SINUSITIS

Four pairs of paranasal

sinuses
Frontal- above eyes in
forehead bone
Maxillary- in cheekbones,
under eyes
 Ethmoid- between eyes and
nose
Sphenoid- in center of skull,
behind nose and eyes
sinuses
 ?What are the sinuses
The sinuses are hollow air-filled sacs
lined by mucous membrane

The ethmoid and maxillary sinuses are

present at birth.
The frontal sinus develops during the 2nd
year
sphenoid sinus develops during the 3rd
year.
 ?What is sinusitis
An acute inflammatory process
involving one or more of the paranasal
sinuses.
INCIDENCE
A complication of 5%-10% of URIs in
children.
 Etiology of Sinusitis
1. Bacterial sinusitis is caused by:
 Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

2. Other causative organisms are:

Staphylococcus aureus
Streptococcus pyogenes,
Gram-negative bacilli
Respiratory viruses
 Predisposing Factors
Allergies,
nasal deformities,
cystic fibrosis,
nasal polyps
HIV infection.
Cold weather
High pollen counts
Smoking in the home
Reinfection from siblings
 Pathophysiology
Usually follows rhinitis, which may be viral
or allergic,abrupt pressure changes (air
planes, diving) or dental extractions or
infections
|
Inflammation and edema of mucous
membranes lining the sinuses
|
 .…Cont
obstruction.
|

This provides for an opportunistic bacterial

invasion.
|
With inflammation, the mucosal lining of the
sinuses produce mucoid drainage.
|
Bacteria invade and pus accumulates inside
the sinus cavities.
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 ..…CONT
Postnasal drainage causes obstruction
of nasal passages and an inflamed
throat
|
If the sinus orifices are blocked by
swollen mucosal lining, the pus
cannot enter the nose and builds up
pressure inside the sinus cavities.
 Types
Acute Sinusitis – respiratory symptoms
last longer than 10 days but less than 30
days.episodes resolve by medical therapy.
Subacute sinusitis – respiratory
symptoms persist longer than 30 days
without improvement. Grey zone between
acute & chronic
Chronic sinusitis – respiratory symptoms
last longer than 120 days.4 or more
episodes of acute sinusitis.surgery
 Subjective Symptoms of
Sinusitis
Pressure,
pain, or tenderness over sinuses Increased pain in the
morning, subsiding in the afternoon
Malaise
Low-grade temperature
Persistent nasal discharge, often purulent
Postnasal drip Cough, worsens at night
Mouthing breathing,
snoring
Sore throat,
bad breath
Headache
 Clinical Presentations of
:Sinusitis
Periorbital edema
Cellulitis
Nasal mucosa is reddened or swollen
Percussion or palpation tenderness over a sinus
Nasal discharge, thick, sometimes yellow or
green
Postnasal discharge in posterior pharynx
Difficult transillumination
Swelling of turbinates ,Boggy pale turbinates
 Diagnostic Tests
sinus radiographs,
ultrasonograms,
CT scanning – indicated if child is
unresponsive to 48 hours of antibiotics and
if the child has a toxic appearance, chronic
or recurrent sinusitis, and chronic asthma.
culture of sinus puncture aspirates.
Pharmacological Plan of Care
Antimicrobials-treat for 10-14 days,
depending upon severity,
1. Amoxicillin: 20-40mg/kg/d in 3
divided doses
2. Augmentin: 25-45mg/kg/d in 2
divided doses,Use chewable or
suspension if child is less than 40kg.
 .…Cont
Relief Medications
Codeine – for severe pain
Rhinocort nasal spray – 2 sprays in each
nostril every 12 hours for children over 6
years of age.
 .…Cont
Acetaminophen or ibuprofen to relieve
pain
Decongestants
Antihistamines
Nasal saline
Non-pharmacological treatment
Humidifier to relieve the drying of mucous
membrances associated with mouth
breathing
Increase oral fluid intake
Saline irrigation of the nostrils
Moist heat over affected sinus
Prolonged shower to help promote
drainage
 Surgery
Endoscopic surgery --
Traditional surgery --