Coass II-Pediatric Sinusitis Akhir

Ruspau Jakarta, 29-06-2006 1


PEDIATRIC SINUSITIS PEDIATRIC SINUSITIS

ASNOMINANDAASNOMINANDA


DEFINITION

• Acute rhinosinusitis

• Chronic rhinosinusitis

• Recurrent acute rhinosinusitis


PATHOPHYSIOLOGY Sinusitis is the result of

inflammatory obstruction of the natural ostium of the sinuses.

An area that appears particularly prone to obstruction is the

ostiomeatal complex , which could result in a secondary bacterial

infection. Allergy is a commonly noted risk

factor for chronic sinusitis


PATHOPHYSIOLOGY


Ostium

Occlusion

Stagnation of secretion

Change in the composition and

pH of secretion

Change of the mucosal gas metabolism

Ciliary and epithelial damage

Inhibition of ventilation and drainage

Change of the host milieu Bacteria become

pathogenic

Inflamation of the lamina propria

Increased mucosal thickness


DYNAMIC OF SINUSITISDYNAMIC OF SINUSITIS

Mucosal swelling

Viral infection Immune deficiency

Allergy

Acute sinusitis

Complications

Sinus ostium blockage

Anatomic predisposition

Subacute sinusitis

Chronic sinusitis


The bacteria

1. Acute and recurrent rhinosinusitis - Streptococcus pneumoniae- Moraxella catarrhalis- Haemophilus influenzae- Staphylococcus aureus

2. Chronic rhinosinusitis- Stapylococcus aureus- Streptococcus pneumonia- Haemophilus influenzae- Pseudomonas aeruginosa- Peptostreptococcus Sp- Aspergilus Sp


Differential Diagnosis

• Chronic sinusitis• Adenoid hypertrophy• Recurrent URTI (viral)• Allergies• Immune deficiencies


DIAGNOSIS

Signs and Symptoms (the “Big Six”) • Purulent nasal discharge• Day and night cough• Nasal airway obstruction• Headache, irritability, or facial pain• Fever• Postnasal drip


Physical Examination1. Only anterior rhinoscopy can be performed in

children.2. Visualize the middle turbinate and then the

middle meatus.3. A clear middle meatus does not ensure that

there is no sinus disease.4. Look for purulent discharge at the middle

meatus.5. Polyps are unusual in children

DIAGNOSIS


Imaging Techniques1. Plain films2. Coronal CT scanning

DIAGNOSIS


DIAGNOSIS

Caldwell


DIAGNOSIS

Waters


DIAGNOSIS


COMPLICATION

1. Orbital - Orbital inflammation- Orbital cellulites- Subperiosteal abscess- Orbital abscess- Cavernous sinus thrombosis- Blindness

2. Intracranial- Meningitis- Epidural abscess- Subdural abscess- Acute, chronic brain abscess


COMPLICATION


Medical Management• Antimicrobial

1. Amoxicillin 5. Cefixime2. Amoxicillin-pot. calavulanate 6. Clindamycin3. Trimethoprim-sulf.methoxazole 7. Clarithromycin4. Cefuroxime axetil 8. Azithromycin

• Antihistamines• Oral or topical decongestants• Oral or topical steroid• Anti-inflamatory agents

MANAGEMENT


Surgical Management1. Adenotonsillectomy2. Antral lavage3. Inferior meatal antrostomy4. Middle meatal antrostomy5. Anterior or anterior and posterior ethmoidectomy (FESS)

MANAGEMENT


MANAGEMENT

OBSTRUKSI MEKANIK- ETIOLOGY- DECONGESTAN

ANTIBIOTIC

ANTIBIOTIC

- MUCOLITIC - IRIGATION - SURGERY

OSTIUM TERSUMBAT

INFEKSI CAMPUR

ANAEROB

O2 & CO2

SEKRET AKUMULASI SEKRET

PENURUNAN MUKOSILIER


Relation of Age to Outcome After

Endoscopic Sinus Surgery in Children

Relation of Age to Outcome After

Endoscopic Sinus Surgery in Children

Hasan H RamadanArch Otolaryngol Head Neck Surg. 2003;129:175-177

Hasan H RamadanArch Otolaryngol Head Neck Surg. 2003;129:175-177


TUJUAN STUDY

• Untuk menentukan apakah Operasi Sinus Endoskopi (FESS) pada anak-anak mempunyai suatu hasil lebih baik pada kelompok umur tertentu.


DESAIN DAN METODA

• Studi Kohort pada Rumah Sakit Anak-anak.


OBJEK PENELITIAN

• 99 anak-anak yg mengalami Operasi Sinus Endoskopi (ESS) antara Januari 1994 sampai Juni 1999


HASIL PENELITIAN

• Angka keberhasilan FESS secara keseluruhan mencapai 82%.

• Anak-anak > 6 tahun, keberhasilan 89 % • Anak-anak < 6 th sekitar 73 %. • Dari 99 pasien, 11 orang (9 %) mengalami

operasi ulang. (9 orang < 6 th, dan 2 orang > 6 th)

• Dari 4 orang anak-anak yang < 3 th, sekitar 3 orang (75 %) dioperasi ulang.


KESIMPULAN

•Operasi Sinus Endoskopik untuk sinusitis kronis pada anak-anak masih dalam tahap pengembangan.

•Keberhasilan prosedur ini sangat rendah pada anak-anak < 3 th, tetapi sangat baik pada anak-anak usia 6 th atau lebih.

•Operasi pada sembarang umur diperbolehkan menurut aturan jika terjadi komplikasi sinusitis kronis.

•Pada anak- anak yang < 6 th mungkin diperlukan operasi ulang lebih lanjut.

Coass II-Pediatric Sinusitis Akhir

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