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Rhinosinusitis

Rhinosinusitis. Definition. Nasal congestion Nasal discahrge Sneezing Nasal itchiness any two for >24 hours. Classification. Infective Allergic Non-infective, Non-allergic. Infective Rhinitis. Viral Bacterial Non-specific Specific syphilis TB Fungal. Allergic Rhinitis. ARIA

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Rhinosinusitis

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  1. Rhinosinusitis

  2. Definition • Nasal congestion • Nasal discahrge • Sneezing • Nasal itchiness • any two for >24 hours

  3. Classification • Infective • Allergic • Non-infective, Non-allergic

  4. Infective Rhinitis • Viral • Bacterial • Non-specific • Specific • syphilis • TB • Fungal

  5. Allergic Rhinitis • ARIA • Allergic Rhinitis and its Impact on Asthma • Mild, Moderate, Severe • Persistent, Intermittent

  6. Non-allergic Non-infective Rhinitis Non-allergic eosinophilic rhinitis Occupational Hormonal Drug induced Gustatory Vasomotor

  7. Infective Rhinitis • Viral • Common cold • Rhinovirus • Parainfluenza • RSV • Adenovirus • Influenza

  8. Infective Rhinitis • Bacterial • Simple • Syphilis • TB • Lupus vulgaris • Atrophic rhinitis

  9. Infective Rhinitis • Fungal Later

  10. Seasonal Pollen from trees, grasses, and weeds Perennial House dust mites Mold and fungus spores Cockroaches Animal danders Food chemicals Allergic Rhinitis - Causes

  11. Allergic Rhinitis Predisposing Factors +ve family history Personal history of atopic disease e.g eczema, urticaria and asthma

  12. Allergic Rhinitis - Symtoms Sensitive to specific allergens, e.g dust Pruritus of the nose, eyes, palate, ears Sneezing > 2 at a time Watery rhinorrhoea Coexistant asthma or eczema Seasonal symptoms Family history of allergies

  13. Investigations History – Present illness, past medical history, family history, environmental history and impact on quality of life Physical Examination – Nose, Eyes, Ears, Lungs and Skin Nasal exam with endoscope – edematous IT, polyps

  14. Investigations Blood test : IgE, eosinophilia Nasal biopsy for differential dx Skin test RAST (radio-allergosorbent test)

  15. Treatment Avoidance of allergen Normal Saline douching

  16. Vasoconstrictors nasal drops oxymetaxoline Steroid beclomethasone Nasonex

  17. Treatment-Topical Vasoconstrictors nasal drops oxymetaxoline Steroid beclomethasone Nasonex

  18. Treatment-Oral Anti-histamine sedating non-sedating Steroid ? Sodium cromoglycate

  19. Treatment-Surgical Surgical - for nasal obstruction only Septoplasty Turbinate reduction Immunotherapy - Desensitization Subcutaneous Sublingual

  20. Vasomotor Rhinitis Autonomic disturbance – excessive parasympathetic activity No specific cause found Symptoms : rhinorrhoea, sneezing, nasal obstruction

  21. Vasomotor Rhinitis Antihistamine piriton Exercise Anticholinergic medication Ipratropium bromide

  22. Rhinitis Medicamentosa Avoid prolong use of vasoconstrictor nose drop

  23. Acute bacterial dental origin – 10% Chronic anatomical allergy polyps immune deficit Sinusitis

  24. Acute sinusitis - Symptoms Proceeding URTI or Dental infection Pain - depends on the involving sinus throbbing aggravated by coughing Nasal obstruction Purulent rhinorrhoea

  25. Acute Sinusitis - Signs Fever Local tenderness Mucopus in nose or nasopharynx Dental caries X-ray with opacity or fluid level

  26. Acute Sinusitis Streptococcus pneumoniae Haemophilus Influenza Staphylococcus Anaerobes

  27. Acute Sinusitis - Treatment Antibiotics x 2 weeks Amoxycillin Augmentin Cefuroxime + metronidazole Vasoconstrictor nose drops – aid drainage

  28. Antral washout – for resistance case • both diagnostic and therapeutic • FESS

  29. Chronic Sinusitis - Symptoms Usually less - no pain Nasal obstruction Nasal/Post nasal purulnt discharge Cacosmia

  30. Chronic Sinusitis - Signs Mucopus in the meati Nasal mucosa congested X-ray show fluid level or opacity

  31. Chronic Sinusitis - Treatment Medical Antibiotic Nasal Decongestant Topical steroid

  32. Chronic Sinusitis - Treatment • Surgical • Open-depends on the site • Caldwell-Luc Operation • Osteoplastic flap • Endoscopic-FESS

  33. FESS • Functional Endoscopic Sinus Surgery • ? Funtional • resume the normal function of sinus • drainage • ventilation

  34. Messerklinger 1960s • sinus mucus drain in a genetically determined path to the natural ostium

  35. Post FESS

  36. FESS-complication • Local • Bleeding • Adhesion • Mucocele • Stenosis • Recurrence • Orbital • Orbital haematoma • Diplopia • Blinding • Intracranial • CSF leakage • Meningitis

  37. Complications of Sinusitis • Local • Mucocele • Osteomyelitis-Pott’s tumor • Orbital • Orbital cellulitis • Orbital abscess • Cavernous sinus thrombosis • Intracranial • Epidural abscess • Subdural abscess • Intracerebral abscess

  38. Fungal Sinusitis • Classification • Non-invasive • Mycetoma • Allergic fungal sinusitis • Invasive • Chronic invasive • Acute fulminant

  39. Fungal sinusitis-treatment • Surgical debridement • Steroid spray • allergic fungal sinusitis • Anti-fungal treatment • invasive fungal sinusitis • Amphotericin B

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