1. Nasal Sinusitis By: Munirah AlRubaian Meriem Souissi Suha Mokiyad
Loloa aldughiman
Alaa Alenazi

2. Acute Sinusitis Definition:
Acute inflammation of sinus mucosa is called acute sinusitis. The sinus most commonly involved is the maxillary followed in turn by ethmoid, frontal and sphenoid

3. AETIOLOGY OF SINUSITIS IN GENERAL:
A. EXCITING CAUSES
1- Nasal infections.
2- Swimming and diving.
3- Trauma. Compound fractures or penetrating injuries of sinus .
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.
They are:
A- Nasal packing B- Deviated septum
C- Oedema of sinus ostia due to allergy
D- Nasal polyp E- Hypertrophic turbinates

5. 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:
AETIOLOGY:
1- Most commonly, it is viral rhinitis which spreads to involve the sinus mucosa. This is followed by bacterial invasion EX:,,Moraxella catarrhalis ,Streptococcus pyogen , Staphylococcus aureus , Klebsiella pneumonia ,Haemophilus influenza ,Streptococcus pneumonia

7. 2-Diving and swimming in contaminated water.
3- Dental infections are important source of maxillary sinusitis.
4- Trauma to the sinus such as compound fracture

8. 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

9. DIAGNOSIS:
Transillumination test. Affected sinus will be found opaque.
X-rays.
Computed tomography (CT) scan

10. TREATMENT: MEDICAL: 1- Antimicrobial drugs.
2- Nasal decongestant drops
3- Steam inhalation.
4- Analgesics.
5- Hot fomentation.
SURGICAL:
Antral lavage.

11. 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

12. ACUTE FRONTAL SINUSITIS
AETIOLOGY
1 .viral infections of upper respiratory tract followed later by bacterial invasion.
2. Entry of water into the sinus during diving or swimming.
3. External trauma to the sinus .
4. Oedema of middle meatus .

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

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

15. 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 and deep to the eye . It is aggravated by movements of the eye ball.
2. Oedema of lids. Both eyelids become puffy and swollen
3. Nasal discharge.

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

17. 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.

18. ACUTE SPHENOID SINUSITIS
AETIOLOGY
Isolated involvement of sphenoid sinus is rare. It is often a part of pansinusitis or is associated with infection of posterior ethmoid sinuses.
CLINICAL FEATURES:
1. Headache.
2. Postnasal discharge

19. 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 .

20. Treatment
Treatment is the same as for acute infection of other sinuses

21. Chronic Sinusitis Definition:
Sinus infection that last 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.

22. The Symptoms : 1- purulent and nasal discharge is the commonest
2- foul-smelling discharge
3- Local pain and headache
And some patient complain of nasal stuffiness and insomnia

23. How to Diagnose it? X-ray – may show mucosal thickening and opacity
Or X-rays with contrast material injection  may show soft tissue changes in the sinus mucosa.
Computed tomography (CT) –
Aspiration and irrigation  finding of pus in the sinus is confirmatory.
useful in ethmoid and sphenoid sinus infections

24. Treatment
the initial treatment is Conservative , including antibiotic , decongestants , antihistamine and sinus irrigation
It is important to search for the underlying cause which obstruct sinus drainage and ventilation
The culture and sensitivity of sinus discharge – helps for the proper antibiotic

25. 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

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

27. 1. Fungal ball.
Maxillary sinus is the most commonly involved followed
by sphenoid, ethmoid and the frontal in that order. 
Not invasive.
Treatment:
is surgical removal of the fungal ball .

28. 2 - Allergic fungal sinusitis.
It is an allergic reaction to the causative 
Not invasive.
3 - Chronic invasive sinusitis.
surgical removal of the involved mucosa, bone and soft tissues followed by antifungal therapy with i.v. amphotericin B.
Invasive
4 - Fulminant fungal sinusitis. It is an acute presentation
and is mostly seen in immunocompromised or diabetic individuals.

29. Complication: 1- Local complication Mucocele of paranasal sinuses
mucous retention cysts
osteomyelitis
- osteomyelitis of the maxilla
- osteomyelitis of the frontal bone

30. 2- Orbital complication
Inflammatory oedema of the lids
Subperiosteal abscess
Orbital cellulitis
Orbital abscess
Superior orbital fissure syndrome
Orbital apex syndrome

31. 3- intracranial complication
Meningitis and encephalitis
Extradural abscess
Subdural abscess
Brain abscess
Cavernous sinus thrombosis
4- descending infection
5- Focal infection

32. THANK YOU
ANY QUESTIONS ?

33. REFERENCES