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

PAIN Burning Stabbing Throbbing Pressure BLOCKED Unilateral Bilateral DISCHARGE Watery/Mucoid Yellow/Green Blood ANOSMIA CACOSMIA ITCHINGEPISTAXIS SINO-NASAL PATHOLOGY SYMPTOMS

PATHOPHYSIOLOGY NASAL CAVITIES SINUS OSTIA MUCOSA CILIA VESSELS MUCUS

Drying 45C Infection Inflammation Propanolol Cocaine Phenylephrine(>) Isotonic saline Ephedrine Corticosteroids (1 wk) “LOVE “ “HATE” 200/cell. 20 strokes/min. CILIA

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

Common cold 10 days (35%) Viral sinusitis Symptoms > 10 days or symptoms worsen after 5-7 days Blocked nose Throat irritation Watery nasal discharge Bacterial sinusitis

VIRAL RHINOSINUSITIS INFLAMMATION (secretions & mucosal oedema) SINUS OSTIA OBSTRUCTION CILIARY DYSFUNCTION STASIS IIr 2 7 sq. mm. 0.5 mm. oedema 3 sq. mm.

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!!

Strep.Pneumoniae H.Influenza M. Catarrhalis Staph. aureus Anaerobes Fungi Tuberculosis MICROBIOLOGY

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’

FUNCTIONAL ENDOSCOPIC SINUS SURGERY SURGERY IN CHRONIC SINUSITIS

DRUGS & THE NOSE Symp./parasimp. Antihistamines Beta-blockers Sex hormones Corticosteroids Cocaine/Lignocaine Antihypertensives Viagra/Cialis