SINUSITIS

DEFINITION:
 Sinusitus is a common inflammation of the paranasal sinuses, the cavities that produce
the mucus necessary for the nasal passages to work effectively. It occurs when mucus
builds up and the sinuses become inflamed. Doctors often refer to sinusitis as
rhinosinusitis (Felman, A., 2017).
 Sinusitis can be caused by infection, allergies, and chemical or particulate irritation of
the sinuses (Shiel, M., 2019).
 classification of sinusitis:
 Acute sinusitis usually starts with cold-like symptoms such as runny, stuffy nose and
facial pain. It may start suddenly and last 2-4 weeks and is the most common type.
 Subacute sinusitis usually symptoms last longer than the normal acute period, lasts 4 to
12 weeks.
 Chronic sinusitis symptoms persist, or continually return, after 12 weeks or longer.
 Recurrent acute rhinosinusitis (RARS) consists of 3 or more episodes of acute bacterial
rhinosinusitis (ABRS) in a year.
 Types of sinusitis
 Infected sinusitis usually is caused by uncomplicated virus infection. Less frequently,
bacterial growth causes sinus infection and fungal sinus infection is very infrequent.
Subacute and chronic forms of sinus infection usually are the result of incomplete
treatment of an acute sinus infection.
 Noninfectious sinusitis is caused by irritants and allergic conditions and follows the
same general time line for acute, subacute and chronic as infectious sinusitis.

INCIDENCE:
Acute Sinusitis
 Sinusitis affects 1 out of every 7 adults in the United States, with more than 30 million
individuals diagnosed each year. Sinusitis is more common from early fall to early
spring. Rhinosinusitis affects an estimated 35 million people per year in the United
States and accounts for close to 16 million office visits per year.
 International prevalence
 Acute sinusitis affects 3 in 1000 people in the United Kingdom. Chronic sinusitis affects 1
in 1000 people. Sinusitis is more common in winter than in summer. Rhinoviral infections
are prevalent in autumn and spring. Coronaviral infection occurs mostly from December to
March.
 Acute sinusitis in children
 An average child is likely to have 6-8 colds (ie, upper respiratory tract infections) per
year, and approximately 0.5-2% of upper respiratory tract infections in adults and 6-13% of
viral upper respiratory tract infections in children are complicated by the development of
acute bacterial sinusitis.
 Sex distribution for acute sinusitis
 Women have more episodes of infective sinusitis than men because they tend to have
more close contact with young children. The rate in women is 20.3%, compared with 11.5%
in men.
Chronic Sinusitis
 Chronic sinusitis is one of the more prevalent chronic illnesses in the United States,
affecting persons of all age groups. The overall prevalence of CS in the United States is
146 per 1000 population. For unknown reasons, the incidence of this disease appears to
be increasing yearly. Chronic sinusitis is the fifth most common disease treated with
antibiotics. Up to 64% of patients with AIDS develop chronic sinusitis.
 International prevalence
 Chronic sinusitis is a common disease worldwide, particularly in places with high levels
of atmospheric pollution. In the Northern Hemisphere, damp temperate climates along
with higher concentrations of pollens are associated with a higher prevalence of chronic
sinusitis. Further, Worldwide the prevalence of CS ranges from about 7% in Korea, 10% in
Europe and 12% in the United States
 sinusitis in children
 Rhinosinusitis is more common in the pediatric population because this term includes
both acute and chronic infection and both viral and bacterial disease. This is likely
secondary to an increased frequency of exposure to upper respiratory tract infections in the
pediatric population.

