Acute Sinusitis

Question 1

Defn of acute sinusitis

Answer 1

Acute inflammation of sinus mucosa

Question 2

Order of involvement of sinusitis

Answer 2

maxillary >ethmoid>frontal > sphenoid

Question 3

pansinusitis unilateral or bilateral

Answer 3

the sinuses of one or both sides are involved simultaneously

Question 4

multisinusitis

Answer 4

more than one sinus is infected

Question 5

Types of Sinusitis

Answer 5

open

closed

depending on whether the inflammatory products of sinus cavity can drain freely into the nasal cavity through the natural ostia or not

Question 6

EXCITING CAUSES OF SINUSITIS

Answer 6

Nasal infections
Swimming and diving
Trauma
Dental infections

Question 7

How does nasal infection lead to sinusitis

Answer 7

Sinus mucosa is a continuation of nasal mucosa and infections from nose can travel directly by continuity or by way of submucosal lymphatics. Most common cause of acute sinusitis is viral rhinitis followed by bacterial invasion.

Question 8

How does Swimming and diving cause sinusitis

Answer 8

Infected water can enter the sinuses through their ostia. High content of chlorine gas in swim- ming pools can also set up chemical inflammation

Question 9

How does trauma cause sinusitis

Answer 9

Compound fractures or penetrating injuries of sinuses—frontal, maxillary and ethmoid—may permit direct infection of sinus mucosa. Similarly, barotrauma may be followed by infection.

Question 10

Dental infects affects which sinus

Answer 10

maxillary sinus

Question 11

How does dental infection causes sinusitis

Answer 11

Infection from the molar or premolar teeth or their extraction may be followed by acute sinusitis.

Question 12

PREDISPOSING CAUSES

Answer 12

• Obstruction to sinus ventilation and drainage
• Stasis of secretions in the nasal cavity
• Previous attacks of sinusitis

Question 13

Causes of Obstruction to sinus ventilation and drainage.

Answer 13

(a) Nasal packing
(b) Deviated septum
(c) Hypertrophic turbinates
(d) Oedema of sinus ostia due to allergy or vasomotor rhinitis
(e) Nasal polypi
(f) Structural abnormality of ethmoidal air cells (g) Benign or malignant neoplasm

Question 14

How does Obstruction to sinus ventilation and drainage cause sinusitis

Answer 14

Normally, sinuses are well-ventilated. They also secrete small amount of mucus, which by ciliary movement, is directed towards the sinus ostia from where it drains into the nasal cavity. Any factor(s) which interfere with this function can cause sinusitis due to stasis of secretions in the sinus.

Question 15

How does climate affect sinus

Answer 15

Sinusitis is common in cold and wet cli- mate

Question 16

Environment factor causing sinusitis

Answer 16

Atmospheric pollution, smoke, dust and overcrowd- ing also predispose to sinus infection.

Question 17

General cause

Answer 17

Recent attack of exanthematous fever (measles, chickenpox, whooping cough), nutritional deficiencies and systemic disorders (diabetes, immune deficiency syndromes).

Question 18

BACTERIOLOGY of sinusitis

Answer 18

acute sinusitis start as viral infections followed soon by bacterial invasion

Bacteria involved are

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes, Staphylococcus aureus and Klebsiella pneumoniae.

Question 19

Anaerobic organisms and mixed infections are seen in sinusitis of ———- origin

Answer 19

dental origin.

Question 20

PATHOLOGY OF SINUSITIS

Answer 20

Acute inflammation of sinus mucosa causes hyperaemia, exu- dation of fluid, outpouring of polymorphonuclear cells and increased activity of serous and mucous glands. Depending on the virulence of organisms, defences of the host and capabil- ity of the sinus ostium to drain the exudates, the disease may be mild (nonsuppurative) or severe (suppurative). Initially, the exudate is serous; later it may become mucopurulent or purulent. Severe infections cause destruction of mucosal lining. Failure of ostium to drain results in empyema of the sinus and destruction of its bony walls leading to complica- tions. Dental infections are very fulminating and soon result in suppurative sinusitis.

