SINUS
What is sinus
anatomical cavities or hollow spaces
air-filled spaces located in the bones of the face and
skull, connected to the nasal cavity.
Frontal sinuses (forehead)
Maxillary sinuses (cheekbones)
Ethmoid sinuses (between the eyes)
Sphenoid sinuses (behind the eyes, deeper in the
skull)
Function:
Lighten the weight of the skull
Produce mucus to moisturize the inside of the nose
Improve voice resonance
Types of sinusitis
Type Duration Cause
Acute Less than 4
weeks Usually caused by
a cold or infection
Subacu 4–12 weeks May follow acute
te sinusitis
Chroni More than Often linked to
c 12 weeks allergies, nasal
issues
Recurr Several Multiple episodes
ent times per of acute sinusitis
year
Nasal Cavity. Anatomy of the nasal cavity,
including the frontal sinus, superior turbinate,
middle turbinate, inferior turbinate, sphenoid
sinus, nasopharynx, adenoid pad, eustachian
tube orifice, fossa of Rosenmuller, and nasal
vestibule
Function of sinus
The nose and sinuses are lined with a layer of mucous-
producing cells
They secrete mucus to protect against infection and
humidify the air you breathe before it reaches the
lungs. The thin mucus traps dirt, dust, and
pollutants and drains out into the throat where
stomach acid ultimately destroys it when it's
swallowed.
Sinuses help to lighten the weight of the skull. Each
sinus opening is inside the cranial bone which
makes it partly hollow, so the head is lighter.
When you have nasal congestion or if your sinuses
are obstructed, the reduced airflow can affect the
quality of your voice resulting in hyponasal speech
(or not enough nasal resonance).
They act as a crumple zone to safeguard the skull in
case of an injury to the face. Think of sinuses like air
pillows, which may be used to protect the face from
trauma.
Sinus conditions, commonly known as sinusitis,
involve inflammation or swelling of the sinuses, air-filled
cavities in the skull near the nose.
Common Sinus Problems
Sinuses can present a range of conditions requiring
relief when the cavities around the nasal passages
become inflamed or obstructed
Sinusitis
when fluid builds in in the sinuses, it allows germs to
grow. Viruses cause most sinus infections, but
bacteria also can cause some. Symptoms include a
stuffy nose, pain or pressure in the face and teeth,
fatigue, cough, sore throat, headache, and fever
Sinus Headache
happens when your sinuses become inflamed due to
an allergy or infection. It can cause deep pain in
your cheekbones, forehead, and the bridge of your
nose that usually worsens when you move your
head.
Allergic Rhinitis
or Hay Fever is the body's reaction to allergens in
the air that can cause a stuffy or runny nose.
Colds
can cause inflammation of sinus tissue which may
create a breeding ground for sinus infections.
Clogged sinuses can slow the usual flow of mucus
which clears out bacteria and may make your
sinuses more prone to infections.
Signs and symptoms
Runny nose
Stuffy nose
Facial pain or pressure
Headache
Mucus dripping down the throat (post-nasal drip)
Sore throat
Cough
Bad breath
Risk factors
A previous cold.
Seasonal allergies.
Smoking and exposure to secondhand smoke.
Structural problems within the sinuses. For
example, growths on the lining of the nose or
sinuses, known as nasal polyps.
A weak immune system or taking drugs that weaken
the immune system.
Causes
Viruses cause most sinus infections, but bacteria can
cause some sinus infections.
Source of info
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NBK513272/
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and-tips-for-prevention/
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e+Or
Recurrent acute rhinosinusitis (RARS)
is defined as experiencing 4 or more episodes of
acute rhinosinusitis per year, with each episode
lasting at least 10 days and without persistent
symptoms in between individual episodes
the most common bacterial pathogens
causing RARS are Streptococcus
pneumoniae, Haemophilus influenzae,
other Streptococcus species, Moraxella
catarrhalis, and Staphylococcus aureus.
Anon JB, Jacobs MR,
Poole MD, Ambrose PG,
Benninger MS, Hadley
JA, Craig WA., Sinus And
Allergy Health
Partnership.
Antimicrobial treatment
guidelines for acute
bacterial
rhinosinusitis. Otolaryng
ol Head Neck Surg. 2004
Jan;130(1 Suppl):1-45.
Methicillin-resistant S aureus (MRSA) often
colonizes the nares and leads to recurrent sinusitis,
especially in patients who have undergone multiple
courses of antibiotics.
