1. Nasal Sinusitis (Acute,Chronic,complication)

2. Sinusitis : Definition:
Acute inflammation of sinus mucosa is called acute sinusitis.

3. AETIOLOGY OF SINUSITIS IN GENERAL:
A. EXCITING CAUSES
1. Nasal infections.
2. Swimming and diving.
3. Trauma. Compound fractures or penetrating injuries of
4. Dental infections.

4. B. PREDISPOSING CAUSES:
LOCAL
1. Obstruction to sinus ventilation and drainage. Normally,
sinuses are well-ventilated.
They also secrete small amount
of mucus. which interfere with this function can cause
sinusitis due to stasis of secretions in the sinus.
They are:
(a) Nasal packing
(b) Deviated septum, Hypertrophic turbinates
(c) Oedema of sinus ostia due to allergy or vasomotor
rhinitis
(d) Nasal polypi.

5. 2. Stasis of secretions in the nasal cavity
2. Stasis of secretions in the nasal cavity. Normal secretions of sinus 3. Previous attacks of sinusitis. ( Local defences of sinus) mucosa are already damaged. GENERAL • Environment . • Poor general health .

6. A. ACUTE MAXILLARY SINUSITIS:
Acute sinitus :
A. ACUTE MAXILLARY SINUSITIS:
Haemophilus influenza .
Moraxella catarrhalis .
Streptococcus pyogenes .
Staphylococcus aureus .

7. CLINICAL FEATURES
1. Constitutional symptoms. It consist of fever, general malaise
2. Headache
3. Pain.
4. Tenderness.
5. Redness and oedema of cheek. Commonly seen in children.
6. Nasal discharge
7. Postnasal discharge.

8. DIAGNOSIS:
• Transillumination test. Affected sinus will be found opaque.
• X-rays.
Computed tomography (CT) scan is to investigate the sinuses.

9. TREATMENT:
MEDICAL
1. Antimicrobial drugs. Ampicillin and amoxicillin are quite
2. Nasal decongestant drops
3. Steam inhalation.
4. Analgesics.
Paracetamol or any other suitable analgesic
should be given for relief of pain and headache.
5. Hot fomentation.
SURGICAL
Antral lavage.

10. COMPLICATIONS:
1. Acute maxillary sinusitis may change to subacute or chronic
sinusitis.
2. Frontal sinusitis.
3. Osteitis or osteomyelitis of the maxilla.
4. Orbital cellulitis or abscess

11. ACUTE FRONTAL SINUSITIS
AETIOLOGY
1 .viral infections of upper respiratory tract
followed later by bacterial invasion.
2. swimming.
3. trauma to the sinus .
4. Oedema of middle meatus.

12. CLINICAL FEATURES: 1. Frontal headache. 2. Tenderness.
3.Oedema of upper eyelid with suffused conjunctiva and
4. Nasal discharge.
TREATMENT :
Medical treatment is the same as for acute maxillary sinusitis.

13. COMPLICATIONS: 1. Orbital cellulitis. 2
COMPLICATIONS: 1. Orbital cellulitis. 2. Osteomyelitis of frontal bone and fistula formation. 3. Meningitis, extradural abscess or frontal lobe abscess. 4. Chronic frontal sinusitis,or brain abscess.

14. ACUTE ETHMOID SINUSITIS
AETIOLOGY: Acute ethmoiditis is often associated with infection of other sinuses. Ethmoid sinuses are more often involved in infants and young children. CLINICAL FEATURES: 1. Pain, It is localized over the bridge of the nose, medial 2. Oedema of lids. Both eyelids become puffy and swollen. 3. Nasal discharge.

15. TREATMENT:
1- Medical treatment is the same as for acute maxillary sinusitis.
2- in the posterior orbit and may require drainage of the ethmoid sinuses into the nose through an external ethmoidectomy incision.

16. COMPLICATIONS: 1. Orbital cellulitis and abscess.
2. Visual deterioration and blindness due to involvement of
optic nerve.
3. Cavernous sinus thrombosis.
4. Extradural abscess, meningitis or brain abscess.