Question 21

AETIOLOGY of ACUTE MAXILLARY SINUSITIS

Answer 21

-viral rhinitis ➡️ bacterial invasion
-Diving and swimming in contaminated water
-Dental infections
-Trauma➡️ compound fractures, pen-
etrating injuries or gunshot wounds

Question 22

How Dental infections AETIOLOGY of ACUTE MAXILLARY SINUSITIS

Answer 22

Roots of premolar and molar teeth are related to the floor of sinus and may be separated only by a thin layer of mucosal covering. Periapical dental abscess may burst into the sinus; or the root of a tooth, during extrac- tion, may be pushed into the sinus. In case of oroantral fistula, following tooth extraction, bacteria from oral
cavity enter the maxillary sinus.

Question 23

Clinical features of ACUTE MAXILLARY SINUSITIS

Answer 23

1. Constitutional symptoms - fever, general malaise and body ache - result of toxaemia.
2. Headache - confined to forehead and may thus be confused with frontal sinusitis.
3. Pain - over the upper jaw, but may be referred to the gums or teeth. aggravated by stooping, coughing or chewing. Occasionally, pain is referred to the ipsilateral supraorbital region and thus may simulate frontal sinus infection.
4. Tenderness. Pressure or tapping over the anterior wall of antrum produces pain.
5. Redness and oedema of cheek. Commonly seen in chil- dren. The lower eyelid may become puffy.
6. Nasal discharge. Anterior rhinoscopy/nasal endoscopy shows pus or mucopus in the middle meatus. Mucosa of the middle meatus and turbinate - red and swollen.
   Postural test. If no pus seen in the middle meatus, it is decongested with a pledget of cotton soaked with a vaso- constrictor and the patient is made to sit with the affected sinus turned up. Examination after 10–15 min may show discharge in the middle meatus.
7. Postnasal discharge. Pus may be seen on the upper soft palate on posterior rhinoscopy or nasal endoscopy.

Question 24

DIAGNOSIS ACUTE MAXILLARY SINUSITIS

Answer 24

Transillumination test. Affected sinus will be found opaque X-rays. Waters’ view will show either an opacity or a fluid level in the involved sinus Computed tomography (CT) scan is
the preferred

Question 25

Antimicrobial drugs for ACUTE MAXILLARY SINUSITIS

Answer 25

- Ampicillin and amoxicillin - Erythromycin or doxycycline or cotrimoxazole - sensitive to penicillin - β-lactamase-producing strains -amoxicillin/ clavulanic acid or cefuroxime axetil.

Question 26

Antibiotics which has single daily dose advantage used in ACUTE MAXILLARY SINUSITIS

Answer 26

Sparfloxacin

Question 27

Nasal decongestant drops used in ACUTE MAXILLARY SINUSITIS

Answer 27

One per cent ephedrine or 0.1% xylo- or oxymetazoline

Question 28

Steam inhalation used in ACUTE MAXILLARY SINUSITIS

Answer 28

Steam alone or medicated with men- thol or Tr. Benzoin Co. provides symptomatic relief and encourages sinus drainage. Inhalation should be given 15–20 min after nasal decongestion for better penetration

Question 29

Analgesics indication for ACUTE MAXILLARY SINUSITIS

Answer 29

relief of pain and headache

Question 30

Hot fomentation in acute maxillary sinusitis

Answer 30

Local heat to the affected sinus is often soothing and helps in the resolution of inflammation

Question 31

SURGICAL methods for acute maxillary sinusitis

Answer 31

Antral lavage It is done only when medical treatment has failed and that too only under cover of antibiotics.

Question 32

COMPLICATIONS of acute maxillary sinusitis

Answer 32

1. Acute maxillary sinusitis may change to subacute or chronic sinusitis. 2. Frontal sinusitis. Due to obstruction of frontal sinus drainage pathway because of oedema. 3. Osteitis or osteomyelitis of the maxilla. 4. Orbital cellulitis or abscess. Infection spreads to the orbit because of oedema either directly from the roof of maxillary sinus or indirectly, after involvement of ethmoid sinuses.

Question 33

AETIOLOGY of ACUTE FRONTAL SINUSITIS

Answer 33

1. Usually follows viral infections of upper respiratory tract followed later by bacterial invasion. 2. Entry of water into the sinus during diving or swimming. 3. External trauma to the sinus, e.g. fractures or penetrating injuries. 4. Oedema of middle meatus, secondary to associated ipsilateral maxillary or ethmoid sinus infection.

