Presentation on theme: "Rhino-Sinusitis: Clinical Features, Diagnosis & Medical Treatment"— Presentation transcript:
1Rhino-Sinusitis: Clinical Features, Diagnosis & Medical Treatment Dr. Vishal Sharma
2DefinitionsRhino-sinusitis: inflammation of lining mucosa of nose & paranasal sinusesAcute: infection lasting < 4 weeksSub acute: infection lasting 4 to 12 weeksChronic: infection lasting > 12 weeksRecurrent: > 3 episodes in 6 months or > episodes per year with asymptomatic intervals of > 10 days
3Types of Sinusitis Acute / sub acute / chronic / recurrent Open / Closed (depending on its drainage)Unilateral / bilateralMaxillary / frontal / ethmoidal / sphenoidalSingle sinusitis / multi-sinusitis / pan-sinusitisAnterior group / posterior groupSuppurative / hypertrophicBacterial / fungal / allergic / occupational
4Etiology Rhinogenic: commonest (85%) following any form of rhinitis Dental: for maxillary sinusitisroot abscess, dental proceduresTrauma:R.T.A., swimming, diving, F.B., barotraumaIatrogenic: nasal packing, septal surgeryHematogenous: rare
32Sinus trans-illumination test Performed in a dark room. High-intensity light source placed inside patient’s mouth or against the cheek (for maxillary sinus) & under medial aspect of supra-orbital ridge (for frontal sinus).Trans-illumination normal = no sinusitisTrans-illumination absent = sinus filled with pusTrans-illumination dull = equivocal result
33Postural test Performed in acute sinusitis (active nasal discharge) Pus cleaned in supine position & pt sits uprightPus appears = frontal or ethmoid sinusitisPus appears on stooping forwards = sphenoid sinusitisNo discharge pt lies in lateral position with affected side up. Pus appears = maxillary sinusitis
34Rhinosinusitis Task Force Criteria Major Minor1. Facial pain / pressure Headache2. Nasal obstruction Fever (non-acute sinusitis)3. Nasal discharge or Halitosisdiscolored postnasal drip 4. Fatigue4. Hyposmia / anosmia Dental pain5. Purulence on examn Cough6. Fever (acute sinusitis) Ear pain / pressure / fullnessPresence of 2 major factors or 1 major + 2 minor factors = sinusitis
38Indications for D.N.E. 1. Patients not responding to medical therapy 2. Anatomic factor preventing adequate examination by anterior rhinoscopy3. Collection of pus from hiatus semilunaris for culture & sensitivity4. Objective monitoring of patients5. Peri-operative nasal inspection & cleaning
48Para-nasal sinus sonography Bony anterior wall is seen as hyper-echoic line. Maxillary cavity filled with air appears as hyper-echoic hence posterior sinus margin not seen.Fluid in sinus, cyst & mucosal thickening are hypoechoic so posterior sinus margin is visible.B mode sonogram differentiates between fluid in sinus, cyst & mucosal thickening.
55C.T. scan paranasal sinus Coronal & axial cuts, plain (without contrast)Coronal planes, cuts of 4 mm or lessIndications:In recurrent acute / chronic sinusitis not responding to medical therapyBefore endoscopic surgeryImpending complications of sinusitis
63Fungal Sinusitis A. Invasive (hyphae present in submucosa) Acute invasive or fulminant (< 4 weeks)Chronic invasive or indolent (> 4 weeks)B. Non-invasiveAllergicFungal ball or mycetomaSaprophyticAspergillosis & Mucormycosis are common
64Acute invasive fungal sinusitis Usually mucormycosisPredisposing factors:Immune-compromise: AIDS, Lymphoma, Cyto-toxic drugs, chronic use of steroid, aplastic anemiaInsulin dependent diabetes mellitusLong term use of broad-spectrum antibioticsC/F: Unilateral nasal discharge with black crusts due to ischaemic necrosis. Cerebral & vascular invasion present. Absence of significant inflammation.
68Allergic fungal sinusitis Associated with ethmoid polyps & asthmaUnilateral thick yellow nasal discharge with mucin, eosinophils & Charcot Leyden crystalsC.T. scan: radio-opaque mass with central area of hyper density (due to hyphae)Tx: Surgical debridement + anti-histamines steroids (oral & topical)
73Fungal ball (Mycetoma) Refractory sinusitis with foul smelling cheesy material in maxillary sinusTx: Surgical removal. No anti-fungal drugs.Saprophytic fungal sinusitisSeen after sino-nasal surgery due to proliferation of fungal spores on mucous crusts