Presentation on theme: "Sinusitis By Emilie Watson. Sinuses What are they for?"— Presentation transcript:
Sinusitis By Emilie Watson
Sinuses What are they for?
….several theories Lightening the weight of the head Humidifying and heating inhaled air Increasing the resonance of speech Serving as a crumple zone to protect vital structures in the event of facial trauma
What is sinusitis? Inflammation of the lining of the sinuses Mucosal oedema, mucus retention (which may become infected. Polyps and septal deviation can lead to poor drainage. Acute (Usually follows URTI but 10% due to tooth infection) Chronic (often due to structural or drainage problems) Can be – viral, bactierial, fungal, and have contributing factors such as trauma
Signs and Symptoms Major Factors Thick colored post nasal drainage or discharge becoming yellowish to yellow-green Congested nasal passages Sneezing Reduction or loss of sense of smell Facial pain Facial pressure or fullness Fever - only with additional symptoms Pus in the nose upon physical exam Minor Factors Fever Fatigue Halitosis Hoarseness Headache Ear pain Irritability Dental pain Persistent cough Blocked feeling/clicking in ears
Investigations Thorough examination – important to rule out any factors that may be causing the sinusitis CT (usefull pre-surgergy) MRI (useful differentiating fungal vs tumour) XRAY – not much use Allergy and immune testing Nasal endoscopy Sinus culture Biopsy and wash out
When should I prescribe an antibiotic for acute sinusitis? Antibiotics are not required for most people presenting with acute sinusitis; instead the mainstay of treatment is symptomatic relief.symptomatic Admit if the person is suspected of having a serious localized or systemic illness that requires further assessment or administration of intravenous antibiotics (for example, if there is evidence of peri-orbital or intracranial complications). Admit Consider an immediate antibiotic prescription only if it is not appropriate to admit the person and they are: Systemically unwell, or At high risk of complications because of a pre-existing comorbidity.comorbidity Consider a delayed prescribing strategy for all other people, especially if symptoms are causing significant discomfort (such as marked pain or profuse, purulent discharge).delayed prescribing strategy If an antibiotic is required, prescribe according to local protocols where available: Amoxicillin is a good first-line choice. Prescribe the maximum oral dose (1 g three times a day) for 1 week. Doxycycline (not in children less than 12 years of age) or a macrolide (erythromycin or clarithromycin for 1 week) are options if the person has a known allergy to penicillin (consider erythromycin for pregnant women).
When to refer immediate referral to an ENT for suspected complications (e.g. periorbital infection) urgent referral to an ENT for suspected sinonasal tumour (persistent unilateral symptoms, such as bloodstained discharge, crusting, or facial swelling) consider ENT referral for: – if there is recurrent or chronic sinusitis – progressive or unremitting facial pain – children with persistent sinusitis after two antibiotic courses dental review – if the infection is suspected to be of dental origin, then refer patient for dental review. Initiate antibiotic treatment, with the addition of antibiotics to cover anaerobic bacteria (e.g. metronidazole)
Surgery – functional endoscopic sinus surgery, removing polyps Side effects – muco or pyocoeles, orbital cellulitis/abscess, osteomyelitis
…. Can be serious Can cause Meningitis Encephalitis Cerebral abscess Cavernous sinus thrombosis
Frontal sinusitis with pus draining from frontal sinus