Rhinology

The Affiliated Hospital of Ningxia Medical

College
Pei Yang
TEL:13895082698
Chapter 5 Sinusitis

Sinusitis is the medical term for

inflammation of 1 or more paranasal
sinuses, which is usually caused by an
infection (viral, bacterial, or
fungal) .Maxillary sinuses are most
common type of sinusitis. The ethmoid,
frontal and sphenoid sinuses are affected
less frequently.
Cause and Pathogenesis
The sinuses are air-filled spaces around the
forehead, cheeks, and eyes that are lined with
mucous membranes. Healthy sinuses contain
no bacteria or other organisms and open,
allowing mucus to drain and air to circulate in
the nasal passages. An attack begins with the
inflammation of the nasal mucous membrane.
This causes an obstruction of the opening of
the sinus, leading to mucosal congestion result
in a reduced ability of the paranasal sinuses to
function normally. The mucociliary transport
system becomes impaired.
Cause and pathgenesis
IN adults Homophiles' influenza and
Streptococcus pneumonia are the most
organisms been founded.
IN children Staphylococcus aureus is an
occasional finding.
The common causes for sinusitis include the
following: Allergies, Changes in atmospheric
pressure (from swimming or climbing high
altitudes). Physical injury to sinuses, Disease
or an abnormal structure in the sinus area,
Infections from dental problems.
Symptoms and Signs

1. A stuffy or runny nose with a daytime cough

that lasts for 10 to 14 days without
improvement.
2. Colored discharge from the nose.
3. Sensation of pressure in head.
4. Breath that suddenly smells bad, even after
brushing teeth.
5. Fever greater than 102 degrees Fahrenheit.
Symptoms and Signs

Different areas
in the
nasal cavity
may cause
referred pain in
various
regions of the
head
Physical and Examination

Purulent secretions in
the middle meatus
(highly predictive of
maxillary sinusitis)
may be seen using a
nasal speculum and
directed light.
Physical and Examination
1. Maxillary sinusitis causes pain in the
maxillary area of the face ,toothache, and
frontal headache.
2. Frontal sinusitis causes frontal pain and
headache.
3. Ethmoid sinusitis causes pain behind the eyes
and frontal headache.
4. Sphenoid sinusitis causes pain in the occipital
region.
Complications

1. Chronic sinusitis.
2. Osteomyelitis.
3. Orbital cellulitis.
4. On rare occasions, acute sinusitis can
result in brain infection and other
serious complications.
Complications

Orbital cellulitis
(Infection from
the right
ethmoid sinusitis)
Treatment

Antibiotics are prescribed if a bacterial

infection is present or suspected .Commonly
used antibiotics for sinusitis include:
1. Amoxicillin as a first-line option.
2. If symptoms have not improved or if they
worsen after 3 days of treatment with a
recommended first-line drugs. Recommended
second-line antibacterials including second
generation cephalosporins, macrolides.
Treatment

The most common surgery done today

is functional endoscopic sinus surgery, in
which the natural openings from the
sinuses are enlarged to allow drainage.
This type of surgery is less invasive than
conventional sinus surgery, and serious
complications are rare.
Cancer of the Nose and Sinuses

1. Cancer of the nose and sinuses accounts

for less than 1% of all malignancies and
about 3% of all head and neck cancers.The
aetiology is unknown.It is not related to
previous nasal disease.
Skin Cancer
Diagnosis

 The diagnosis is generally confirmed

by biopsy and x-ray evaluation.
 Treatment

 Radiation therapy
 Treatment usually consists of irradiation
followed by complete surgical excision of
the maxilla.
Cyst