case history sinusitis
DESCRIPTION
ENTTRANSCRIPT
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April 11, 2023 2
MaxillarMaxillary y
SinusitiSinusitissDr. ZahoorDr. Zahoor
House Surgeon, House Surgeon,
E.N.T DepartmentE.N.T Department
Capital HospitalCapital Hospital
Case Presentation
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CASE NO:CASE NO: 11
Acute on Chronic Maxillary Acute on Chronic Maxillary SinusitisSinusitis
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PERSONAL DATAPERSONAL DATA
NameName :: Mehboob Mehboob HussainHussain
F/OF/O :: CDA Employee.CDA Employee.
AgeAge :: 66 Years male66 Years male
BedBed :: OSW 22/2OSW 22/2
D.O.AD.O.A :: 9.6.20039.6.2003
D.O.DD.O.D :: 18.6.200318.6.2003
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HISTORYHISTORY
MAIN COMPLAINTS:MAIN COMPLAINTS: Pain over cheeks and forehead – 1 yearPain over cheeks and forehead – 1 year
HISTORY OF PRESENTING ILLNESS:HISTORY OF PRESENTING ILLNESS: Pain:Pain: According to the patient, he was According to the patient, he was
alright a year back when he started alright a year back when he started developing pain over the cheeks and developing pain over the cheeks and forehead, which developed gradually forehead, which developed gradually and slowly so much so that he started to and slowly so much so that he started to have severe pain on bowing his head have severe pain on bowing his head down for sajda during prayers. He got down for sajda during prayers. He got some medical treatment off and on with some medical treatment off and on with little improvement. Now he has severe little improvement. Now he has severe pain over the cheeks for last 15 days for pain over the cheeks for last 15 days for which he agreed to get admitted at which he agreed to get admitted at capital hospital. capital hospital.
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PAST HISTORY-PAST HISTORY- Patient has past Patient has past history of maxillary sinus wash but details history of maxillary sinus wash but details are not available. are not available.
FAMILY HISTORY-FAMILY HISTORY- Not significant.Not significant.
PERSONAL HISTORY-PERSONAL HISTORY- Smoker (1 Smoker (1 pack per day for last 20 years) pack per day for last 20 years) with with normal bowel habits.normal bowel habits.
……HISTORYHISTORY
Contd.
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DRUG HISTORY-DRUG HISTORY- Had been taking antibiotics Had been taking antibiotics for sinusitis off and on. No history of any drug for sinusitis off and on. No history of any drug allergy.allergy.
SOCIOECONOMIC HISTORY-SOCIOECONOMIC HISTORY- Belongs to Belongs to lower middle class.lower middle class.
……HISTORYHISTORY
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GENERAL GENERAL PHYSICAL PHYSICAL
EXAMINATIONEXAMINATION
A old man sitting anxiously in bed, A old man sitting anxiously in bed, well oriented to time, place and well oriented to time, place and person.person.
AnaemiaAnaemia JaundiceJaundice ClubbingClubbing Absent Absent CyanosisCyanosis Palpable NodesPalpable Nodes
Contd.
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Temp:Temp: AfebrileAfebrile
Pulse:Pulse: 80 beats per min. Regular,80 beats per min. Regular,
BP:BP: 140/90 mm Hg.140/90 mm Hg.
……GENERAL PHYSICAL GENERAL PHYSICAL EXAMINATIONEXAMINATION
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SYSTEMIC SYSTEMIC EXAMINATIONEXAMINATION
Resp. System:Resp. System: CVS:CVS: NAD NAD CNS:CNS: GIT:GIT:..
