鼻窦炎英文版讲义

1、鼻窦炎英文版Anatomy of the nasal sinusesAnterior sinus : maxillary sinus frontal sinus anterior ethmoidal sinusThey all open in the middle meatus.Posterior sinus: posterior ethmoidal sinus :open in the superior meatus sphenoid sinus: open in sphenoethmoidal recess overviewSinusitis has been defined as an

2、inflammation of the mucous membrane of the sinuses.two types- acute sinusitis and chronic sinusitis.Acute sinusitisAcute 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:Pans

3、inusitis:Aetiology of sinusitis in generalExciting causesNasal infectionSwimming and divingTraumaDental infectionPredisposing causeslocalObstruction to sinus ventilation and drainage1、nasal packing3、hypertrophic turbinates4、nasal polypi5 、oedema of sinus ostia due to allergy or vasomotor rhinitis 6、

4、 benign or malignant neoplasmGeneral Environment : atmospheric pollution , smoke , dustPoor general health nutritional deficiencies systemic disorders( diabets, immune deficiency syndromes) Bacteriology Viral infection -bacterial invasionpneumococci, streptococci, H. influenzaeAnaerobic organisms an

5、d mixed infections Pathology of sinusitisAcute 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 ostiu

6、m to drain the exudates, the disease may be mild (none-suppurative) or severe( suppurative)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

7、of its bony walls leading to complications.Acute maxillary sinusitis AetiologyMost 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.

8、 Trauma Clinical featuresClinical 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.Constitutional symptoms consist of fever, general malaise and body ache. They are

9、the result of toxaemia.Headache PainTendernessRedness and oedema of cheek.Nasal discharge Post nasal dischargeDiagnosis X-rays or CT scan : an opacity or a fluid level in the involved sinus.TreatmentMedicalAntimicrobial drugsAmpicillin or amoxicillinErythromycin or doxycycline or cotrimoxazole -lact

10、amase-producing strains of influenzae may necessitate the use of amoxicillin/clavulanic acid sparfloxacinNasal decongestant drops1% ephedrine steroidsAs nasal spraysAvoid long-term systemic steroidsSteam inhalationSteam alone provides symptomatic relief and encourage sinus drainage.Inhalation should

11、 be given 15 to 20 minutes after decongestion for better penetration.AnalgesicsParacetamol Hot fomentationLocal heat to the affected sinus is often soothing and helps in the resolution of inflammation.SurgicalAntral puncture and irrigationMost cases of acute maxillary sinusitis respond to medical tr

12、eatment. Antral puncture and irrigation is rarely necessary. It is done only when medical treatment has failed and only under cover of plicationsChronic sinusitisOsteomyelitis of the maxillaOrbital cellulitis or abscessAcute frontal sinusitisAetiologyUsually follows viral infections of upper respira

13、tory 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.Clinical featuresFrontal headacheTendernessOedema of upper eyelid with suffused co

14、njunctiva and photophobia.Nasal dischargeTreatement 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 s

15、inus drainage and ventilation.If patient shows response to medical treatment and pain is relieved ,treatment is continued for full 10 days to 2 weeks.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 i

16、s increasing , frontal sinus is drained externally.Complications Orbital cellulitisOsteomyelitis of frontal bone Meningitis , extradural abscess or frontal lobe abscess.Chronic frontal sinusitis.Acute ethmoid sinusitisAetiology Acute ethmoiditis is often associated with infection of other sinuses. E

17、thmoid sinuses are more often involved in infants and young children. Clinical features Pain Oedema of lidsNasal dischargeSwelling of the middle turbinateTreatment Medical treatment is the same as for acute maxillary sinusitis.Visual deterioration and exophthalmos indicate abscess in the posterior o

18、rbit and may require drainage of the ethmoid sinuses into the nose.Complications Orbital cellulitis and abscessVisual deterioration and blindness due to involvement of optic nerve .Cavernous sinus thrombosis.Extradural abscess, meningitis or brain abscess.Acute sphenoid sinusitisAetiology Isolated i

19、nvolvement of sphenoid sinus is rare . It is often a part of pansinusitis or is associated with infection of posterior ethmoid sinuses.Clinical featuresHeadache : occiput or vertexPostnasal dischargeDifferential diagnosis neoplasms of the sphenoid sinus may clinically simulate features of acute infe

20、ction of sphenoid sinus and should always be excluded in any case of isolated sphenoid sinus involvement.Treatment Chronic sinusitisIn generalSinus infection lasting for months or years is called chronic sinusitis. Most important cause of chronic sinusitis is failure of acute infection to resolve.pa

21、thophysiologyPersistence of infection causes mucosal changes, such as loss of cilia , oedema and polyp formation, thus continuing the vicious cycle.pathologyIn chronic infections , process of destruction and attempts at healing proceed simultaneously.Sinus mucosa becomes thick and polypoidal or unde

22、rgoes atrophy.Bacteriology Mixed aerobic and anaerobic organism are often presentClinical featuresClinical 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. L

23、ocal pain and headache are often not marked . Some patients complain of nasal stuffiness and anosmia.Diagnosis X-ray or CT scan : mucosal thickening or opacityAspiration and irrigation: finding of pus in the sinus is confirmatory.Treatment It is essential to search for underlying aetiological factor

24、s 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.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.Recently , endoscopic sinus surgery is replacing radical operations on the sinuses and provides good drainage and ventilation. It also avoi