Infectious Rhino-Sinusitis PDF

Rhinosinusitis DR. Shorash Sindi FIBMS(ENT) Acute RS: ≤ 4 weeks, commonly caused by viral, may complicated by bacterial infection (so give ATB if symptoms not resolved after 1 week) Viruses: rhinovirus, RCV, influenza, parainfluenza viruses. Bacteria: S pneumonae, H.infuenzae, M catarrhalis....

Rhinosinusitis DR. Shorash Sindi FIBMS(ENT) Acute RS: ≤ 4 weeks, commonly caused by viral, may complicated by bacterial infection (so give ATB if symptoms not resolved after 1 week) Viruses: rhinovirus, RCV, influenza, parainfluenza viruses. Bacteria: S pneumonae, H.infuenzae, M catarrhalis. Infection of dental origin: anaerobic and mixed. Single sinus infection: dental, fungal ball, FB. Rx 1. Oral antibiotics for 3-4 weeks if symptoms > 1 week (amoxicillin or amoxiclav (better), 3rd gen cephalosporin. Levo or macrolides (if allergic to penicillin)) 2 Local decongestant ( 12 weeks CFx Nasal obstruction is most common, followed by facial congestion, Discolored nasal discharge, hyposmia High fever usually absent Fatigue and myalgias are common Ex: maybe normal, Mucosasl edema, Nasal polyp, Purulent secretion in acute exacerebation, Local predisposing factors as septal deviation Ix: native CT, coronal view. Rx Medical 1- Antibiotics (Amoxiclav, levofloxacilin is better). To treat acute exacerebation of CRS 2- Steroid nasal spray: to reduce inflammation and osteal obstruction (8-12 weeks) 3- Oral steroid: (if polyps) 4- Nasal douche by isotonic solution 5- LTRA as montelukast Surgical: Functional endoscopic sinus surgery FESS Acute RS: Symptoms lasting for less than 4 weeks with complete resolution. Subacute RS: Duration 4-12 weeks. Chronic RS: Duration ~ 12 weeks. Recurrent RS: Four or more episodes of RS per year; each lasting for 7-10 days or more with complete resolution in between the episodes. Acute exacerbation of chronic RS is the sudden worsening of chronic RS with return to baseline after treatment. Defenition : Rhinosinusitis simply defined is an inflammatory and/or infectious condition of nasal cavity and one ntI neustnn sina.in or more of the paranasal sinus cavities. manner he yffi stated yq am middle gg EE e IntoNorolaum Why rhinosinusitis ? Usually rhino sinusitis is combined together bcs the mucosa of both continuous with each other T The ciliated respiratory mucosal lining of the nose and paranasal sinuses are, however, contiguous and it would be rare for one to be affected without the other. Typically affects qq.EE.EE children ethmg.in cneaveyf.no Pathogenesis of Infectios rhinosinusitis a 2 stagnation This is a vicious cycle i g which needs to be breaked 2  Classification of rhinosinusitis Classification of rhinosinusitis Infectious: 1. Acute rhinosinusitis 2. Chronic nonspecific RS, Chronic specific RS (TB, Syphilis, Atrophic rhinitis and Rhinoscleroma) Non-infectious: 1. Allergic rhinitis 2. Non allergic rhinitis: Idiopathic/vasomotor, Occupational, Hormonal, Drug induced (aspirin, nsaids, methyldopa, ACEi, β ⊖, OCP), Rhinitis medicamentosa, NARES. trauma Smokin Hamge epithelium 2- Non infectious rhinitis 1- Infectious rhinitis 2 A- Acute : B- 1- chronic nonspecific RS 2 A- Allergic B-Non allergic rhinitis : rhinosinusitis rhinitis 1- Idiopathic rhinitis 2- Chronic :specific RS attain ( vasomotor rhinitis) TB, 2- Occupational rhinitis syphilis , 7 atrophic rhinitis When inferior turbinate is cut as 3 Hormonal rhinitis 4 Drug induced an old treatment of allergic rhinitsn (empty nose syndrome) rhinitis and Rhinoscleroma 5Rhinitis medicamentosa Infective rhinosinusitis Infective rhinosinusitis is one of the most common disorders encountered by otorhinolaryngologists. The acute viral form of rhinosinusitis is part of the common cold and hence affects almost everyone. Nasal  Rhinters IP ta Acute viral RS It is caused by respiratory viruses, usually the common cold viruses such as rhinoviruses, influenza and parainfluenza. Spread by aerosolised droplets through coughing and sneezing. Incubation period is 1-4 days. Clinical features include nasal congestion (blockage), rhinorrhoea, sneezing and low-grade fever. Unless complicated by bacterial infection, the patient improves within a week or 10 days. It is a self-limiting disease. Treatment is symptomatic with use of Topical nasal decongestants Antihistamines Analgesics (aspirin should be avoided, as it causes increased shedding of the virus) Plenty of fluid intake should be encouraged Nasal saline sprays are useful Antibiotics are not needed if patient is immunocompromised, it can convert to bacterial RS, and also cause pharyngitis, bronchitis, pneumonia or otitis media. dfsinusouh. T Obstruction Acute bacterial RS Usually follows viral upper respiratory infection. virus damages the cilia and epithelium, and causes oedema of the mucosa membrane and obstruction of sinus ostia with stasis of sinus secretion and subsequent bacterial infection. 