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E.N.T E.N.T EXAMINATIONEXAMINATION
NASAL EXAMINATIONNASAL EXAMINATION
Inspection:Inspection: Anterior Rhinoscopy: Swollen inferior Turbinates Anterior Rhinoscopy: Swollen inferior Turbinates
with some mucopus along the nasal floor.with some mucopus along the nasal floor. Posterior Rhinoscopy: NADPosterior Rhinoscopy: NAD
PalpationPalpation: Tenderness over cheeks: Tenderness over cheeks
EXAMINATION OF THROATEXAMINATION OF THROAT Poor oral hygienePoor oral hygieneGingivitisGingivitis
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EXAMINATION OF EARSEXAMINATION OF EARS
Inspection:Inspection: Surrounding area, pinnae, Surrounding area, pinnae, EAM, EAC, T.M normal. EAM, EAC, T.M normal.
Palpation:Palpation: NADNAD Hearing Test: Hearing Test: Hears forced wisper at ear Hears forced wisper at ear
levellevel Tunning Fork Tests:Tunning Fork Tests:
Rinne’sRinne’s :: Positive on both sidesPositive on both sides WeberWeber :: CentralCentral ABC ABC :: Reduced by 5 seconds both sides.Reduced by 5 seconds both sides.
Contd.
……E.N.T EXAMINATIONE.N.T EXAMINATION
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PROVISIONAL PROVISIONAL DIAGNOSISDIAGNOSIS
Acute on Chronic Maxillary Acute on Chronic Maxillary SinusitisSinusitis
With Gingivitis & Mild SNHLWith Gingivitis & Mild SNHL
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INVESTIGATIONSINVESTIGATIONS
CP:CP: Within normal limits. Within normal limits. ESR:ESR: 05 mm within 1st hr. 05 mm within 1st hr. Renal Profile:Renal Profile: Within Normal Limits Within Normal Limits Blood Sugar (Random):Blood Sugar (Random): 90 mg/dl 90 mg/dl
Contd.
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……INVESTIGATIONSINVESTIGATIONS
X-Ray PNS (OM View):X-Ray PNS (OM View): Rt. Max. Sinus is Hazy, Lt. Rt. Max. Sinus is Hazy, Lt.
hazy but less compared to Rt.hazy but less compared to Rt. Both Middle and inf. turbinates Both Middle and inf. turbinates
Swollen with obliteration of Swollen with obliteration of both nasal spaces.both nasal spaces.
X-Ray chest :X-Ray chest :
NormalNormal..
Contd.
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TREATMENTTREATMENT
MEDICAL TREAMENTMEDICAL TREAMENT Inj. Ampicillin 500 mg I/V TDSInj. Ampicillin 500 mg I/V TDS Xynosine nasal spray tdsXynosine nasal spray tds Steam inhalations tds.Steam inhalations tds. Tab. Flagyl 400mg tds.Tab. Flagyl 400mg tds. Gargalene dil. mouth wash.Gargalene dil. mouth wash.
Drugs Advised by Medical Drugs Advised by Medical Department.Department.
Tab. Lexillium 3 mg 1 x HSTab. Lexillium 3 mg 1 x HS Tab. Capace 25 ½ X BDTab. Capace 25 ½ X BD
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Patient was much relieved of his Patient was much relieved of his symptoms at the time of discharge symptoms at the time of discharge and a check X-Ray revealed and a check X-Ray revealed improvement improvement
RESULTS & FOLLOW RESULTS & FOLLOW UPUP
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CASE
2
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Fungal Sinusitis with Fungal Sinusitis with PolypiPolypi
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PERSONAL DATAPERSONAL DATA
NameName :: DoniaDonia
D/OD/O :: Muhammad Farid - CDA Muhammad Farid - CDA Employee.Employee.
