2. Definition
group of disorders characterized by inflammation of
the mucosa of the nose and paranasal sinuses.
Nasal congestion
Nasal discharge
Sneezing
Nasal itchiness

3. Pathophysiology
Viral infection nose and sinuses, anatomical abnormalities
sinus Ostia obstruction reduced
mucociliary clearence
stasis of secretion
Secondary bacterial infection.

4. Factors causing Rhinosinusitis
Anatomical factors  Mucociliary clearance
 Agar nasi cells Primary
 Over pneumatized bulla  Kartagener’s
ethmodalis syndrome
 Young’s syndrome
 Paradoxical turbinate
 Cystic fibrosis
 Concha bullosa
 Secondary
 DNS  Allergy
 Haller cells  Infection
 @HA_COP  trauma

5. Organisms
Ac rhinosinusitis
Strepto pneumonia
H influenza
M cattarahalis
Ch rhinosinusitis
Bacteria causing ac rhinosinusitis +
pseudomonas
anaerobes

6. Acute Rhinosinusitis - Symptoms
1 Proceeding URTI or Dental infection
2Constitutional symptoms
 Fever , malaise
3Headache/ facial pain
 Maxillary –maxillary region, aggravated on stooping ,coughing
and chewing heache frontal
 Frontal – Office headache at frontal
 Ethmoidal- bridge of the nose
 Sphenoidal -vertex
4 Nasal discharge , nasal obstruction
5 Redness and oedema frontal-upper eylid
maxillary-same region plus lowe eye lid

7. Acute Rhinosinusitis - Signs
Fever
Congested nasal mucosa
Local tenderness
Mucopus in nose or nasopharynx
Dental caries

8. Investigation
Radiological study
X-ray : water’s view and lateral views
opacity or fluid level at affected sinus
CT scan: coronal view nose and pns preferred
MRI – recent
• Nasal swab
• Diagnostic nasal endoscopy
• Mucosal biposy

9. Radiological studies

11. Medical Rx
Antibiotics x 2 weeks
Amoxicillin
Augmentin
Cefuroxime
Nasal decongestants – 0.1% xylometazoline drop or spray
Antihistamines
Analgesics and antipyretics
• Medicated steam inhalation
• Hot fomentation

12. surgical
Antral lavage esp for maxillary also in fronatal to rule
out max co-infection
Trephination of frontal sinus
indication
1 (both )Persistane symptoms after 48 hrs of medical
therapy
2 Threatened orbital complication

13. Chronic Rhinosinusitis
Symptoms Signs
Usually less - no pain n Mucopus in the meati
headache
Nasal obstruction Nasal mucosa congested
Nasal/Post nasal purulent X-ray show fluid level or
discharge opacity
hyposmia / anosmia

14. Task force criteria
2 major criteria or 1 major and 2 minor criteria
Major criteria Minor criteria
Facial pain/pressure Headache
Facial congestion/fullness Halitosis
Nasal obstruction/blockage Fatigue
Nasal discharge/purulence Dental pain
Hyposmia /anosmia Cough
Purulence on nasal Ear pain/pressure/
examination fullness
Fever (acute RS only)
Fever (nonacute)
@CDEF2H2

15. Investigations (similar)

17. CRS Rx
Medical management
Antibiotic
Corticosteroid
Antihistamine
Nasal decongestants

18. Chronic Sinusitis - Treatment
Surgical
Open-depends on the site
 Antral puncture , intranasal antrostomy, Caldwell-
Luc Operation- maxillary
 Intranasal/external ethmoidectomy.
 Trephination of frontal sinus, Osteoplastic flap
operation, external frontoethmoidectomy
Endoscopic-FESS

19. FESS
Functional Endoscopic Sinus Surgery
? Funtional
resume the normal function of sinus
 drainage
 ventilation

20. FESS-complication
Local
 Bleeding
 Adhesion
 Mucocele
 Stenosis
 Recurrence
Orbital
 Orbital haematoma
 Diplopia
 Blinding
Intracranial
 CSF leakage
 Meningitis

21. END