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ACUTE & CHRONIC ( RHINO-) “SINUSITIS”. Classification by duration of symptoms. ACUTE – lasting up to 4 weeks, with total resolution of symptoms SUBACUTE – persisting more than 4 weeks, but less than 12 weeks, with total resolution of symptoms CHRONIC – 12 weeks or more of signs / symptoms
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Classification by duration of symptoms • ACUTE – lasting up to 4 weeks, with total resolution of symptoms • SUBACUTE – persisting more than 4 weeks, but less than 12 weeks, with total resolution of symptoms • CHRONIC– 12 weeks or more of signs / symptoms • RECURRENT ACUTE– 4 or more episodes per year, with resolution of symptoms between attacks
PATHOPHYSIOLOGY NASAL CAVITIES SINUS OSTIA MUCOSA CILIA VESSELS MUCUS
CILIA 200/cell. 20 strokes/min. “LOVE “ “HATE” Drying < 10C >45C Infection Inflammation Propanolol Cocaine Phenylephrine(>) Isotonic saline Ephedrine Corticosteroids (1 wk)
PREDISPOSING FACTORS Septum deviation Pollution Polyps Allergy Tumour Diet Trauma Immune supression Dental Endocrinological Nose packs Diabetis N/G tubes Kartegener Foreign body Drugs ADENOIDITIS GE(L)RD
Blocked nose Throat irritation Common cold 10 days (35%) Watery nasal discharge Viral sinusitis Symptoms > 10 days or symptoms worsen after 5-7 days Bacterial sinusitis
VIRAL RHINOSINUSITIS INFLAMMATION SINUS OSTIA OBSTRUCTION 7 sq. mm. 0.5 mm. oedema 3 sq. mm. (secretions & mucosal oedema) CILIARY DYSFUNCTION 2 IIr STASIS
BACTERIAL SINUSITIS Fever > 38C Sinus pain: Throbbing Bending Coughing Walking Percussion ??? Dental pain Nasal: Discharge Congestion CHRONIC SINUSITIS (?)
PUS SWABS Absence of puss does not exclude sinusitis!!
MICROBIOLOGY Strep.Pneumoniae H.Influenza M. Catarrhalis Staph. aureus Anaerobes Fungi Tuberculosis
TREATMENT OF ACUTE SINUSITIS (See it as an abscess and treat it as such!) Antibiotics 10 – 14 days Drainage: Decongestant - local ( drops,spray,) systemic,?? Flushing (steam inhalations, saline) Hypertonic saline- 1/2tsp in 250 ml Sterile water Prednisone Mucolytics ?????? Anti-inflammatory Antihistamines ‘Drying up’
SURGERY IN CHRONIC SINUSITIS FUNCTIONAL ENDOSCOPIC SINUS SURGERY
DRUGS & THE NOSE Symp./parasimp. Antihistamines Beta-blockers Sex hormones Corticosteroids Cocaine/Lignocaine Antihypertensives Viagra/Cialis