ACUTE &

CHRONIC
(RHINO-)
SINUSITIS
 Classification by duration of
symptoms

ACUTE lasting up to 4 weeks, with total

resolution of symptoms
SUBACUTE persisting more than 4 weeks, but
less than 12 weeks, with total resolution of
symptoms
CHRONIC 12 weeks or more of signs /
symptoms
RECURRENT ACUTE 4 or more episodes per
year, with resolution of symptoms between
attacks
 SINO-NASAL PATHOLOGY
SYMPTOMS

PAIN BLOCKED DISCHARGE

Burning Unilateral Watery/Mucoid
Stabbing Bilateral Yellow/Green
Throbbing Blood
Pressure

ANOSMIA ITCHING EPISTAXIS

CACOSMIA
PATHOPHYSIOLOGY

NASAL CAVITIES
SINUS OSTIA
MUCOSA
CILIA
VESSELS
MUCUS
 CILIA
200/cell. 20 strokes/min.

LOVE HATE

Drying
< 10C >45C
Isotonic saline
Infection
Ephedrine
Inflammation
Corticosteroids (1 wk)
Propanolol
Cocaine
Phenylephrine(>)
 PREDISPOSING FACTORS
Septum deviation Pollution
Polyps Allergy
Tumour Diet
Trauma Immune supression
Dental Endocrinological
Nose packs Diabetis
N/G tubes Kartegener
Foreign body Drugs
ADENOIDITIS
GE(L)RD
 Blocked nose
Common cold Throat irritation
10 days (35%)
Watery nasal
discharge

Viral sinusitis
Symptoms > 10 days or
symptoms worsen after
5-7 days

Bacterial sinusitis
VIRAL RHINOSINUSITIS

INFLAMMATION

SINUS OSTIA OBSTRUCTION 7 sq. mm.

(secretions & mucosal oedema) 0.5 mm. oedema

3 sq. mm.

CILIARY DYSFUNCTION
2
IIr
STASIS
BACTERIAL SINUSITIS
Fever > 38C
Sinus pain: Throbbing
Bending
Coughing
Walking
Percussion ???
Dental pain

Nasal: Discharge
Congestion
CHRONIC SINUSITIS (?)
SPECIAL INVESTIGATIONS
 PUS SWABS

Absence of puss does not exclude sinusitis!!

MICROBIOLOGY

Strep.Pneumoniae
H.Influenza
M. Catarrhalis
Staph. aureus
Anaerobes
Fungi
Tuberculosis
TREATMENT OF ACUTE SINUSITIS
(See it as an abscess and treat it as such!)
Antibiotics 10 14 days
Drainage: Decongestant - local ( drops,spray,) systemic,??
Flushing (steam inhalations, saline)
Hypertonic saline- 1/2tsp in 250 ml
Sterile water
Prednisone
Mucolytics ??????
Anti-inflammatory
Antihistamines
Drying up
 SURGERY IN CHRONIC SINUSITIS

FUNCTIONAL ENDOSCOPIC SINUS SURGERY

DRUGS & THE NOSE

Symp./parasimp.
Antihistamines
Beta-blockers
Sex hormones
Corticosteroids
Cocaine/Lignocaine
Antihypertensives
Viagra/Cialis