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  2. INTRODUCTION  Paranasal sinuses are a group of 4 paired air filled spaces that surround the nasal cavity.  Frontal sinus  Ethmoid sinus  Sphenoid sinus  Maxillary sinus  They reduce the weight of the skull and they humidify the inspired air.
  3. DEFINITION Sinusitis is an inflammation of the mucus membrane of the Paranasal sinuses. Pansinusitis is infection of more than one sinus. Rhinosinusitis is referred to as an inflammatory disease of the nose or sinuses.
  4. CLASSIFICATION S. NO . ON THE BASIS OF LOCATION ON THE BASIS OF DURATION 1. Frontal sinusitis Acute sinusitis( infection lasts up to 4 weeks) 2. Ethmoid Sinusitis Sub-acute sinusitis ( lasts between 4 -12 weeks) 3. Maxillary sinusitis Chronic sinusitis( more than 12 weeks) 4. Sphenoid sinusitis Re-current acute bacterial sinusitis
  5. ETIOLOGY  BACTERIOLOGY: Streptococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis, Streptococcus pyogenes, Satphylococcus aureus, Klebsiella pneumoniae.  VIRAL INFECTION: 90% of sinusitis occurs due to Rhinovirus, Coronavirus.
  6. ETIOLOGY Cont… • Pollutants: Chemical/irritants may trigger the build of mucus (e.g. pollens, dust etc.) • Nasal infections: Viral rhinitis followed by bacterial invasion. • Swimming and diving: infected water enters sinuses through ostium. • Trauma: Compound fractures or penetrating injuries. • Dental infections
  7. ETIOLOGY Cont… PREDISPOSING CAUSES :  LOCAL: Obstruction to sinus ventilation and drainage ( DNS, polyp, neoplasms, edema of ostium).  Stasis of secretions in nasal cavity ( Cystic fibrosis ,enlarged adenoids, choanal atresia)  Previous histories of sinusitis.
  8. ETIOLOGY Cont… GENERAL • Environment: Cold and wet climate. • Poor general health: Exanthematous fever (measles, chickenpox),nutritional deficiencies, systemic disorders.
  10. PATHOPHYSIOLOGY Acute infection Destroys normal ciliated epithelium Impairs drainage from sinus Pooling & stagnation of secretions Persistence of infection Mucosal changes-loss of cilia, edema, polyp formation etc. leads to SINUSITIS
  11. CILIA
  12. CLINICAL MANIFESTATIONS Maxillary sinusitis: Pain in the upper jaw. Frontal sinusitis: Pain in the forehead. Ethmoid sinusitis: Pain over nasal bridge. Sphenoid sinusitis: Pain over the occiput or vertex.
  13. CLINICAL MANIFESTATIONS Common sign and symptoms are Fever, sore throat, headache, facial pain and pressure, malaise. In more advance cases the symptoms are Anosmia, Nasal congestion and discharge, halitosis etc.
