Sinusitis

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Sinusitis

• By Emilie Watson

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Sinuses

• What are they for?

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.several theories

• Lightening the weight of the head
• Humidifying and heating inhaled air
• Increasing the resonance of speech
• Serving as a crumple zone to protect vital
  structures in the event of facial trauma

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(No Transcript)
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What is sinusitis?

• Inflammation of the lining of the sinuses
• Mucosal oedema, mucus retention (which may become
  infected. Polyps and septal deviation can lead
  to poor drainage.
• Acute (Usually follows URTI but 10 due to tooth
  infection)
• Chronic (often due to structural or drainage
  problems)
• Can be viral, bactierial, fungal, and have
  contributing factors such as trauma

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Signs and Symptoms

• Major Factors
• Thick colored post nasal drainage ordischarge
  becoming yellowish to yellow-green
• Congested nasal passages
• Sneezing
• Reduction or loss of sense of smell
• Facial pain
• Facial pressure or fullness
• Fever - only with additional symptoms
• Pus in the nose upon physical exam

• Minor Factors
• Fever
• Fatigue
• Halitosis
• Hoarseness
• Headache
• Ear pain
• Irritability
• Dental pain
• Persistent cough
• Blocked feeling/clicking in ears

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Investigations

• Thorough examination important to rule out any
  factors that may be causing the sinusitis
• CT (usefull pre-surgergy)
• MRI (useful differentiating fungal vs tumour)
• XRAY not much use
• Allergy and immune testing
• Nasal endoscopy
• Sinus culture
• Biopsy and wash out

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DD

• Migraine,
• TMJ dysfunction
• Neuralgias
• Cervical spine disease
• Temporal arteritis
• Herpes Zoster
• Dental pain

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Treatments
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??? Antibiotics???
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When should I prescribe an antibiotic for acute
sinusitis?

• Antibiotics are not required for most people
  presenting with acute sinusitis instead the
  mainstay of treatment is symptomatic relief.
• Admit if the person is suspected of having a
  serious localized or systemic illness that
  requires further assessment or administration of
  intravenous antibiotics (for example, if there is
  evidence of peri-orbital or intracranial
  complications).
• Consider an immediate antibiotic prescription
  only if it is not appropriate to admit the person
  and they are
• Systemically unwell, or
• At high risk of complications because of a
  pre-existing comorbidity.
• Consider a delayed prescribing strategy for all
  other people, especially if symptoms are causing
  significant discomfort (such as marked pain or
  profuse, purulent discharge).
• If an antibiotic is required, prescribe according
  to local protocols where available
• Amoxicillin is a good first-line choice.
  Prescribe the maximum oral dose (1 g three times
  a day) for 1 week.
• Doxycycline (not in children less than 12 years
  of age) or a macrolide (erythromycin or
  clarithromycin for 1 week) are options if the
  person has a known allergy to penicillin
  (consider erythromycin for pregnant women).

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When to refer

• immediate referral to an ENT for suspected
  complications (e.g. periorbital infection)
• urgent referral to an ENT for suspected sinonasal
  tumour (persistent unilateral symptoms, such as
  bloodstained discharge, crusting, or facial
  swelling)
• consider ENT referral for
• if there is recurrent or chronic sinusitis
• progressive or unremitting facial pain
• children with persistent sinusitis after two
  antibiotic courses
• dental review
• if the infection is suspected to be of dental
  origin, then refer patient for dental review.
  Initiate antibiotic treatment, with the addition
  of antibiotics to cover anaerobic bacteria (e.g.
  metronidazole)

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• Surgery functional endoscopic sinus surgery,
  removing polyps
• Side effects muco or pyocoeles, orbital
  cellulitis/abscess, osteomyelitis

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. Can be serious

• Can cause
• Meningitis
• Encephalitis
• Cerebral abscess
• Cavernous sinus thrombosis

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Frontal sinusitis with pus draining from frontal
sinus
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Polyp causing chronic sinusitis
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Chronic atrophic changes