AgeAge :: 22 Years, Female22 Years, Female
BedBed :: F.10, E.N.T Dept. Capital F.10, E.N.T Dept. Capital Hospital Hospital
D.O.AD.O.A :: 05.05.200305.05.2003
D.O.DD.O.D :: 30.05.200330.05.2003
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HISTORYHISTORY
MAIN COMPLAINTS:MAIN COMPLAINTS: Nasal BlockageNasal Blockage -- 5 months5 months HeadacheHeadache -- 5 months5 months
HISTORY OF PRESENTING ILLNESS:HISTORY OF PRESENTING ILLNESS: Nasal Obstruction:Nasal Obstruction: According to the patient she According to the patient she
was alright 5 months back when she slowly was alright 5 months back when she slowly developed difficulty breathing through nose, so developed difficulty breathing through nose, so much so that now she can hardly breath and much so that now she can hardly breath and has to keep her mouth open during night. She has to keep her mouth open during night. She said that this nasal obstruction is also said that this nasal obstruction is also associated with some facial disfiguration associated with some facial disfiguration especially prominence of eye balls. especially prominence of eye balls.
Headache:Headache: Nasal obstruction was also Nasal obstruction was also accompanied by headache on the forehead, accompanied by headache on the forehead, which is mild in intensity. which is mild in intensity.
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PAST HISTORY-PAST HISTORY-
FAMILY HISTORY-FAMILY HISTORY-
PERSONAL HISTORY-PERSONAL HISTORY-
……HISTORYHISTORY
Contd.
Nothing significantNothing significant..
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DRUG HISTORY-DRUG HISTORY- Had been taking antibiotics Had been taking antibiotics and other drugs as prescribed by different G.P’s. and other drugs as prescribed by different G.P’s. No history of any drug allergy.No history of any drug allergy.
SOCIOECONOMIC HISTORY-SOCIOECONOMIC HISTORY- Belongs to Belongs to lower middle class.lower middle class.
……HISTORYHISTORY
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GENERAL GENERAL PHYSICAL PHYSICAL
EXAMINATIONEXAMINATION
A young girl sitting anxiously in bed, with A young girl sitting anxiously in bed, with proptosed eyes and well oriented to time, proptosed eyes and well oriented to time, place and person.place and person.
AnaemiaAnaemia JaundiceJaundice ClubbingClubbing Absent Absent CyanosisCyanosis Palpable NodesPalpable Nodes
Contd.
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Temp:Temp: AfebrileAfebrile
Pulse:Pulse: 86 beats per min. Regular,86 beats per min. Regular,
BP:1BP:1 130/70 mm Hg.130/70 mm Hg.
……GENERAL PHYSICAL GENERAL PHYSICAL EXAMINATIONEXAMINATION
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SYSTEMIC SYSTEMIC EXAMINATIONEXAMINATION
Resp. System:Resp. System: CVS:CVS: N0RMAL N0RMAL CNS:CNS: GIT:GIT:..
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E.N.T EXAMINATIONE.N.T EXAMINATION
NASAL NASAL EXAMINATIONEXAMINATION
Inspection:Inspection:
Proptosis more on right Proptosis more on right side.side.
TelecanthusTelecanthus Swelling over the right Swelling over the right
cheekcheek Anterior Rhinoscopy: Anterior Rhinoscopy:
Bilateral polypoidal mass Bilateral polypoidal mass with some cheesy material & with some cheesy material & mucopus.mucopus.
PalpationPalpation: Firm swelling : Firm swelling
over right cheek which was over right cheek which was tender.tender.
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EXAMINATION OF THROATEXAMINATION OF THROAT
NADNAD
EXAMINATION OF EARSEXAMINATION OF EARS
NADNAD
Contd.
……E.N.T EXAMINATIONE.N.T EXAMINATION
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C.N I - XIIC.N I - XII Intact.Intact.
EXAMINATION OF EXAMINATION OF CRANIAL NERVESCRANIAL NERVES
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INVESTIGATIONSINVESTIGATIONS CP:CP:
TLC:TLC: 9.0 Thsd/Cu mm9.0 Thsd/Cu mmDLC:DLC: N-69%N-69%
L-29%L-29%
M-01%M-01%
E-01%E-01%
ESR:ESR: 38 mm within 1st hr. 38 mm within 1st hr. B.T:B.T: 2 min 30 sec.2 min 30 sec. C.T:C.T: 5 min 50 sec.5 min 50 sec. Renal Profile:Renal Profile:
Urea: 29 mg/dlUrea: 29 mg/dl
Creatinine: 0.8 mg/dlCreatinine: 0.8 mg/dl
LFT’s:LFT’s: Normal Normal
Contd.
