Sinusitis (1)

SINUSITIS

NORAFIDATUL ASNI BT ZAMANI (2010663124)NOORASHIKIN BT HAMIZAN (2010272762)NUR IZZATI BT MD SUBI (2010294592)NOOR SYAKILA BT NOORUL DIN (2010833522)HANISAH BT NASOHA (2010610654)FARHANA AQILAH BT AB AZIZ (2010423804)

What is sinuses??? Hollow spaces in the bone of our face and skull Connect with nose through small opening Like the nose, they are lined with membrane

that make mucus frontal sinuses ~ over eyes in brow area maxillary sinuses ~ inside each cheekbone ethmoid sinuses ~ just behind the bridge of the nose & between the eyes sphenoid sinuses ~ behind the ethmoids in the upper region of the nose

and behind the eyes

Definition Infection or inflammation of one or more

of the paranasal sinuses Sinusitis is usually preceded by a cold,

allergy attack or irritation from environmental pollutants

Classification of sinusitis

You can have sinusitis that lasts a long time called chronic sinusitis.

Short attacks that last for four weeks or less are called acute sinusitis.

Bacterial and viral acute sinusitis are difficult to distinguish.

However, if symptoms last less than 10 days, it is generally considered viral sinusitis.

When symptoms last more than 10 days, it is considered bacterial sinusitis (usually 30% to 50% are bacterial sinusitis)

CAUSES OF SINUSITIS????

Fungi Bacteria Allergens

Viruses Immune system problems Structural problems in the

nasal cavities

Colds and Flu An irritation in the sinuses :-

result of extreme weather changes and poor air quality (smoke, dust and other air pollutants). 

Asthma sufferers:-more prone to this condition

“Many people enjoy the fall season, when the leaves start to change colors, but others suffer from cold and flu-like symptoms that they can't get rid of. When your face still hurts, your nose is still stuffy and you still have a cough weeks later, you could have sinusitis”

PATHOPHYSIOLOGY OF SINUSITIS

Sinuses are normally lined by ciliated, pseudostratified columnar epithelium, interspread with mucus-secreating cells.

Blockage of OMC

Bacterial colonization and initiation of mucusal gas metabolism exchange

Cilia damaged

Inflammation and bacterial infection develop in the sinus cavity

pH and lowered oxygen tension

Normally cilia clean mucus and air toward the

OMC ostia

Sinusitis occurs because of a vicious cycle that lead to further mucosal thickening and edema, creating further blockage.

Factors contribute to obstruction

Failure of normal mucus transport Mucosal edema Bacterial or viral infections Allergic rhinitis Dental infections Immunodeficiency states Nasal dryness Anatomic variations – deviated septum and turbinate

hypertrophy

SIGN & SYMPTOMS OF SINUSITIS

Major Symptoms Nasal obstruction (most common

symptom) Pain, tenderness, swelling and pressure

over sinus areas (near the nose, above the teeth, the

forehead) Purulent or non-purulent nasal drainage

Either rhinorrhea or post-nasal drip Hyposmia/anosmia Facial congestion/fullness Fever

Minor Symptoms

Halitosis Cough, especially at night Sore throat (nasal drainage irritate the

throat) Fatigue Malaise - feeling generally unwell Painful headache when wake up in the

morning and when bend the head down or forward

Aching in the upper jaw and teeth

Chronis Sinusitis

Also known as rhinosinusitis Lasting >12 weeks Includes two or more major symptoms

Or at least one major and two minor symptoms

With or without findings on physical examination

Diagnosis

X-ray : show fluid in the sinuses CT scan : the extent & severity of

sinusitis Endoscopic rhinoscopy : evaluate the

upper nasal airway down to the level of vocal chords

Complication of sinusitis

General complica

tion

Abscess

Osteomyeliti

s

meningitis

Skin infectio

n around the eye

Blood Clot

Complication of Acute sinusitis

Asthma flare-ups. Acute sinusitis can trigger an asthma attack

Chronic sinusitis. Acute sinusitis may be a flare-up of a long-term problem known as chronic sinusitis. Chronic sinusitis is sinusitis that lasts longer than eight weeks.

Meningitis. This occurs when infection spreads to the lining of the brain.

Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness. This is a medical emergency that requires immediate treatment to prevent potentially permanent damage.

Aneurysms or blood clots. Infection can cause problems in the veins surrounding the sinuses, interfering with blood supply to your brain and putting you at risk of a stroke.