  14. DIAGNOSTIC TESTS History taking Physical examination CBC CT scan Sinus radiography shows opacification of the sinus, thickened mucous membrane. Sinus aspirate culture
  17. MEDICAL MANAGEMENT  Treatment depends on the how long condition lasts. Most acute cases resolves without treatment  In most of the sinusitis antibiotics are not recommended because viral causes  Symptomatic treatment is given to the patient
  18. TREATMENT  Sinusitis develops as a complication of a viral infection of Upper respiratory tract  In most cases, any rhinoviral illness improves within 7-10 days  Therefore, a bacterial sinusitis requires the persistence of symptoms for longer than 10 days  A 7-10 days of watchful waiting before antibiotics are prescribed which is reasonable, since symptoms in most patients resolved without the use of antibiotics
  19. TREATMENT cont…  Treatment of symptoms with ANALGESICS, ANTIPYRETICS  DECONGESTANTS (Xylometazoline nasal drops. These are used to reduce nasal edema & are preferred as initial strategy for management)  ANTIHISTAMINES
  20. TREATMENT cont…  Mucolytic agents  Steam inhalation  Pseudoephedrine and Phenylephrine can be used for 10 to 14 days. These drugs allow the restoration of normal mucocilliary function and drainage
  21. TREATMENT cont… Conditions required action before 7 days:- Fever>100 degree F Upper tooth ache Severe symptoms Known anatomical blockage (e.g. nasal polyps, DNS, recurrent sinusitis) need immediate treatment
  22. ANTIBIOTICS 1ST LINE: AMOXICILLIN (45 mg/kg/day) AMOXYCLAV 625 mg(Amoxycillin 500 mg + clavulanic acid 125 mg) in patients not responding to amoxicillin in <72 hours. 2ND LINE: MACROLIDE(Azithromycin, Clarithromycin) FLUOROQUINOLONE (Levofloxacin, Ofloxacin, Moxyfloxacin) Cefdinir, Cefuroxime, Cefpodoxime
  23. SURGICAL MANAGEMENT Functional Endoscopic sinus surgery:-  The main objective of FESS is to reestablish the sinus ventilation and Mucocilliary clearance  Small fiberoptic endoscopes are passed through the nasal cavity and into the sinus.  It allows the direct visualization of the sinuses in order to remove diseased tissue and to enlarge sinus Ostia.
  24. Functional Endoscopic sinus surgery:-  Possible complications includes nasal bleeding, pain, scar formation.  After FESS , nasal packing may be inserted to minimize nasal bleeding.
  25. Functional Endoscopic sinus surgery
  26. External spheno-ethmoidectomy:-  It is a surgical procedure performed to remove diseased mucosa from the sphenoidal or ethmoidal sinus  A small incision is made over the ethmoidal sinus on the lateral nasal bridge and the diseased mucosa is removed  Nasal and ethmoidal packing then inserted
  27. External sphenoethmoidectomy
  28. Nasal antrostomy:-  Maxillary antrostomy is a surgical procedure to enlarge the opening (ostium) of the maxillary sinus  This allows for improved sinus drainage
  29. Caldwell –Luc procedure  Caldwell-luc antrostomy —also known as Radical antrostomy— is an operation to remove irreversibly damaged mucosa of the maxillary sinus  It is done when maxillary sinusitis is not cured by medication or other non-invasive technique  The approach is mainly done from anterior wall of maxilla bone
  30. Caldwell –Luc procedure
  31. NURSING MANAGEMENT  Apply warm compresses in the sinus area.  Increase fluid intake  Educate the patient to avoid cold environment  Promote good oral hygiene  Avoid smoking  Avoid blowing nose
  32. NURSING MANAGEMENT  For the first 24 hours after sinus surgery ,observe the client for nasal bleeding, respiratory distress, orbital and facial edema.  Explain the client to engage in minimal physical exercise, avoid strenuous activity.  Teach the client to sneeze only with the mouth open.  Nasal saline spray may be started 3 to 5 days after the surgery to moisten the mucosa
  33. NURSING MANAGEMENT  A nasal drip pad is taped beneath the nares to absorb drainage after nasal or sinus surgery
  34. NURSING DIAGNOSIS  Risk for infection related to disease process.  Ineffective breathing pattern related to nasal congestion/discharge  Altered comfort related to facial fullness, nasal discharge.  Hyperthermia related to inflammation process.
  35. COMPLICATIONS  Pansinusitis  Middle ear infection  Pharyngitis, Laryngitis and tracheo-bronchitis  Perorbital and orbital cellulitis  Osteomyelitis of the axilla  Aggravation of asthma  Mucocele or pyocele
  36. TERMS  Periorbital cellulitis is an infection of the eyelid and area around the eye; orbital cellulitis is an infection of the eyeball and tissues around it.
  37. • Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs.
  38.  A mucocele is formed when drainage of mucus from one of the paranasal sinuses becomes blocked by obstruction of its ostium. If the contents of a mucocele beco me secondarily infected, the resulting mass is called a pyocele or mucopyo- cele.