Question 34

CLINICAL FEATURES of ACUTE FRONTAL SINUSITIS

Answer 34

1. Frontal headache - severe and localized over the affected sinus. It shows characteristic periodicity, i.e. comes up on waking, gradually increases and reaches its peak by about mid day and then starts subsiding. It is also called “office headache” because of its presence only during the office hours. 2. Tenderness. Pressure upwards on the floor of frontal sinus, just above the medial canthus, causes exquisite pain. It can also be elicited by tapping over the anterior wall of frontal sinus in the medial part of supraorbital region. 3. Oedema of upper eyelid with suffused conjunctiva and photophobia. 4. Nasal discharge. A vertical streak of mucopus is seen high up in the anterior part of the middle meatus. This may be absent if the ostium is closed with no drainage. Nasal mucosa is inflamed in the middle meatus.

Question 35

MEDICAL TREATMENT for ACUTE FRONTAL SINUSITIS

Answer 35

same as for acute maxillary sinusitis

Question 36

SURGICAL TREATMENT of FRONTAL SINUSITIS

Answer 36

Trephination of frontal sinus. If there is persistence or exacerbation of pain or pyrexia in spite of medical treat- ment for 48 h, or if the lid swelling is increasing and threat- ening orbital cellulitis, frontal sinus is drained externally. A 2 cm long horizontal incision is made in the superomedial aspect of the orbit below the eyebrow (Figure 36.1). Floor of frontal sinus is exposed and a hole drilled with a burr. Pus is taken for culture and sensitivity, and a plastic tube inserted and fixed. Sinus can now be irrigated with nor- mal saline two or three times daily until frontonasal duct becomes patent. This can be determined by adding a few drops of methylene blue to the irrigating fluid and its exit seen through the nose. Drainage tube is removed when frontonasal duct becomes patent.

Question 37

COMPLICATIONS of FRONTAL SINUSITIS

Answer 37

1. Orbital cellulitis. 2. Osteomyelitis of frontal bone and fistula formation. 3. Meningitis, extradural abscess or frontal lobe abscess, if infection breaks through the posterior wall of the sinus. 4. Chronic frontal sinusitis, if the acute infection is neglected or improperly treated.

Question 38

ACUTE ETHMOID SINUSITIS | AETIOLOGY

Answer 38

associated with infection of other sinuses. Ethmoid sinuses are more often involved in infants and young children.

Question 39

CLINICAL FEATURES of | ACUTE ETHMOID SINUSITIS

Answer 39

1. Pain - localized over the bridge of the nose, medial and deep to the eye. It is aggravated by movements of the eye ball. 2. Oedema of lids - Both eyelids become puffy and swollen. There is increased lacrimation. Orbital cellulitis is an early complication in such cases. 3. Nasal discharge. On anterior rhinoscopy, pus may be seen in middle or superior meatus depending on the involvement of anterior or posterior group of ethmoid sinuses. 4. Swelling of the middle turbinate.

Question 40

TREATMENT for ACUTE ETHMOID SINUSITIS

Answer 40

same as for acute maxillary sinusitis

Question 41

Indication for drainage of the ethmoid sinuses

Answer 41

Visual deterioration and exophthalmos indicate abscess in the posterior orbit

Question 42

COMPLICATIONS of ACUTE ETHMOID SINUSITIS

Answer 42

1. Orbital cellulitis and abscess. 2. Visual deterioration and blindness due to involvement of optic nerve. 3. Cavernous sinus thrombosis. 4. Extradural abscess, meningitis or brain abscess.

Question 43

ACUTE SPHENOID SINUSITIS | AETIOLOGY

Answer 43

often a part of pansinusitis or is associated with infection of poste- rior ethmoid sinuses.

Question 44

CLINICAL FEATURES of ACUTE SPHENOID SINUSITIS

Answer 44

1. Headache. Usually localized to the occiput or vertex. Pain may also be referred to the mastoid region. 2. Postnasal discharge. It can only be seen on posterior rhi- noscopy. A streak of pus may be seen on the roof and posterior wall of nasopharynx or above the posterior end of middle turbinate.

Question 45

X-rays of ACUTE SPHENOID SINUSITIS shows

Answer 45

Opacity or fluid level may be seen in the sphenoid sinus. Lateral view of the sphenoid sinus is taken in supine or prone position and is helpful to demonstrate the fluid level

Question 46

TREATMENT for ACUTE SPHENOID SINUSITIS

Answer 46

Treatment is the same as for acute infection of other sinuses.