SINUSITIS
SUDESHNA BANERJEE DUTTA
SENIOR LECTURER

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.

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.

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

ETIOLOGY
 BACTERIOLOGY: Streptococcus pneumoniae,
Haemophilus influenza, Moraxella catarrhalis,
Streptococcus pyogenes, Satphylococcus aureus,
Klebsiella pneumoniae.
 VIRAL INFECTION: 90% of sinusitis occurs due to
Rhinovirus, Coronavirus.

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

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.

ETIOLOGY Cont…
GENERAL
• Environment: Cold and wet climate.
• Poor general health: Exanthematous fever
(measles, chickenpox),nutritional
deficiencies, systemic disorders.

MACULOPAPULAR RASH

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

CILIA

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.

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.

DIAGNOSTIC TESTS
History taking
Physical examination
CBC
CT scan
Sinus radiography shows opacification
of the sinus, thickened mucous
membrane.
Sinus aspirate culture

CT SCAN OF HEALTHY vs.
INFECTED SINUS

SINUS RADIOGRAPHY

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

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

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

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

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

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

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.

Functional Endoscopic sinus
surgery:-
 Possible complications includes nasal
bleeding, pain, scar formation.
 After FESS , nasal packing may be
inserted to minimize nasal bleeding.

Functional Endoscopic
sinus surgery

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

External
sphenoethmoidectomy

Nasal antrostomy:-
 Maxillary antrostomy is a surgical procedure
to enlarge the opening (ostium) of the
maxillary sinus
 This allows for improved sinus drainage

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

Caldwell –Luc procedure

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

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

NURSING MANAGEMENT
 A nasal drip pad is taped beneath the nares
to absorb drainage after nasal or sinus
surgery

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.

COMPLICATIONS
 Pansinusitis
 Middle ear infection
 Pharyngitis, Laryngitis and tracheo-bronchitis
 Perorbital and orbital cellulitis
 Osteomyelitis of the axilla
 Aggravation of asthma
 Mucocele or pyocele

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.

• 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.

 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.