Sinusitis

What are paranasal sinuses?

Air containing cavities in certain bones of the skull and
face
Lined by mucous membrane
Four pairs of sinuses:
1. Anterior group-Maxillary, Frontal and anterior ethmoidal
2. Posterior group- Posterior ethmoidal and sphenoid

Location

 The maxillary sinus is the largest paranasal sinus and is

the first sinus to develop .
Frontal is formed by the upward movement of anterior
ethmoid cells after the age of 2. Developmentally, this
is the last sinus to pneumatize.
Maxillary, sphenoid and ethmoidal sinusitis common
ininfants and toddlers
Frontal sinsusitis ages 4-7

Terminology
Sinusitis is defined as an inflammation of the mucous membrane
that lines the paranasal sinuses.
Acuterhinosinusitis A new infection that may last up to four
weeks.
Recurrent acute rhinosinusitis Four or more separate episodes of
acute sinusitis that occur within one year
Subacuterhinosinusitis An infection that lasts between 4 and 12
weeks, and represents a transition between acute and chronic
infection
Chronicrhinosinusitis When the signs and symptoms last for more
than 12 weeks.
Acute exacerbation of chronic rhinosinusitis When the signs and
symptoms of chronic rhinosinusitis exacerbate, but return to
baseline after treatment

Aetiology:
Exciting causes:
1. Nasal infection
2. Swimming and diving
3. Trauma
4. Dental

.Predisposing causes:
1. Local obstruction
2. Stasis
3. Previous sinusitis
4. Environment
5. Poor general health

Organisms
Mostly viral with superimposed bacterial invasion
Strep pnemoniae
Haemophilus influenza
Moraxella catarrhalis
Strep pyogenes
Staph aureus

Acute Maxillary Sinusitis

Clinical features:
1. Constitutional symptoms
2. Headache confined to forehead
3. Pain over upper jaw worsens on stooping , coughing or
chewing
4. Tenderness on anterior wall of antrum
5. Nasal discharge
6. Post nasal discharge

Diagnosis
Xray- Waters view
Transillumination

Treatment
Medical
1. Antimicrobial drops- ampicillin/amoxicillin
2. Nasal decongestants
3. Steam inhalation
4. Analgesics
5. Hot formentation
.Surgical
1. Antral lavage
.Complications

Acute Frontal Sinusitis

Clinical features:
Frontal headache with periodicity- office headache
Tenderness above medial canthus
Nasal discharge
Oedema of upper eyelid
Diagnosis:
X rays- Waters view and lateral views.

Treatment
Medical:
1. Same as maxillary sinusitis
2. Pledget of cotton soaked in vasoconstrictor in middle meatus
.Surgical:

Trephination of frontal sinus

Indications:
a) Exacerbation of pain/pyrexia 48 hours after treatment
b) Increasing lid swelling
c) Threatening orbital cellulitis

 Removal of tube patency of nasolacrimal duct

Tested by methylene blue
Complications:
1. Orbital cellulitis
2. Osteomyelitis
3. Intracranial complications- meningitis, extradural abbesses
or frontal lobe abscess
4. Chronic frontal sinusitis

Acute Ethmoid Sinusitis

Clinical features:
1. Pain over the bridge of nose; aggravated by
movements of eyeball
2. Oedema of lids
3. Increased lacrimation
4. Swelling of middle turbinate

Treatment
Medical same
Surgical
External ethmoidectomy incision
Indications :
a) Visual deterioration
b) Exophthalmos

)Complications:

Acute Sphenoid Sinusitis

Clinical features:
Headache localised to occiput or vertex
Post nasal discharge
Xrays- supine and prone position to demonstrate fluid level
Must be differentiated from a mucocele or neoplasm in
isolated sphenoid sinus involvement
Treatment- same