鼻窦炎英文版.ppt

,sinusitis,1,2,Anatomy of the nasal sinuses,Anterior sinus : maxillary sinus frontal sinus anterior ethmoidal sinus They all open in the middle meatus.,3,Posterior sinus: posterior ethmoidal sinus :open in the superior meatus sphenoid sinus: open in sphenoethmoidal recess,4,overview,Sinusitis has been defined as an inflammation of the mucous membrane of the sinuses. two types- acute sinusitis and chronic sinusitis.,5,Acute sinusitis,Acute inflammation of sinus mucosa This commonly follows a cold . The sinus most commonly involved is the maxillary followed in turn by ethmoid, frontal and sphenoid. Multisinusitis: Pansinusitis:,6,Aetiology of sinusitis in general,7,Exciting causes,Nasal infection Swimming and diving Trauma Dental infection,8,Predisposing causes,9,local,Obstruction to sinus ventilation and drainage,10,1、nasal packing,11,2、deviated septum,12,3、hypertrophic turbinates,13,4、nasal polypi,14,5 、oedema of sinus ostia due to allergy or vasomotor rhinitis 6、 benign or malignant neoplasm,15,General,Environment : atmospheric pollution , smoke , dust Poor general health nutritional deficiencies systemic disorders( diabets, immune deficiency syndromes),16,Bacteriology,Viral infection -bacterial invasion pneumococci, streptococci, H. influenzae Anaerobic organisms and mixed infections,17,Pathology of sinusitis,Acute inflammation of sinus mucosa causes hyperaemia, exudation of fluid , outpouring of polymorphonuclear cells and increased activity of serous and mucous glands. Depending on the virulence of organisms, defences of the host and capability of the sinus ostium to drain the exudates, the disease may be mild (none-suppurative) or severe( suppurative),18,Initially ,the exudate is serous; later it may become mucopurulent or purulent. Severe infections cause destruction of mucosal lining. Failure of ostium to drain results in empyema of the sinus and destruction of its bony walls leading to complications.,19,Acute maxillary sinusitis,20,Aetiology,Most commonly, it is viral rhinitis which spreads to involve the sinus mucosa. This is followed by bacterial invasion. Diving and swimming in contaminated water. Dental infections are important source of maxillary sinusitis. Trauma,21,Clinical features,Clinical features depend on severity of inflammatory process and efficiency of ostium to drain the exudates. Closed ostium sinusitis is of greater severity and leads more often to complications.,22,Constitutional symptoms consist of fever, general malaise and body ache. They are the result of toxaemia. Headache Pain Tenderness Redness and oedema of cheek. Nasal discharge Post nasal discharge,23,Diagnosis,X-rays or CT scan : an opacity or a fluid level in the involved sinus.,24,Treatment,25,Medical,26,Antimicrobial drugs,Ampicillin or amoxicillin Erythromycin or doxycycline or cotrimoxazole -lactamase-producing strains of influenzae may necessitate the use of amoxicillin/clavulanic acid sparfloxacin,27,Nasal decongestant drops,1% ephedrine,28,steroids,As nasal sprays Avoid long-term systemic steroids,29,Steam inhalation,Steam alone provides symptomatic relief and encourage sinus drainage. Inhalation should be given 15 to 20 minutes after decongestion for better penetration.,30,Analgesics,Paracetamol,31,Hot fomentation,Local heat to the affected sinus is often soothing and helps in the resolution of inflammation.,32,Surgical,Antral puncture and irrigation Most cases of acute maxillary sinusitis respond to medical treatment. Antral puncture and irrigation is rarely necessary. It is done only when medical treatment has failed and only under cover of antibiotics.,33,34,complications,Chronic sinusitis Osteomyelitis of the maxilla Orbital cellulitis or abscess,35,Acute frontal sinusitis,36,Aetiology,Usually follows viral infections of upper respiratory tract followed later by bacterial invasion. Entry of water into the sinus during diving or swimming. External trauma to the sinus. Oedema of middle meatus,secondary to associated maxillary or ethmoid sinus infection.,37,Clinical features,Frontal headache Tenderness Oedema of upper eyelid with suffused conjunctiva and photophobia. Nasal discharge,38,Treatement,39,Medical,This is same as for acute maxillary sinusitis: antimicrobials, decongestion ,analgesics, steroid . Placing a pledget of cotton soaked in a vasoconstrictor in the middle meatus,once or twice daily,helps to relieve ostial oedema and promotes sinus drainage and ventilation.,40,If patient shows response to medical treatment and pain is relieved ,treatment is continued for full 10 days to 2 weeks.,41,Surgical,Trephination of frontal sinus. If there is persistence of pain or pyrexia in spite of medical treatment for 48 hours, or if the lid swelling is increasing , frontal sinus is drained externally.,42,43,44,Complications,Orbital cellulitis Osteomyelitis of frontal bone Meningitis , extradural abscess or frontal lobe abscess. Chronic frontal sinusitis.,45,Acute ethmoid sinusitis,46,Aetiology,Acute ethmoiditis is often associated with infection of other sinuses. Ethmoid sinuses are more often involved in infants and young children.,47,Clinical features,Pain Oedema of lids Nasal discharge Swelling of the middle turbinate,48,Treatment,Medical treatment is the same as for acute maxillary sinusitis. Visual deterioration and exophthalmos indicate abscess in the posterior orbit and may require drainage of the ethmoid sinuses into the nose.,49,Complications,Orbital cellulitis and abscess Visual deterioration and blindness due to involvement of optic nerve . Cavernous sinus thrombosis. Extradural abscess, meningitis or brain abscess.,50,Acute sphenoid sinusitis,51,Aetiology,Isolated involvement of sphenoid sinus is rare . It is often a part of pansinusitis or is associated with infection of posterior ethmoid sinuses.,52,Clinical features,Headache : occiput or vertex Postnasal discharge,53,Differential diagnosis,neoplasms of the sphenoid sinus may clinically simulate features of acute infection of sphenoid sinus and should always be excluded in any case of isolated sphenoid sinus involvement.,54,Treatment,55,Chronic sinusitis,56,In general,Sinus infection lasting for months or years is called chronic sinusitis. Most important cause of chronic sinusitis is failure of acute infection to resolve.,57,pathophysiology,Persistence of infection causes mucosal changes, such as loss of cilia , oedema and polyp formation, thus continuing the vicious cycle.,58,pathology,In chronic infections , process of destruction and attempts at healing proceed simultaneously. Sinus mucosa becomes thick and polypoidal or undergoes atrophy.,59,Bacteriology,Mixed aerobic and anaerobic organism are often present,60,Clinical features,Clinical features are often vague and similar to those of acute sinusitis but of lesser severity. Purulent nasal discharge is commonest complaint. Foul-smelling discharge suggests anaerobic infection.,61,Local pain and headache are often not marked . Some patients complain of nasal stuffiness and anosmia.,62,Diagnosis,X-ray or CT scan : mucosal thickening or opacity Aspiration and irrigation: finding of pus in the sinus is confirmatory.,63,Treatment,It is essential to search for underlying aetiological factors which obstruct sinus drainage and ventilation. A workup for nasal allergy may be required. Culture and sensitivity of sinus discharge helps in the proper selected of an antibiotic.,64,Initial treatment of chronic sinusitis is conservative, including antibiotics, decongestants, antihistaminics and steroids . Some form of surgery is required either to provide free drainage and ventilation or radical surgery to remove all irreversible diseases.,65,Recently , endoscopic sinus surgery is replacing radical operations on the sinuses and provides good drainage and ventilation. It also avoids external incisions.,66,Surgery,67,Chronic ma