Dr.Safaa Hussain Alturaihy
Lecture3
Rhinosinusitis
Rhinitis is defined as inflammation of the lining of the nose,characterized by one
or more of the following symptoms
Nasal congestion
Rhinorrhea
Sneezing and itching
The term sinusitis refers to a group of disorder charecterized by inflammation of
the mucosa of paranasal sinuses.
Because the inflammation always also involve the nose ,it is now generally
accepted that "Rhinosinusitis" is preferred term to desecribe the inflammation of
the nose and paranasal sinusesThe ciliated mucosa of the nose and paranasal
sinuses are contiguous and it would be rare for one to be affected without the
other so the term rhinosinusitis always used
Differential diagnosis
Polyp
Mechanical factors
NSD
Hypertrophic turbinate
Obstruction OMC
F.B
Choanal atrasia
Tumours..Benign or malignant
Granuloma
CSF Rhinorrhea
Acute rhinosinusitis ARS is acute infection of sudden onset with duration
of less than four weeks, 7 days to four weeks as viral rhinosinusitis follow
viral URTI and mimic it`s symptoms so five to seven days was
recommended perior to an acute bacterial rhinosinusitis.
Subacute rhinosinusitis SRS the duration is last for 4- 12 weeks
Recurrent acute infection RARS are defined by four or more episodes
per year
Chronic rhinosinusitis CRS occur when the duration of symptoms is
greater than 12 weeks
Acute exacerbation of chronic rhinisinusitis AECRS is is sudden worsening
of CRS with return to baseline CRS
Signs and symptoms
Rhinosinusitis requires two major factors,or one major and two minor
Major symptoms
Facial pain\ pressure
Facial congestion/fullness
Nasal obstruction
Nasal discharge/purulent/posterior drainage
Hyposmia/Anosmia
Purulence on nasal examination
Fever (acute rhinosinusitis only)
Minor symptoms
Headache
Fever (non acute)
Halitosis
Fatigue
Dental pain
Cough
Ear pain/pressure/fullness
Microbiology of acute bacterial rhinosinusitis
Streptococcus pneumoniae 20-43%
Haemophilus influenzae 22-35%
Strep species
Anaerobes
Moraxella catarrhlis
Staphylococcus aureas
Predisposing factors
Either
Local or general
◙
mucosal obstruction ,deviation,polyp
◙
obstruction of the sinus ostea by allergic rhinitis
◙
neighbouring infection especially in children
General factors
◙
immunedifficiancy
◙
mucocilliary disorder
◙
allergy
Treatment
Medical
1 treatment of infection
Systemic penicilline always effective
If not do culture and sensitivity
2 treatment of pain
Asprin or codien
3 establishment of drainage of sinus
Either local like ephedrine and normal saline or systemic by
pseudoephedrine and antihistamine.
Always be aware of Rebound phenomenon on using common nasal
decongestant!!
Surgical operations for chronic sinusitis
█
maxillary sinuses
►
antral washout
►►
intranasal antrostomy
●Middle meatus antrostomy (endoscopic)
●Inferior meatus antrostomy
►
Caldwell-Luc operation
Frontoethmoidospheno █
►
Trephenation of frontal sinuses
►►
Intranasal ethmoidectomy
►►►
FESS Functional endoscopic sinus surgery
►►►►
Transnasal ethmoidectomy
►►►►►
external frontoethmoidosphenoidectomy