0 The most common bacteria responsible for RS are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus. Clinical features include nasal obstruction and purulent rhinorrhoea. Facial pain/pressure are the cardinal symptoms. Hyposmia/anosmia, cough, fever, headache, fullness of ear, dental pain or halitosis may be other associated symptoms. fr Pain1pL  _snpnau Acute rhinosinusitis Duration equal or less 48 than 4 weeks Most commonly caused by viral infection and may complicated by secondary bacterial infection So only give antibiotics when symptoms not resolved for more than 1 week Causative agents Viruses: rhinovirus, RCV, influenza, parainfluenza viruses. Bacteria: S pneumonae, H.infuenzae, M catarrhalis. Infection of dental origin: anaerobic and mixed. ⚫ Viruses ⚫ Bacteria postie ⚫ The most frequently ⚫ Streptococcus detected viruses pneumonae pontiffs wrote ,H.infuenzae,Marexella 0 ⚫ include rhinovirus, catarrhalis Moraxella ⚫ respiratory syncytial ⚫ Infection of dental origin virus, ⚫ influenza virus, 80 anaerobic and mixed 0 infection ⚫ and parainfluenza virus. D.dx of single sinus infection: - Dental origin - Fungal ball - Foreign body Major symptoms (Major criteria) f bending ⚫Facial pain/pressure woke when leaning ⚫ Facial congestion/fullness ⚫ Nasal obstruction/blockage ⚫ Nasal discharge/purulence/discoloured (Anterior) ⚫ posterior drainage ⚫ Hyposmia/anosmia ⚫ Purulence on nasal examination ⚫ Fever (acute RS only) gym Minor symptoms Minor criteria ⚫ Headache ⚫ Fever (nonacute) ⚫ Halitosis badbreath odor ⚫ Fatigue healer ⚫ Dental pain a ⚫ Cough f Due to posterior drainage Post nasal drip ⚫ Ear pain/pressure/ a new fullness on Ey For diagnosis Require two major factors or one major with 2 minor criteria 2495110 or lmajoutzmino.i.E.EE Ex On examination ⚫ On examination ⚫Tenerness over the affeted sinus 0 ⚫ Pus in the8 middle meatus ⚫ Swellen red turbinate Investigation Acute RS is a clinical diagnosis No Need for Investigations CT needed if you suspect complications or condition not resolved with treatment Acute Rs Air-fluid level a Frothy secretions  better within If doesntget one week Treatment of acute RS if > 1 week: amoxicillin or amoxiclav (better), 3rd gen cephalosporin. 8 1 Antibiotics Levofloxacin or macrolides (if allergic to penicillin) Oral antibiotics for 3-4 weeks 0 Xylometazoline Oxymetazoline 2 Local decongestant (not more thamn 3 days )3.5170 3 Analgesia 4 Nasal irrigation to liquefy nasal secretion (hypertonic saline Topical use of xylometazoline should be limited only for few days as prolonged use can cause rhinitis medicamentosa. Chronic rhinosinusitis CRS lasting 12 ⚫ CRS is defined as an inflammatory condition of the nasal cavity and paranasal sinuses lasting for longer than 12 weeks. Can be infectious (usually mixed) or non infectious subacute: 4-12 weeks Nowadays subacute is not used because you don’t know how to treat whether to treat as acute or chronic, so only they use acute and chronic Acute < 3 months Chronic > 3 months Clinical features of CRS ⚫ The signs and symptoms ⚫ of CRS often vary in severity and prevalence. Nasal obstruction (is the most common symptom, followed ⚫ by facial congestion-pressure-fullness , There is no rhinosinusitis without nasal obstruction ⚫ Discolored nasal discharge ⚫ and hyposmia ⚫ High fevers are usually absent, although fatigue and myalgias are common On examination ⚫ Mucosasl edema Lois ⚫ Nasal polyp yes (CRS classified to without polyp and with polyp) a ⚫Purulent secretion in case of acute exacerebation ⚫ Local predisposing factors like septal deviation - Maybe normal Investigation of CRS Ct can CT- of the scan nosenose of the and paranasal sinusessinuses is and paranasal investigation ofview Native CT, coronal choice chronic PE Native CT, coronal view Mucosal thickness a Treatment of CRS 1- Antibiotics c 0 (Amoxiclav, levofloxacilin is better) To treat acute exacerebation of CRS Route of adminstration Oral Intravenous Recently local route by nebulizer Treatment of CRS con…. 