Definitiongroup of disorders characterized by

inflammation of the mucosa of the nose and paranasal sinuses.

Nasal congestionNasal dischargeSneezingNasal itchiness

Pathophysiology

Viral infection nose and sinuses, anatomical abnormalities

sinus Ostia obstruction reduced mucociliary clearence

stasis of secretion

Secondary bacterial infection.

Factors causing Rhinosinusitis

Anatomical factorsAgar nasi cellsOver pneumatized

bulla ethmodalisParadoxical turbinateConcha bullosaDNSHaller cells@HA_COP

Mucociliary clearancePrimary

Kartagener’s syndrome

Young’s syndromeCystic fibrosis

SecondaryAllergyInfectiontrauma

OrganismsAc rhinosinusitis

Strepto pneumoniaH influenzaM cattarahalis

Ch rhinosinusitisBacteria causing ac rhinosinusitis +pseudomonasanaerobes

Acute Rhinosinusitis - Symptoms

1 Proceeding URTI or Dental infection

2Constitutional symptomsFever , malaise

3Headache/ facial painMaxillary –maxillary region, aggravated on

stooping ,coughing and chewing heache frontalFrontal – Office headache at frontalEthmoidal- bridge of the noseSphenoidal -vertex

4 Nasal discharge , nasal obstruction5 Redness and oedema frontal-upper eylid maxillary-same region plus lowe eye

lid

Acute Rhinosinusitis - Signs

Fever

Congested nasal mucosa

Local tenderness

Mucopus in nose or nasopharynx

Dental caries

Investigation

Radiological study X-ray : water’s view and lateral views opacity or fluid level at affected

sinus CT scan: coronal view nose and pns

preferred MRI – recent • Nasal swab• Diagnostic nasal endoscopy • Mucosal biposy

Radiological studies

Medical RxAntibiotics x 2 weeks

Amoxicillin Augmentin Cefuroxime

Nasal decongestants – 0.1% xylometazoline drop or spray

Antihistamines

Analgesics and antipyretics• Medicated steam inhalation • Hot fomentation

surgicalAntral lavage esp for maxillary also in

fronatal to rule out max co-infection Trephination of frontal sinus indication 1 (both )Persistane symptoms after 48 hrs of

medical therapy 2 Threatened orbital complication

Chronic Rhinosinusitis

Symptoms

Usually less - no pain n headache

Nasal obstruction

Nasal/Post nasal purulent discharge

hyposmia / anosmia

Signs

Mucopus in the meati

Nasal mucosa congested

X-ray show fluid level or opacity

Task force criteria

Major criteriaFacial pain/pressureFacial congestion/fullnessNasal

obstruction/blockageNasal discharge/purulenceHyposmia /anosmiaPurulence on nasal

examinationFever (acute RS only)

Minor criteriaHeadacheHalitosisFatigueDental painCoughEar pain/pressure/fullnessFever (nonacute)@CDEF2H2

2 major criteria or 1 major and 2 minor criteria

Investigations (similar)

CRS RxMedical management

AntibioticCorticosteroid AntihistamineNasal decongestants

Chronic Sinusitis - TreatmentSurgical

Open-depends on the siteAntral puncture , intranasal antrostomy,

Caldwell-Luc Operation- maxillary Intranasal/external ethmoidectomy.Trephination of frontal sinus, Osteoplastic

flap operation, external frontoethmoidectomy

Endoscopic-FESS

FESSFunctional Endoscopic Sinus Surgery

? Funtionalresume the normal function of sinus

drainageventilation

FESS-complicationLocal

BleedingAdhesionMucoceleStenosisRecurrence

OrbitalOrbital haematomaDiplopiaBlinding

IntracranialCSF leakageMeningitis

END