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lecture 4

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abubakarduule
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Sinusitis

Sinusitis is defined as an inflammatory disorder of


the paranasal sinuses.
Sinusitis Classification
1. Acute Sinusitis
• Is an as an acute inflammatory disorder of the paranasal
sinuses.
• Acute onset of S & S of sinusitis
• Duration < 1 weeks
Predisposing factors of Acute sinusitis
• Local predisposing Factors
– Nasal septal defects
– Presence of Nasal foreign bodies
– Use of Contaminated Nasal tubes
– Presence of Nasal polyps or nasal tumors

• Systemic predisposing factors


– DM
– AID
– Malnutrition
– Chemotherapy
– Long term steroid Rx
2. Chronic Sinusitis
• Is defined as a chronic inflammatory disorder of
the par nasal sinuses.
• Chronic onset
• 20 days – 60 days or more or
• 4 episodes of acute sinusitis each > 10 days in a single
year
Why Chronic Sinusitis occur?

• Due to the presence of drug Resistant infectious


microorganisms
• Patient has Underlying systemic illness (esp. DM)
Either Acquired or inherited Immunodeficiency
• Irreversible nasal mucosal changes
Epidemiology

• Bacterial infection of the sinuses follows viral


infections
• Sinusitis occurs in 2% of cases of viral upper
respiratory infections (URI) in adults
• Occurs in 6% to 13% of children after viral URI
Etiology

 Streptococcus pneumonia
- the most frequently isolated organism
 Haemophilus influenza and Moraxella catarrhalis as a
second causative agents

• Now days there is decrease in S. pneumonia as causative


agent of sinusitis with an increase in β-lactamase–producing
H. influenza
Mechanism of sinusites
– Usually nasal congestion due to rhinitis or viral infection
occurs
– Mucous stagnation in the sinus
– Bacteria overgrowth in the the pranasal sinus
– Bacterial Colonizing and replication in the sinusitis
– Sinuses occluded
– Nasal Ciliary dysfunction
– Nasal Mucosal edema due to inflammation
– Acute sinus Inflammation
– Chronic sinus inflammation if not resolved
Clinical presentations
• Fever
• malaise
• Nasal congestion
• Nasal discharge which is thick & colored
• Severe headache when prostrating
• Pain and Tenderness over sinuses
• Physical findings:
• Erythematous in nasal mucosa
• Edematous in nasal mucosa
• Purulent secretions
• Percussion tenderness
• Bad smelling
Signs of Dangerous complications in acute
sinusitis
• Periorbital swelling
• Frontal swelling
• Cheek edema
• Proptosis
• Ophthalmoplegia
• Signs of Meningeal irritations
Diagnosis
• lab diagnosis: not useful
• Sinus culture some times may help
Clinical diagnosis
• The following three clinical presentations will identify patients with acute
bacterial sinusitis:
• Onset with persistent symptoms or signs, lasting at least 10 days without
evidence of clinical improvement

• Onset with severe symptoms or signs of high fever (≥39° C) and purulent
nasal discharge lasting for 3 to 4 consecutive days

• Onset with worsening symptoms or signs characterized by the new


development of fever, headache, or increased nasal discharge after a typical
viral URI that lasted 5 to 6 days with initial improvement

• Imaging = routinely not indicated in the diagnosis


Treatment

 Antibiotics
 Anti pain
 Decongestant
 Anti histamine in case of presence of
allergy
 Surgical drainage
Treatment
• Drug of choice :
- amoxicillin with or without clavulanate remains drug of
choice for sinusitis
-Amoxicillin 500 mg PO q 8 h
- Augmentin 625mg q 8 h
• alternative medications :
- fluoroquinolones or
- combination of cefixime with clindamycin.
• The duration of therapy should last 7 days after the patient
becomes free of signs and symptoms.
• Adjunctive therapies including antihistamines, decongestants,
nasal steroids, and nasal washes have provided minimal
improvement in acute sinusitis.
• Surgical drainage is indicated incase of complications
Fungal Sinusitis
– Sinusitis due to fungal infection
 Common in immune-compromised people
 Also may affect immune-competent

Categories of fungal sinusitis :-


1. Noninvasive localized fungal sinusitis
2. Fulminant fungal sinusitis infection with soft tissue
invasion
3. Progressive indolent invasive disease
Major risk factors of fungal sinusitis

– Over use of antibiotics or steroids


– Uncontrolled DM
– AIDS
– Prolonged chemotherapy
Etiology

 Aspergillus is the most common pathogen causing


fungal sinusitis

 Rhizopus (mucormycosis) is the second most


common one

 Candida albicans after Aspergillus and Rhizopus


Treatment
• Admit the patient
• Treat other medical illnesses
• Give
- High dose Amphotencin B +/- fluconazole

Surgical:
- Surgical debridement and drainage in some cases
General complications of sinusitis
• Meningitis
• Facial osteomyelitis
• Facial cellulitis
• Orbital cellulitis
• Cavernous sinus thrombosis
• Septic thrombophlebitis

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