RISK FACTORS:
The following may increase a person’s risk of developing sinusitis:
 Previous respiratory tract infections, such as the common cold
 Nasal polyps, or small growths in the nasal passage that can lead to inflammation
 Weakened immunity, due, for example to a health condition or some kinds of treatment
 And allergic reaction to substances such as dust, pollen, and animal hair.
 Structural problems in the nose, for example, adeviated septum ( when septum is bent
to one side, either through injury or growth, it can lead to repeated infections and
inflammation).
MANIFESTATIONS:
 Headache due to pressure in partially or completely blocked sinuses. The pain may
increase when the person bends down.
 Facial tenderness and/or swelling when facial areas over sinus areas are touched
 Pressure or pain due to mucus pressing on sinus tissue or inflammation of sinuses.
 Fever due to inflammation of sinus tissues and infection.
 A cloudy, discolored nasal drainage is often seen in bacterial sinus infections.
 Congestion is a feeling of nasal stuffiness, and occurs with both infectious and non-
infectious sinusitis.
 Post nasal drip is mucus overproduction from sinusitis that flows to the throat and
irritates throat tissue.
 Sore throat is inflammation of throat tissue by post nasal drip.
 Cough is a response to post nasal drip and body's attempt to clear out throat tissue
irritants.
 Tooth pain caused by pressure on surrounding nerves and tissues
 Ear pain caused by pressure on surrounding nerves and tissues
 Eye pain caused by pressure on surrounding nerves and tissues
 Fatigue due to fever, immune response and/or coughing
 Bad breath usually is due to bacterial infections
 Itching/sneezing - In noninfectious sinusitis, other associated allergy symptoms of
itching eyes and sneezing may be common, but may include some of the symptoms
listed above for infectious sinusitis.
 Nasal drainage usually is clear or whitish-colored in people with noninfectious sinusitis.
 Ulceration can occur with rare fulminant fungal infections with sharply defined edges
and a black, necrotic center in the nasal area. Some fungal infections cause dark, black-
appearing exudates. This requires immediate medical evaluation.
 Multiple chronic (over one to three months) symptoms usually are a sign of subacute or
chronic sinusitis
Medical Management
 Laboratory Examinations and Diagnostic Procedures
 Doctor will carry out a physical examination and ask the patient about their symptoms.
This is usually enough to make a diagnosis.
 The doctor may visually examine the nasal cavity with a light source, or a small,
handheld device with a light attached called an otoscope, which can also be used to
examine the ears.
 If symptoms persist, a doctor may refer a person with sinusitis to an ear, nose, and
throat specialist (ENT) for a more in-depth examination. They may insert an endoscope into
the nose, a small, thin, flexible tube with a light and camera attached. This can provide
more detailed images.
 Mucus cultures: If sinus infection is chronic or has not improved after several rounds of
antibiotics, a mucus culture may help to determine what is causing the infection. Most
mucus samples are taken from the nose. However, it is sometimes necessary to get mucus
(or pus) directly from the sinuses. Knowing what kind of bacteria is causing the infection
can lead to more effective antibiotic therapy. A fungus could also cause sinus infection.
Confirming the presence of fungus is important. Fungal sinus infection needs to be treated
with antifungal agents, rather than antibiotics. In addition, some forms of fungal sinus
infection – allergic fungal sinus infection, for example – do not respond to antifungal agents
and often require the use of oral steroids.
 In cases of persistent or severe sinusitis, a CT scan may be needed. This test can help to
define the extent of the infection.
 Biopsies: A danger of more serious types of fungal sinus infection is that the fungus
could penetrate into nearby bone. Only a bone biopsy can determine if this has happened.
Biopsies involving sinus tissue are taken with flexible instruments inserted through the
nose. Biopsies of the sinus tissue are also used to test for immotile cilia syndrome, a rare
disorder that can cause people to suffer from recurrent infections, including chronic sinus
infection, bronchitis and pneumonia.
 Treatments
Non-pharmacologic
Rest
 People should try to get as much rest as they can while they have a sinus infection. This
will help the body recover and allow it to spend its energy fighting the infection. Staying
at home and resting can also help prevent spreading the infection to other people.
Hydration
 Drinking plenty of clear fluids will help people stay hydrated and can also help loosen
mucus and clear congestion. Good choices for fluids to drink when a person has a sinus
infection include:
 plain water
 hot water with lemon, honey, or ginger
 herbal teas
 vegetable broth
Warm compresses
 Applying a warm compress to the face can help ease pain and relieve pressure from the
blocked sinuses.
Humidifiers
 People can use a humidifier to add moisture to the air. Extra moisture can help soften
dried mucus, allowing it to flow more easily and reduce congestion.
Pharmacologic
Antibiotics
 Antibiotics are standard treatments for bacterial sinus infections. Patients with sinus
symptoms should consider taking an antibiotic only if symptoms (including discolored
nasal discharge) persist beyond 7-10 days. Antibiotics help eliminate a sinus infection by
attacking the bacteria that cause it, but until the drugs take effect, they do not do much
to alleviate symptoms. Some over-the-counter medications can help provide relief.

Nasal decongestant sprays

 Topical nasal decongestants can be helpful if used for no more than three to four days.
These medications shrink swollen nasal passages, facilitating the flow of drainage from
the sinuses. Overuse of topical nasal decongestants can result in a dependent condition
in which the nasal passages swell shut, called rebound phenomenon.

Antihistamines
 Antihistamines block inflammation caused by an allergic reaction so they can help to
fight symptoms of allergies that can lead to swollen nasal and sinus passages.

Nasal decongestants and antihistamines

 Over-the-counter combination drugs should be used with caution. Some of these drugs
contain drying agents that can thicken mucus. Only use them when prescribed by
allergist.

Topical nasal corticosteroids

 These prescription nasal sprays prevent and reverse inflammation and swelling in the
nasal passages and sinus openings, addressing the biggest problem associated with
sinus infection. Topical nasal corticosteroid sprays are also effective in shrinking and
preventing the return of nasal polyps. These sprays at the normal dose are not
absorbed into the blood stream and could be used over long periods of time without
developing "addiction."

Nasal saline washes

 Nasal rinses can help clear thickened secretions from the nasal passages.

Surgery
 If drug therapies have failed, surgery may be recommended as a last resort. It is usually
performed by an otolaryngologist. Anatomical defects are the most common target of
surgery.

Nursing Responsibilities
Advise the patient to:
- Reducing normal activities until acute symptoms have subsided;
- Drink lots of fluids, especially water, to help loosen secretions;
- Blow the nose gently;
- Elevate the head when lying down to relieve the stuffy feeling

Nursing Care Plan

Nursing diagnosis
Acute pain related to inflammatory process as manifested by eye pain , Sore throat and
headache.

Nursing inference
Inflammatory process can cause the release of chemicals such as bradykinin and
histamine that stimulate nerve endings. Thus, acute pain occur.

Nursing goals
After 6-8 hours of providing appropriate nursing interventions, the patient will be able to
reduce the pain.

Nursing interventions
Nursing responsibilities
1. Assess client's level of pain
-Knowing the client's level of pain in determining further action

2. Explain the causes and effects of pain on the client

-With the causes and consequences of pain the client is expected to participate in
treatment to reduce pain

3. Teach relaxation techniques and distractions

-The client knows the distraction and relaxation techniques can be practiced so as if in pain

4. Observation of vital signs and client complaints

-Knowing the general state and development of the client's condition.

Nursing outcomes
After 8 hours of providing appropriate nursing interventions, the patient was able to
reduced the pain.
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