Ear infection. Acute sinusitis may occur along with an ear infection.

http://melayuboleh.8forum.net/t350-acute-sinusitis

Complication for Chronic Sinusitis

Erosion of the thinning of the bone between the brain and the sinuses or the eye and the sinuses can occur if the infection is prolonged.

Blocked sinuses form mucus and enlarged become mucocoele (mucus filled cyst)

-headaches, double vision Sinus infection may spread bacteria into

blood stream and cause sepsis (systemic blood borne infection)- make high fever and renal failure

Can Sinusitis Be Prevented?

Keep your nose as moist as possible with frequent use of saline sprays or washes.

Avoid very dry indoor environments and use a humidifier, if necessary. Be aware, however, that a humid environment also may increase the amount of dust mite, or allergens in your home. this is important only if you are allergic to any of those organisms.

Avoid exposure to irritants such as cigarette and cigar smoke or strong odors from chemicals.

Avoid exposure to substances to which you are allergic. If you haven’t been tested for allergies and you are getting

frequent sinus infections, ask your healthcare professional to give you an allergy evaluation or refer you to an allergy specialist.

Avoid long periods of swimming in pools treated with chlorine, which can irritate the lining of the nose and sinuses.

Avoid water diving, which forces water into the sinuses from the nasal passages.

investigation and treatment for

SINUSITIS

INVESTIGATION OF SINUSITIS

TRANSILLUMINATION (CAT SCAN)It is a diagnostic

technique in which the combined use of a computer and x-

rays are passed through the body at

different angles, producing clear, cross-sectional

images of the nasal cavities.

NASAL ENDOSCOPY

This is a narrow, flexible fiber-optic

scope that is placed into the nasal cavity through the nostrils. It allows the doctor to view where the

sinuses and middle ear drain into the

nose.

FINE NEEDLE ASPIRATION

BIOPSYThe sinus is

aspirated, the contents sent for

culture and staining, and the sinus may be flushed with a saline

solution. This is technically the most

accurate way to diagnose infectious

sinusitis.

RHINOSCOPYIt is a procedure

where the nostril is spread open with a

small bunt speculum and the

nasal passages can be directly

examined with a headlight. This

examination gives limited view of the interior of the nasal

cavity.

CT OR MRI SCANSThey both are helpful in looking at cancers of the nasal cavities

and paranasal sinuses. MRI is better

than CT in distinguishing fluid

from tumor, and sometimes they can help the doctor tell

the difference between a benign

tumor and a cancerous one.

CHEST X-RAYIf nasal cavity or paranasal sinus cancer has been

diagnosed, one of these tests may be

done to find out whether the cancer has spread to the lungs, which is the most common site

of spread other than lymph nodes.

TREATMENTS

CORTICOSTEROIDS

Reduce inflammation in

the nasal passages.

Examples:beclomethasone

(Beconase),mometasone (Nasonex).

MUCOLYTICSThin mucus.

Example: guaifenesin (Robitussin)

SURGERY

ENDOSCOPIC SINUS SURGERY This surgery removes anatomical and

pathological obstructions associated with sinusitis in order to restore normal clearance

of the sinuses.

BALLOON SINUPLASTYThis method, similar to balloon

angioplasty used to unclog arteries of the heart, utilizes balloons in an attempt to

expand the openings of the sinuses in a less invasive manner.

CALDWELL-LUC RADICAL ANTROSTOMYThis surgery involves an incision in the upper gum,

opening in the anterior wall of the antrum, removal of the entire diseased maxillary sinus mucosa and drainage is allowed into inferior

or middle meatus by creating a large window in the lateral nasal wall.

PHYSIOTHERAPY MANAGEMENT

NEBULISATION

LASER THERAPY

THERAPEUTIC

ULTRASOUND

RHINOFLOW

THERAPY

SHORTWAVE

DIATHEMY

MASSAGE

THANK YOU….for being so

attentive.

References Tichenor, W. S. (2007). Sinusitis for Physicians.

Sinusitis: A Treatment Plan That Works. Retrieved from http://www.sinuses.com/md.html

Jacewicz, M. (2008). Sinusitis. The Merck Maual Home Healthn Handbook. Retrieved from http://www.merckmanuals.com/home/ear_nose_and_throat_disorders/nose_sinus_and_taste_disorders/sinusitis.html

Torpy, J. M. (2009). Acute Sinusitis. The Journal of the American Medical Association, (301)17. Retrieved from http://jama.ama-assn.org/