15 - Acute Suppurative Sinusitis & Chronic Sinusitis

8/13/2019 15 - Acute Suppurative Sinusitis & Chronic Sinusitis

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DefenitionAcute infection and inflammation of paranasal

sinuses


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DiagnosisAt least 2 major symptoms or 1 major and 2 minor symptoms

Major sx Facial pain/ pressure Facial fullness

Nasal obstruction Nasal dicharge Hyposmia/ anosmia Fever

Minor sx Headache Halitosis Fatigue Dental pain Cough Ear pressure/ fullness


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Etiology-Viral: Rhinovirus, Influenza, Parainfluenza

-Bacterial: Streptococcus Pneumoniae,

Haemophilus Influenzae, Moraxella catarhalis,anaerobes


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Clinical features-Sudden onset of :-Nasal blockage and or nasal discharge/ posterior

nasal drip-Facial pain or pressure-Hyposmia Signs more suggestive of a bacterial etiology:-Erythematus nasal mucosa-Mucopurulent discharge

-Pus originating from middle meatus-Presence of nasal polyps of a deviated septum Acute viral rhinsinusitis lasts < 10 days.


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Diagnosis-Anterior rhinoscopy

-X-ray/ CT scan not recomnded unless

complications are suspected


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Management:-Symptoms relieved within 5 days symptomatic

relief and expectant management

-Moderate symptoms that worsen or persist

beyond 5 days intranasal corticosteroid spray-Severe symptoms that worsen or persist beyond 5

days and refractory to intranasal corticosteroid

Clarythromycin, INCS , referral to specialist

Surger if medical treatment fails


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Defintion:Inflammation of the paranasal sinuses lasting

>3months


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Etiology-Inadequate treatment of acute sinusitis

-Untreated nasal allergy

-Allergic fungal rhinosinusitis-Anatomic abnormality e.g. deviated septum

-Underlying dental disease

-Cilliary disorder e.g. CF

-Chronic inflammatory disorder e.g. wegeners


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Organisms-Bacterial: S. Pneumoniae, H. Influenzae, M.

catarhalis, S.pyogenes, S.auereus, anaerobes

-Fungal: Aspergillus


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Clinical features-Chronic nasal obstruction

-Purulent nasal discharge

-Pain over sinuses and headache-Halitosis

-Yellow-brown post-nasal discharge

-Chronic cough

-Maxillary dental pain


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Treatmentantibiotics for 3 to 6 weeks for infectious etiology

augmented penicillin (Clavulin), macrolide(clarithromycin), fluoroquinolone

(levofloxacin), clindamycin, FlagyjTM topical nasal steroid, saline spray surgery if medical therapy fails or fungal

sinusitis Surgical Treatment

removal of all diseased soft tissue and bone,post-op drainage and obliteration of pre-existing sinus cavity

functional endoscopic sinus surgery


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Complications of rhinosinusitis range fromrelatively benign to potentially fatal.

The incidence of complications from bothacute and chronic rhinosinusitis hasdecreased as a result of the use of antibiotics.[2]

Complications can be divided into three

categories: Orbital, intracranial, and bony.


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Orbital complications

The orbit is the structure most commonlyinvolved in complicated sinusitis.

Orbital extension is usually the result ofethmoid sinusitis.

Children are more prone to orbital

complications, probably secondary to highincidence of URI and sinusitis.


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IC are uncommon but devastating. Two major mechanism:

Direct extension.

Retrograde thrombophlebitis viavalveless diploe veins.

* Frontal sinus is rich in diploe veins

especially during adolescence


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MeningitisSphenoid, ethmoid Epidural abscess Frontal

Subdural abscess Frontal

Intracerebral abscess

Frontal Cavernous sinus thrombosisSphenoid,

ethmoid ..proptosis ,chemosis andopthalmoplegia chatacterize it .

Superior sagittal sinus thrombosisFrontal


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Thank you

15 - Acute Suppurative Sinusitis & Chronic Sinusitis

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