17. ACUTE SPHENOID SINUSITIS
AETIOLOGY
Isolated involvement of sphenoid sinus is rare.
CLINICAL FEATURES:
1. Headache.
2. Postnasal discharge.

18. DIFFERENTIAL DIAGNOSIS
1-X-rays . Opacity or fluid level may be seen in the sphenoid sinus.
2- Lateral view of the sphenoid sinus is taken in supine or
prone position .
3- CT scan is more useful.
DIFFERENTIAL DIAGNOSIS
Mucocele of the sphenoid sinus or its neoplasms .

19. BACTERIOLOGY. CHRONIC SINUSITIS
Sinus infection lasting for months or years is called chronic sinusitis.
Most important cause of chronic sinusitis is failure of acute infection to resolve.
BACTERIOLOGY.
Mixed aerobic and anaerobic organisms are often present.

20. CLINICAL FEATURES: What are the symptoms of chronic sinusitis?
1- The most prominent symptom is usually nasal obstruction , And when have runny nose the discharge may be green/yellow.
2- Foul-smelling discharge
3- Pain over the affected sinus, and headache .
4 - Some patients complain of nasal stuffiness and anosmia.
Other symptoms that sometimes occur include:
A feeling of pressure or fullness in the ears

21. DIAGNOSIS
1. X-ray of the involved sinus may show mucosal thickening and opacity or X-rays after injection of contrast material may show soft tissue changes in the sinus mucosa.
2. Computed tomography (CT) scan is particularly useful in ethmoid and sphenoid sinus infections .
3. Aspiration and irrigation: Finding of pus in the sinus is
confirmatory.

22. TREATMENT
1- It is essential to search for underlying aetiological factors which obstruct sinus drainage and ventilation. 2- Culture and sensitivity of sinus discharge helps in the proper selection of an antibiotic. Initial treatment of chronic sinusitis is conservative, including: antibiotics, decongestants, antihistaminics .

23. CHRONIC SINUSITIS: CHRONIC MAXILLARY SINUSITIS
1. Antral puncture and irrigation
2. Intranasal antrostomy.
3. Caldwell–Luc operation.
CHRONIC FRONTAL SINUSITIS
1. Intranasal drainage operations.
2.Trephination of frontal sinus
3. External frontoethmoidectomy
4. Osteoplastic flap operation.

24. CHRONIC SINUSITIS CHRONIC ETHMOID SINUSITIS
1. Intranasal ethmoidectomy.
2. External ethmoidectomy.

25. FUNGAL INFECTIONS OF SINUSES:
1. Fungal ball.
Maxillary sinus is the most commonly involved followed
by sphenoid, ethmoid and the frontal in that order. Treatment
is surgical removal of the fungal ball .
2. Allergic fungal sinusitis.
It is an allergic reaction to the causative .
3. Chronic invasive sinusitis. surgical removal of the involved mucosa, bone and soft tissues followed by antifungal therapy with i.v. amphotericin B.
4. Fulminant fungal sinusitis. It is an acute presentation
and is mostly seen in immunocompromised or diabetic
individuals.

26. Complications of Sinusitis
Complications of paranasal sinus Infection: A. Local • Mucocele/Mucopyocele • Mucous retention cyst • Osteomyelitis • Frontal bone (more common) • Maxilla bone(second common)

27. B. Orbital • Preseptal inflammatory oedema of lids • Subperiosteal abscess • Orbital cellulitis • Orbital abscess • Superior orbital fissure syndrome • Orbital apex syndrome

28. C. Intracranial • Meningitis • 1-Extradural abscess • 2-Subdural abscess • 3-Brain abscess • 4-Cavernous sinus thrombosis D. Descending infections E. Focal infections

29. References
Diseases of Ear, Nose and Throat.

30. BY:
Fatima alkhalil , Yagoot almutiri , Asma asiri