Nose 2

Inflammations of the Nose &

Sinuses
M. A. El - Begermy
Large adenoids ‫تضخم الغدانيات‬

Wrong tilting
may hide large
adenoid
Classification of Nasal
Inflammations
 Allergic Rhinitis
‫تحسس (حساسية) األنف‬
+ + + Sneezing
+ + + Rhinorhea
+++ Itching

+ Obstruction
-/+ Headache
Purple mucosa in allergic rhinitis
 Vaso-motor rhinitis (VMR)
‫ألتهاب األنف الوعائى‬
Obstruction + + +
Headache ++

Sneezing +/-

Hypertrophied inf. Turbinate

Acute Rhinitis
Chronic Rhinitis
 Rhinoscleroma
Cause: Klebsiella rhinoscleromatis (Frisch bacillus)
Pathology: Mikulicz cells, plasma cells, Russel bodies

Granulomatous stage: Broad nose due to long

nasal granulation tissue standing disease
Tuberculosis‫الدرن‬
Lupus vulgaris
‫الذئبة المتوحشة‬
Cause Attenuated TB

Apple jelly nodule of the nasal

mucosa and face (butterfly area)
 Lupus vulgaris ‫الذئبة المتوحشة‬

Late stages: anterior septal perforation & Skin fibrosis

Leprosy
Congenital
Syphilis
Aquired Nasal
Syphilis
 Fungal Granulomas

Rhinosporidiosis
 Cutaneous
Leishmaniiasis
Sinusitis
 Maxillary
Sinusitis

Plain X-ray

CT scan
Anterior rhinoscopy, Endoscopy
 Maxillary
Sinusitis

CT,coronal view: total

diffuse opacity of max.S
Rt maxillary sinusitis: shows in addition there is
Total diffuse opacity in ethmoidal sinuitis which is
plain X ray, sinus walls are not seen in plain X ray
preserved
 Fluid Level in Maxillary
Sinusitis

In plain X ray In coronal CT scan

Sphenoid sinusitis
 Management
Pharmacotherapy
Immunotherapy
Surgery:
Conventional surgery
Functional endoscopic sinus surgery
(FESS)
 Pharmacotherapy

Nasal wash, moisture

Antibiotics
Decongestants (local-systemic)
Antihistamins (local-systemic)
Steroids (local-systemic)
 Antibiotic Choice

Factors determining antibiotic choice

Cost
Empirical
Affects most organisms
Secreted in nasal secretions
Suitable for particular patient
Antibiotic Choice: Spectrum, Secretion
Penicillins: Unasyn
Macrolides:
Penicillin G, Ospen (phenoxy methyl P.) Augmentin
Cehalosporins: first, secon & third gen. Flumox
(mainly concentrated
Ampicillin, Amoxycillin in tissues but not
First G: cefalexin (Keflex), Cephradine
Sulpha:
secretions) Zinnat,
(Velosef), (Not
Ampicillin+ secreted)
sulbactam (Unasyn)
Tetracyclins:
Sulphamethoxazol + trimethoprim
Erythromycin ceclor
Second G: Cefuroxime
Amoxycillin+
Quinolones clavlinic (Zinnat),
acid
(Septrin
Tetracyclin
Spiramycin
Cefaclor –Bactrim)
(Short acting)
(Rovamycin)
(ceclor) (expensive) Septrin
(Augmentin)
Ciprofloxacin (cipro, ciprobay, ciprone)
Anaerobes (Vibramycin)
Doxycyclin
Azithromycin
Amoxycillin+ (zithromax)
Third G: Cef=perazone (Cefobid),
Flucloxacillin (Flumox) Vibramycin
Longer
Ofloxacinaction,
Clindamycin
Ceftraxone effective,
( Tarivid,
(Dalacin
(Rocephin) secreted
oflox)
C) late
{expensive,
suitable
Rulid for children, lactation,
Not Suitable
[ulcerative
injection } { forcomplictions}
children, pregnancy,
colitis]
for Ciprofloxacin
pergnancy
Excellentsecreted,
Effective, in gram negative infection,
suitable for children
lactation
no improvement(Flagyl)
Metronidazol with previous antibiotics Flagyl
[given as adjuvant therapy]
Sinusitis: effect of medical
treatment

Before treatment

After treatment
 Surgery

Puncture lavage
Conventional surgery
(Culdwel-Luc operation)

Functional Endoscopic Sinus

Surgery (FESS)
Puncture, lavage
 Surgical management
of maxillary sinusitis

Inferior meatal antrostomy

Culdwell- Luc operation, sublabial incision

Anatomical Basis Of
FESS
Physiological basis of
FESS
Steps of
FESS
Complications
of Sinusitis

Frontal mucocele
Fronto-ethmoid muco-pyocele

Orbital abscess
Complications of sinusitis

Sub-periosteal abscess
 DD
Ethmoid mucocele
Dacryocystitis
Internal angular dermoid cyst
Nasal Polypi
 Nasal Polypi
Nasal polypi protruding
in the oropharynx

Enlarged posterior end of

inferior turbinate
 Nasal Polypi In Children

Causes: Fungal Sinusitis

Primary ciliary diskinesia (Kartagner syndrome)
Mucopolysacharoidosis ( as this case)
.Antrochoanal polyp
Antro-Choanal Polyp
 Fungal Sinusitis
CT scan showing fungal mycetoma in ethmoid and
sphenoid sinuses. It appears as nonhomogenous
opacity with dense area of fungal metabolites
Nasal polyposis, Fungal sinusitis
Fungal Sinusitis causing: intracranial
extension
Erosion of lamina paparacea
Allergic nasal polypi
 Next lecture
Nasal Tumours

Benign Locally Malignant

Osteomas Malignant Carcinoma
Palilloma Inverting Lymphomas
Angioma papilloma
Neurofibroma