Defenition Acute infection and inflammation of paranasal sinuses

Diagnosis At least 2 major symptoms or 1 major and 2 minor symptoms

Major sx Facial pain/ pressure Facial fullness Nasal obstruction Nasal dicharge Hyposmia/ anosmia Fever Minor sx Headache Halitosis Fatigue Dental pain Cough Ear pressure/ fullness

Etiology -Viral: Rhinovirus, Influenza, Parainfluenza -Bacterial: Streptococcus Pneumoniae, Haemophilus Influenzae, Moraxella catarhalis, anaerobes

Clinical features -Sudden onset of : -Nasal blockage and or nasal discharge/ posterior nasal drip -Facial pain or pressure -Hyposmia Signs more suggestive of a bacterial etiology: -Erythematus nasal mucosa -Mucopurulent discharge -Pus originating from middle meatus -Presence of nasal polyps of a deviated septum Acute viral rhinsinusitis lasts < 10 days.

Diagnosis -Anterior rhinoscopy -X-ray/ CT scan not recomnded unless complications are suspected

Management: -Symptoms relieved within 5 days symptomatic relief and expectant management -Moderate symptoms that worsen or persist beyond 5 days intranasal corticosteroid spray -Severe symptoms that worsen or persist beyond 5 days and refractory to intranasal corticosteroid Clarythromycin, INCS , referral to specialist Surger if medical treatment fails

Defintion: Inflammation of the paranasal sinuses lasting >3months

Etiology -Inadequate treatment of acute sinusitis -Untreated nasal allergy -Allergic fungal rhinosinusitis -Anatomic abnormality e.g. deviated septum -Underlying dental disease -Cilliary disorder e.g. CF -Chronic inflammatory disorder e.g. wegeners

Organisms -Bacterial: S. Pneumoniae, H. Influenzae, M. catarhalis, S.pyogenes, S.auereus, anaerobes -Fungal: Aspergillus

Clinical features -Chronic nasal obstruction -Purulent nasal discharge -Pain over sinuses and headache -Halitosis -Yellow-brown post-nasal discharge -Chronic cough -Maxillary dental pain

Treatment antibiotics for 3 to 6 weeks for infectious etiology augmented penicillin (Clavulin), macrolide (clarithromycin), fluoroquinolone (levofloxacin), clindamycin, FlagyjTM topical nasal steroid, saline spray surgery if medical therapy fails or fungal sinusitis Surgical Treatment removal of all diseased soft tissue and bone, post-op drainage and obliteration of preexisting sinus cavity functional endoscopic sinus surgery

Complications of rhinosinusitis range from relatively benign to potentially fatal. The incidence of complications from both acute and chronic rhinosinusitis has decreased as a result of the use of antibiotics.
[2]

Complications can be divided into three categories: Orbital, intracranial, and bony.

Orbital complications
The orbit is the structure most commonly involved in complicated sinusitis.

Orbital extension is usually the result of ethmoid sinusitis.

Children are more prone to orbital complications, probably secondary to high incidence of URI and sinusitis.

IC are uncommon but devastating. Two major mechanism:

Direct extension. Retrograde thrombophlebitis via valveless diploe veins. * Frontal sinus is rich in diploe veins especially during adolescence

Meningitis Sphenoid, ethmoid Epidural abscess Frontal Subdural abscess Frontal Intracerebral abscess Frontal Cavernous sinus thrombosis Sphenoid, ethmoid ..proptosis ,chemosis and opthalmoplegia chatacterize it . Superior sagittal sinus thrombosis Frontal

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