Understanding Sinusitis: Causes and Treatment
Translated by
ScribdTranslationsUnderstanding Sinusitis: Causes and Treatment
Translated by
ScribdTranslationsSinusitis
ANATOMY
Paranasal sinuses.
act as cameras of
resonance for the voice;
provide protection to
brain against trauma;
moisten and humidify the
air quality, and
lighten the weight of the
facial skeleton
Previous
flows into the
middle meat and
posterior meatus
superior.
SINUSITIS
It is the inflammation
from the mucosa of the
paranasal sinuses.
It can affect one of the paranasal sinuses (monosinusitis) or two or
more sinuses (associated sinusitis: ethmoid-maxillary,
frontoethmoidal, sphenoethmoidal.
85% maxillary sinus, 15% some alteration
secondary to one structural at the level of the
odontogenic process of uncinate process of the
first or second ostiomeatal unit
upper molar (septal deviation, tumor).
EPIDEMIOLOGY
. It is estimated that children experience between 6 to 8 colds per year.
they can complicate in 5 to 10% of cases with acute sinusitis, no
There is no preference for race or sex.
. 1-2% of those that affect adults
. Chronic sinusitis affects 15% of the population.
The prevalence of sinusitis is
higher in children who suffer
some type of respiratory allergy
and in older children.
Maxillary and ethmoidal sinuses
they form during the
third and sixth month of
gestation
The frontal sinuses
they start to
develop from
from 6 to 7 years.
The sphenoidal sinuses
from 3 to 4 years old The most common sinusitis in children is
the ethmoidal followed by the maxillary
ETIOPATHOGENESIS
OBSTRUCTION
OF THE OSTEUM
Accumulation
Inflammation
of
mucosa
secretions
Proliferation Decrease
from the pressure
of of oxygen and
pathogens pH
Factors that favor sinusitis
. Dryness of the inspired air (air conditioning, heating).
. Pollution (Smoking).
. Allergic rhinitis.
. Structural malformations: deviation of the nasal septum
. Immunodeficiencies; (AIDS).
. Abuse of nasal sprays.
. Situations that cause nasal mucosa congestion: Nasal irritants.
. Mechanical obstruction: foreign bodies, etc.
. Nasal trauma
. Recent intubation.
. Dental infection.
. Adenoid hypertrophy.
Streptococcus pneumoniae (35%).
Haemophilus influenzae (20-35%)
(+children)
Bacterial Streptococcus pyogenes (10%).
Moraxella catarrhalis (5%).
Anaerobic bacteria (odontogenic and
50% of chronic S.
Adenovirus
Influenza
Viral
Parainfluenza
Allergic
Rhinovirus
ACUTE SINUSITIS
Children under 12 weeks with complete resolution of symptoms
Clinical manifestations
. Nasal congestion
. Pain on facial pressure and percussion
. Pain in the affected breast (sensation of
heaviness, stabbing pain
. Exudate (rhinorrhea)
. Headache (Increases when making efforts,
bend down, cough
. Periorbital edema (ethmoidal sinusitis)
. Foul breath
. Persistent cough (+ childish)
CHRONIC SINUSITIS
Over 12 weeks old.
. The pathophysiology is not fully understood,
. Systemic, local, and environmental factors play roles
important predisposing factors.
. Presence or absence of nasal polyps
. Anaerobes can play an important role (up to 50%
of the cases).
SEMIOLOGY AND EXPLORATION
Anamnesis, clinical and examination
Exploration:
Anterior rhinoscopy (systematic routine):
•Exudado nasal: cantidad, coloración
Cornets: amplitude, narrowness of the meatuses.
Nasal mucosa: coloration, swelling.
Nasal septum: deformities.
Secretion that may flow through the middle meatus.
Bleeding points.
Neoformations.
Foreign bodies.
Posterior rhinoscopy:
•Coanas: forma, exudado
Tail of the horns.
Partition.
Mucosa.
Complementary explorations:
Radiological study Transillumination
Application of a
light to the wall
average of the veil of
palate, in a
dark room
. Reveals the presence of hydro-aerial levels,
. Mucous thickening,
TC . Obstruction or blockage of the ostiomeatal complex,
. Predisposing anatomical factors.
In special cases:
recurrent sinusitis
graves, complications
Laboratory:
. Sinus aspiration and cultures of the aspirate
Differential diagnosis
TREATMENT
Objectives:
1st Eradicate the germ of the breast.
2. Alleviate the symptoms.
3. Improve the drainage of the affected sinuses.
Treatment analgesics-antipyretics
symptomatic corticosteroids
Improve the nasal humidification and irrigation
drainage vasoconstrictors (decongestants)
ANTIBIOTIC TREATMENT
Nasal rinses with saline solution:
They moisten the mucosa and decrease the
viscosity.
Surgical treatment
Endoscopic surgery of the affected sinuses.
When Chronic Sinusitis:
. Do not respond to the medical treatment
. Existence of an anatomical abnormality or
mucosal pathology
. Symptomatic polyposis
COMPLICATIONS
Intracranial: epidural or subdural abscess, brain abscess, meningitis,
cerebritis and thromboses of the cavernous sinus.
Oseas: maxillary osteomyelitis or frontal bone osteomyelitis
Fungal Sinusitis
Non-invasive disease in a host
immunocompetent, (AIDS, Diabetes Mellitus)
Classic fungal pathogens are Aspergillus, Mucor.
rhizopus
Mild sinusitis Unilateral sinusitis Fungal sinusitis
insidious mushroom ball allergic
Generally, it is Correct by means of Patients with polyps
cure with a surgery of surgery and in case nasal and asthma
endoscopic and without of bone erosion Presence of mucus
antifungals. antifungals. thick with
abundant eosinophils
and consistency of
butter of
peanut
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