ANATOMY
The boundaries of the nasal cavity are the cribriform
plate superiorly and the palatine processes of the
maxilla inferiorly. Located on the lateral wall of the
nose are the inferior, middle, superior turbinates,
and, in some individuals, the supreme turbinates.
The ostia for the anterior ethmoid sinuses and
maxillary sinuses are beneath the middle turbinate,
whereas the nasolacrimal duct opens beneath the
inferior turbinates. The sphenoid ostium is located
between the posteromedial border of the superior
turbinate and the nasal septum. The nasal septum
divides the nasal cavity and is comprised of both
cartilage and bone and lined by respiratory mucosa.
The boundaries of the nasal cavity are the cribriform
plate superiorly and the palatine processes of the
maxilla inferiorly. Located on the lateral wall of the
nose are the inferior, middle, superior turbinates,
and, in some individuals, the supreme turbinates.
The ostia for the anterior ethmoid sinuses and
maxillary sinuses are beneath the middle turbinate,
whereas the nasolacrimal duct opens beneath the
inferior turbinates. The sphenoid ostium is located
between the posteromedial border of the superior
turbinate and the nasal septum. The nasal septum
divides the nasal cavity and is comprised of both
cartilage and bone and lined by respiratory mucosa.
Ethmoid Sinus
The ethmoid sinus is made of small air cells and
divided into two groups: anterior and posterior.
Anterior ethmoid cells include:
o Frontal recess cells
o Bullar cells
o Infundibular cells
These drain through a passage called the
infundibulum, which lies next to the middle
turbinate (a structure inside the nose).
The uncinate process is a thin bone that helps
form the drainage path.
Most of the anterior ethmoid cells drain into the
middle meatus (a space in the nasal cavity).
The posterior ethmoid cells drain into the
sphenoethmoidal recess, near the top/back of the
nose.
Blood supply comes from the anterior and
posterior ethmoidal arteries, and nerve supply
comes from the ophthalmic nerve (a branch of the
5th cranial nerve).
Maxillary Sinus
Located under the eyes, shaped like a triangle.
Boundaries:
o Top: Orbital floor (bottom of the eye socket)
o Inner side: Nasal wall
o Outer side: Cheek bone area
Drains through a small opening (natural ostium) into
the hiatus semilunaris.
Sometimes has extra drainage holes (accessory
ostia).
Frontal Sinus
Develops from frontal recess cells of the anterior
ethmoid.
Not fully developed until 18–20 years old.
Separated into left and right sides by a septum.
Drains through the nasofrontal recess into the
hiatus semilunaris, under the middle turbinate.
Ostiomeatal Complex
A critical drainage area in the nose.
Includes:
o Middle turbinate
o Uncinate process
o Middle meatus
o Hiatus semilunaris
o Infundibulum
Sinuses that drain here: frontal, anterior ethmoid,
and maxillary.
If this area gets blocked (by polyps, swelling, or
pus), sinus infections can happen.
Sphenoid Sinus
Located deep in the skull, behind the nasal cavity.
Present at birth but starts growing around 3 years
old.
Size varies a lot between people.
Drains into the sphenoethmoidal recess, next to
the superior turbinate.
Nearby important structures:
o Pituitary gland (above)
o Optic nerves, carotid arteries, and
cavernous sinus (sides)
o Sometimes the bone over these structures is
very thin or missing.
Histology
The paranasal sinuses are lined by respiratory
epithelium, which consists of pseudostratified ciliated
columnar epithelium with goblet cells. Numerous
mucous and serosanguinous glands are present. In
addition to mucus, the sinus glands also secrete
immunoglobulins, interferons, and lysozyme. The
anterior portion of the nares and nasal septum are
covered by skin with adnexa. The roof of the nasal cavity
contains specialized olfactory epithelium with bipolar
olfactory neurons.
The most effective antibiotics against Staphylococcus
aureus were vancomycin (100%) and levofloxacin
(82.14%), followed by amikacin (75%), cotrimoxazole
(60.71%), cefoxitin (50%), clindamycin (46.42%),
amoxicillin-clavulanic acid (28.57%), and azithromycin
(7.14%). Vancomycin (100%) showed the highest
susceptibility to methicillin-resistant Staphylococcus
aureus (MRSA), followed by levofloxacin (58.33%),
clindamycin (25%), and azithromycin (33.33%).
Ref-M. Panduranga
Kamath, Vijendra
Shenoy S *, Nithin
Mittal, Nitish Sharma