2-Steroid nasal spray : to reduce inflammation and osteal obstruction 3-Oral steroid :can be given ,with tappered dose, And monitored for side effects (If polyps) 4-nasal douche by is0tonic solution 5- leuktrein atagonist Antihistamine thicken the mucus Surgical treatment of CRS Functional endoscopic sinus surgery. (FESS) Minimally invasive Avoid external scar Treat the pathology under direct vision  Orbital: all more in children 7-10 years Preseptal cellulitis: oral ATB Orbital cellulitis: IV ATB Subperiosteal & Orbital abscess: drainage + sinus surgery. Cavernous sinus thrombosis: IV ATB, sinus surgery ± AC. Complications of RS Intracranial: meningitis, extradural, subdural and brain abscess. Pott Puffy Tumor is osteomyelitis of the frontal bone with the development of a subperiosteal abscess manifesting as a puffy swelling on the forehead or scalp. It usually A-Orbital complication: Chandler's classification occurs as a complication of frontal sinusitis. 1. periorbital edema Preseptal cellulitis presents with unilateral swelling of the eyelids, erythema, local pain and sometimes pyrexia. There should be no proptosis and no limitation of eye movement. It is important to be aware that infection can progress rapidly and spread beyond the orbital septum could lead to abscess formation and threaten vision. 2. orbital cellulitis tewif n1e The following are important clinical features that should be identified, documented and monitored: conjunctival oedema (chemosis), limitation of eye movement (ophthalmoplegia), nsttnatcn.se painful eye movements, proptosis, pupillary reaction, visual acuity and color vision. With orbital cellulitis, there may be some degree of ophthalmoplegia related to edema of the 1 extraocular muscles, and a mild decrease in visual acuity related to corneal edema. Colour vision affected first infection of fat airuseles offend 3. subperiosteal abscess Abscesses typically arise adjacent to the lamina papyracea, although some extend or arise superiorly beneath the thin floor of the frontal sinus. Displacement of the globe, proptosis and ophthalmoplegia can all arise from orbital cellulitis or a subperiosteal or orbital abscess. However, it can be very difficult to fully examine the eye in a sick, unwell, uncooperative In child, and the presence of painful eye movements, chemosis and/or proptosis should instigate an urgent CT scan 4. orbital abscess formation of an orbital abscess. Severe proptosis, chemosis, ophthalmoplegia, and visual loss are usually present. 5. cavernous sinus thrombosis results from retrograde thrombophlebitis of the valveless ophthalmic veins  serif (Frozen eye) brainabscess Periorbital edema can usually be treated in an outpatient setting with oral antibiotics and close follow-up in the absence of medical comorbidities such as uncontrolled diabetes. Orbital cellulitis usually responds to intravenous antibiotics, whereas subperiosteal and orbital abscesses require operative drainage of the abscess with concurrent sinus surgery. Cavernous sinus thrombosis can truly be life-threatening. Even in the post-antibiotic era, the mortality rate of cavernous sinus thrombosis is 30%.an Intravenous antibiotic treatment should be instituted immediately, and, if indicated, the involved sinuses should be surgically drained. The role of anticoagulation to prevent further thrombus formation and systemic steroid therapy is controversial. The incidence of all orbital complications is higher in the pediatric 7-10 years population than in adults. say o O Abscess G v Complications of RS con…. B- intracranial B- intracranialinfection infection Like extradural ,subdural and menigitis ,brain abscess C. Pott Puffy Tumor C. Tumor Pott puffy tumor is an osteomyelitis of the frontal bone with the development of a subperiosteal abscess manifesting as a puffy swelling on the forehead or scalp. It usually occurs as a complication of frontal sinusitis Antibiotics for 4 to 6 weeks surgical drainage THANK YOU I