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……INVESTIGATIONSINVESTIGATIONS
X-Ray PNS (OM View):X-Ray PNS (OM View): Hazy maxillary and ethmoid Hazy maxillary and ethmoid
sinusessinuses Also nasal cavity appears Also nasal cavity appears
obliterated.obliterated.
X-Ray chest :X-Ray chest :
NormalNormal..
Contd.
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……INVESTIGATIONSINVESTIGATIONS
C-T Scan (Nose and PNS)C-T Scan (Nose and PNS) Obliteration of the nasal cavity, Rt. Obliteration of the nasal cavity, Rt.
Maxillary sinus, ethmoids with little Maxillary sinus, ethmoids with little extension into anterior cranial fossa. extension into anterior cranial fossa. Lt. maxillary sinus is minimally Lt. maxillary sinus is minimally affected.Destruction of Rt. Medial affected.Destruction of Rt. Medial orbital wall is also noted with little orbital wall is also noted with little extension into orbit. extension into orbit.
Likely lesion could be Nasal Likely lesion could be Nasal polyposis, fungus. However polyposis, fungus. However malignancy cannot be excluded. malignancy cannot be excluded.
Contd.Coronal Views
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Axial Views
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PROVISIONAL PROVISIONAL DIAGNOSISDIAGNOSIS
Fungal Sinusistis with polypiFungal Sinusistis with polypi
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SURGICAL TREATMENTSURGICAL TREATMENTAfter thorough preoperative preparation on After thorough preoperative preparation on 17.5.2003 at 10.00 a.m following surgical 17.5.2003 at 10.00 a.m following surgical procedure was performed under general procedure was performed under general G/A with oro-trachial intubation through G/A with oro-trachial intubation through oral cavity and throat packing. oral cavity and throat packing.
1.1. Bilateral polypectomyBilateral polypectomy2.2. Cald well Luc’s operation on right side Cald well Luc’s operation on right side
including transantral ethmoidectomy and including transantral ethmoidectomy and antrostomy.antrostomy.
3.3. Left sided transnasal ethmoidectomy. Left sided transnasal ethmoidectomy. BIPP & clotrim imprenated packing done in BIPP & clotrim imprenated packing done in antrum and nasal cavity. antrum and nasal cavity.
TREATMENTTREATMENT
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……TREATMENTTREATMENT
MEDICAL TREAMENTMEDICAL TREAMENT
Inj. Ceftim 1 gm i/v BDInj. Ceftim 1 gm i/v BD for 5 daysfor 5 days Followed by Cap.Kefril 500 mg TDSFollowed by Cap.Kefril 500 mg TDS 1 wk.1 wk. Inj. Chymoral 1 amp I/M TDS Inj. Chymoral 1 amp I/M TDS 2 days2 days Xynosine nasal spray tdsXynosine nasal spray tds Myconil drops tdsMyconil drops tds Liquid Paraffin drops tds.Liquid Paraffin drops tds. Steam inhalations tds.Steam inhalations tds. Inj. Dicloran 1 amp. I/M SOSInj. Dicloran 1 amp. I/M SOS Tab. Brufen tds. Tab. Brufen tds. Tab. Diflucan 200 mg ODTab. Diflucan 200 mg OD 4 4
weeks.weeks.
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FOLLOW UPFOLLOW UP
Nasal pack removed on 2nd post operative day.
Antral pack (BIPP) removed over 1 week.
Follow up on 15th post operative day showed normal nasal patency and markedly reduced disfiguration
Monthly followup till Dec. was satisfactory, however was advised to repeat scan.
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Thank you!
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