Rhinosinusitis

2. Rhino-sinusitis is an inflammation of the mucous membrane of nose and paranasal sinuses Definition

3. The paranasal sinuses are a group of air containing spaces that surround the nasal cavity Each sinus is name for the bone in which it is located: Maxillary (one sinus located in each cheek) Ethmoid (approximately 6-12 small sinuses per side, located between the eyes) Frontal (one sinus per side, located in the forehead) Sphenoid (one sinus per side, located behind the ethmoid sinuses, near the middle of the skull) anatomy

4. anatomy

5. anatomy

6. Since they are actually pneumatic diverticuli from the primitive nasal cavity, their lining mucosa is similar to that of the nasal cavity, as a result of which, any pathological changes affecting the nasal mucosa can spread to the paranasal sinuses. anatomy

7. Sinuses have small orifices (ostia) which open into recesses (meati) of the nasal cavities. Meati are covered by turbinates (conchae). Turbinates consist of bony shelves surrounded by erectile soft tissue. There are 3 turbinates and 3 meati in each nasal cavity (superior, middle, and inferior). The drainage of the sinuses Frontal, maxillary, anterior ethmiod ? middle meatus Posterior ethmoid ? superior meatus Sphenoid ? sphenoethmoidal recess

8. anatomy

9. anatomy

10. Sinuses are formed as a result of a process where in solid facial skeletal elements surrounding the nose are invaded by respiratory mucosa and subsequently pneumatized . this process begins in 3rd- 4th month of fetal life and further development takes place after birth Development of sinuses

11. The Ethmoid sinuses are present at birth, reach adult size by age 12. The Maxillary present at birth. Frontal sinus rarely present at birth; usually not visible until age 2, great variability in size; congenitally absent in 5% Sphenoid sinuses are rarely present at birth, usually seen around age 4. Development of sinuses

12. pathogenesis

14. Acute Rhinosinusitis … up to 4 weeks Sub acute Rhinosinusitis … 4 to 12 weeks Chronic Rhinosinusitis .. > 12 weeks Recurrent acute Rhinosinusitis classification

15. It is an inflammatory condition of one or more of the para-nasal cavities lasts up to four weeks can range from acute viral rhinitis (the common cold) to acute bacterial rhino-sinusitis Acute Rhinosinusitis

16. lasts 4-12 weeks Sub-acute rhino-sinusitis usually involves one or two pairs of the paranasal cavities. Sub acute Rhinosinusitis

17. It is the inflammatory and infection that concurrently affects the nose and para-nasal sinuses lasts for longer than 12 weeks Chronic Rhinosinusitis

18. four or more recurrences of acute disease within a 12-month period, with resolution of symptoms between each episode lasts greater than 2 months . In most cases, each episode lasts for at least seven days Recurrent acute Rhinosinusitis

19. URTI Cold weather Day care attendance Smoking in the home Anatomic abnormalities : nasal polyps, ciliary disorder, septal deviation, concha bullosa turbinate hypertrophy, tumors, congenital abnormalities i.e. cleft palate Immunesupressed Direct extension: dental infection, facial fractures Inflammatory disorder: Wegener's Granulomatosis Sarcoidosis Mucosal disorder CF Allergic Rhinitis and other hyperreactivity Samter syndrome Asthma Nasal Polyps Aspirin intolerance . Predisposing Factors

20. Viral (10-15%) Rhinovirus (most common viral sinusitis cause), Influenza, Parainfluenza, Adenovirus Bacterial Acute Sinusitis :Streptococcus Pneumoniae, Haemophilus Influenzae, Moraxella, Streptococcus Pyogenes Chronic Sinusitis: Anaerobes (>50%) Bacteroides, Anaerobic Gram Positive Cocci, Fusobacterium species Other less common causes Staphylococcus aureus, Hemophilus Influenzae, Pseudomonas aeruginosa, Escherichia coli, Beta-hemolytic Streptococcus, Neisseria causes Fungal (Immunocompromised or DM) Aspergillus, Mucormycosis… Etiology

21. Thank you By Shorooq Abdoh