SINUSITIS

2.  Paranasal sinuses are a group of 4 paired air filled spaces that surround the nasal cavity. 1. Frontal
sinus 2. Ethmoid sinus 3. Sphenoid sinus 4. Maxillary sinus  They reduce the weight of the skull and
they humidify the inspired air.

3.  Sinusitis is an inflammation of the mucus membrane of the Paranasal sinuses.  Pansinusitis is

infection of more than one sinus.  Rhinosinusitis is referred to as an inflammatory disease of the nose
or sinuses.  It is a common condition and a complication of 5%-10% of URIs in children.  It affects 1 in
8 adults per year.

4. ON THE BASIS OF LOCATION ON THE BASIS OF DURATION Frontal sinusitis Acute sinusitis( infection
lasts up to 4 weeks) Ethmoid Sinusitis Subacute sinusitis ( lasts between 4 -12 weeks) Maxillary sinusitis
Chronic sinusitis( more than 12 weeks) Sphenoid sinusitis

5. Viral infection: 90% of sinusitis. Rhinovirus, coronavirus. Bacteria: Streptococcus pneumoniae ,H

Influenza others, Pollutants: Chemical/irritants may trigger the build of mucus. Fungi: Rare.

6. URIs such as common cold Nasal polyps Deviated nasal septum Dental infection Swimming

7. Smoking and Intranasal cocaine. Tonsillar and adenoid hypertrophy. Pregnancy, hormonal changes
with puberty. Iatrogenic factors such as mechanical ventilation, NG tubes, nasal packing etc.

8. Common sign and symptoms are Fever, sore throat, headache, facial pain and pressure, malaise. In
more advance cases the symptoms are Anosmia, Nasal congestion and discharge, halitosis etc.

9. Maxillary sinusitis: Pain in the upper jaw. Frontal sinusitis: Pain in the forehead. Ethmoid sinusitis: Pain
over nasal bridge. Sphenoid sinusitis: Pain over the occiput or vertex.

10.  History taking  Physical examination  Watchful waiting: If sinusitis less than 10 days without
symptom then viral . More than 10 days bacterial sinusitis.  X ray finding conforms.  CBC  CT scan. 
Sinus radiography shows opacification of the sinus, thickened mucous membrane.  Culture and
sensitivity test

11.  Treatment depends on the how long condition lasts. Most acute cases resolves without treatment.
 In most of the sinusitis antibiotics are not recommended because viral causes.  Symptomatic
treatment is given to the patient.

12. Antibiotics are not prescribed routinely , because many cases of sinusitis are viral. First line therapy
at most centers is amoxicillin for 14 days. Antibiotic therapy- Amoxyclav 625 mg(Amoxycillin 500 mg +
clavulamic acid 125 mg).

13.  Xylometazoline nasal drops.  These are used to reduce nasal edema.

14.  Mucolytic agents such as Guaifenesin and Saline lavage used to decrease the duration of sinus
infections.
15.  Pseudoephedrine and Phenylephrine can be used for 10 to 14 days.  These drugs allow the
restoration of normal mucociliary function and drainage.  These are contraindicated in clients with
Cardiovascular diseases and competitive athletes.

16.  These are used to reduce mucosal inflammation. 

17.  Antihistamines are beneficial for reducing osteomeatal obstruction in clients with allergies and
sinusitis. 

18.  Normal saline solution irrigations or A vaporizer or humidifier is used to prevent nasal crusting
.These are also used to moisten secretions.

19.  Antral lavage is a surgical procedure in which a cannula is inserted into the opening of the maxillary
sinus via the inferior meatus to allow irrigation and drainage of the sinus.

20. Functional Endoscopic sinus surgery. Nasal antrostomy External sphenoethmoidectomy Caldwell –
Lue procedure.

21.  The main objective of FESS is to reestablish the sinus ventilation and Mucociliary clearance.  It is
an outpatient surgical procedure using local anesthesia.  Small fiberoptic endoscopes are passed
through the nasal cavity and into the sinus.  It allows the direct visualization of the sinuses in order to
remove diseased tissue and to enlarge sinus Ostia.

22.  Possible complications includes nasal bleeding, pain, scar formation.  After FESS , nasal packing
may be inserted to minimize nasal bleeding.

23.  It is a surgical procedure performed to remove diseased mucosa from the sphenoidal or ethmoidal
sinus.  A small incision is made over the ethmoidal sinus on the lateral nasal bridge and the diseased
mucosa is removed .  Nasal and ethmoidal packing then inserted.

24.  Maxillary antrostomy is a surgical procedure to enlarge the opening (ostium) of the maxillary sinus.
This allows for further surgical intervention within the maxillary sinus cavity as well as improved sinus
drainage. 

25.  Caldwell-luc antrostomy —also known as Radical antrostomy— is an operation to remove

irreversibly damaged mucosa of the maxillary sinus.  It is done when maxillary sinusitis is not cured by
medication or other non-invasive technique.  The approach is mainly from anterior wall of maxilla bone

26.  Warm compresses apply in the sinus area.  Increase fluid intake  Educate the patient to avoid
cold environment  Promote good oral hygiene  Avoid smoking  Avoid blowing nose.

27.  For the first 24 hours after sinus surgery ,observe the client for nasal bleeding, respiratory distress,
orbital and facial edema.  Explain the client to engage in minimal physical exercise, avoid strenuous
activity.  Teach the client to sneeze only with the mouth open.  Nasal saline spray may be started 3 to
5 days after the surgery to moisten the mucosa.  A nasal drip pad is taped beneath the nares to absorb
drainage after nasal or sinus surgery.
28.  Risk for infection related to disease process.  Ineffective breathing pattern related to nasal
congestion/discharge  Altered comfort related to facial fullness, nasal discharge.  Hyperthermia
related to inflammation process.

29. Meningitis. Osteomyelitis Brain abscess