SINUSITIS

Four pairs of paranasal sinuses
FrontalFrontal- above eyes in forehead bone MaxillaryMaxillary- in cheekbones, under eyes EthmoidEthmoid- between eyes and nose SphenoidSphenoid- in center of skull, behind nose and eyes

sinuses

What are the sinuses?
Th si s s r h ll w ir-fill d s cs irli d by m c s m mbr Th thm id d m xill ry si s s r r s t t birth. Th fr t l si s d v l s d ri g th 2 d y r s h id si s d v l s d ri g th 3rd y r.

What is sinusitis?
An c t infl mm t ry r c ss inv lving ne r m re f the aranasal r nasal sinuses.

INCIDENCE
A c m licati n f 5%-10% f URIs in 10% children.

Etiology of Sinusitis
1. Bacterial sinusitis is caused by:  Strept c ccus pneum niae

Haem philus influenzae M raxella catarrhalis
2. Other causative rganisms are:

Staphyl c ccus aureus Strept c ccus py genes, Gram-negative bacilli GramRespirat ry viruses

Predisposing Factors
Allergies, nasal def rmities, cystic fibr sis, 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. |

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 days.4 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 LowLow-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, Antimicrobials10depending upon severity, 1. Amoxicillin: 20-40mg/kg/d in 3 Amoxicillin: 20-40mg/kg/d divided doses 2. Augmentin: 25-45mg/kg/d in 2 Augmentin: 25-45mg/kg/d divided doses,Use chewable or suspension if child is less than 40kg. 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

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