definition chronic inflammation of the mucosal lining of one or more paranasal sinuses, usually...
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Definition Chronic inflammation of the mucosal
lining of one or more paranasal sinuses, usually caused by anatomical / pathological obstruction to its drainage, and is characterized by chronic postnasal mucopurulent discharge with or without recurrent headache / facial pain. (more than 1month).
Types Open / Close Unilateral / bilateral Single sinus / multi-sinusitis / pan-sinusitis Anterior group / posterior group Suppurative / Hypertrophic
Etiopathogenesis
Usually Rhinogenic. Other routes- rare.Unresolved acute sinusitisAny form of rhinitis Mucosal
odema in OMC Pathological obstruction
Any anatomical variation Anatomical obstruction
Stagnation and secondary chronic sinusitis
Impaired drainage of sinuses in the MM/ OMC
Pathological obstruction
Anatomical obstruction
Mucosal odema/ polyp formation
Mechanical: DNS, anatomical
variations in the MM/ OMC, etc.
Infective / reactive rhinitis
Stagnation and secondary infection
Chronic sinusitis
Pathological mucous/ mucociliary dysfunction
Pathogenesis :Mucosal odemaMechanical obstruction (anatomical)Mucous- thickPrimary mucociliary dysfunction
Anterior ethmoids is the key area for causation of chronic anterior group sinusitis because Ostiomeatal complex is situated within itActs as reservoir of infection
Types & Mucosal changesOpen/ closed typeMucosal changes:
HyperemiaHypertrophy Increased mucosal glands Polypoidal changesMucopurulent secretionsMicroabscessesFibrosis, hyalinizationAtrophy, squamous metaplasia, granulations
Bacteriology
Mixed infection Streptococcus pneumoniae, Hemolyticus,
Staph aureus, gram negative bacteriae,etc. Anaerobic infection> fowl smelling
discharge
Clinical features: Symptoms
Mucopurulent/ purulent post nasal discharge
Cachosmia- anaerobic Headache/ facial pain- depending on the
site and type- usually dull aching. Nasal obstruction Aural and throat symptoms
Clinical features: Signs
Discharge in the MM on anterior rhinoscopy Mucosal changes in the MM Discharge in MM/ SM on posterior
rhinoscopy Tenderness in acute excerbations Postural/ Transillumination tests Prominent lateral pharyngeal band
Investigations Plain radiographs “Water’s”
Mucosal thickening, haziness, opacity, polyp CT scan of OMC/ paranasal sinuses (coronal
cuts) X-ray nasopharynx in children Diagnostic nasal endoscopy Allergic tests if suspected Proof puncture for maxillary sinus Culture and sensitivity- rarely done Fungal culture of cheesy discharge, if
present
Treatment: Medical Antibiotics Nasal decongestants- topical/ systemic Antihistaminics Analgesic-antiinflammatory Medicated steam inhalation Alkaline nasal douches Steroid nasal spray/ short course of
systemic steroids Antiallergy treatment
Treatment: SurgicalWhen refractory to medical treatmentSurgery for predisposing causes like
DNS, polyp, etc.Surgical procedure depends on the
sinus involvedAll sinuses may be surgically accessed endoscopically
Chronic maxillary sinusitis
Surgical options
Antral punctureIntranasal antrostomyCaldwel-Luc operationFESS (Functional endoscopic sinus surgery)
• Opening through canine fossa• Counter opening into inferior
meatus • Radical mucosal debridement
CALDWELL LUC SURGERY
Chronic ethmoiditis
Intranasal ethmoidectomy Blind & dangerous
Trans-antral ethmoidectomy Via Caldwel-Luc operation
External ethmoidectomy (Howarth operation)
Endoscopic ethmoidectomy (FESS)
Chronic frontal sinusitis External frontoethmoidectomy (Lynch-
Howarth operation) Osteoplastic operation Obliteration of frontal sinus Endoscopic frontal sinusostomy
Chronic sphenoidal sinusitis Intranasal sphenoethmoidectomy External sphenoethmoidectomy Endoscopic sphenoidotomy
Functional endoscopic sinus surgery (FESS)
Uncinectomy (infundibulotomy) Middle meatal antrostomy Frontal recess clearance Anterior ethmoidectomy