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CHRONIC SINUSITIS

GROUP 9
Case review
Male, 18 y/o
Smelling reduced ( 6 months ago)
Nasal congestion
Thick & sometime smelly mucus that are ingested into the
throat
Headache
No sneezing & nasal itching
Previous history of same disease
No family history of atopy

Diagnosis:
Bilateral anterior ethmoidal sinusitis, left posterior ethmoidal
sinusistis, bilateral frontal sinusitis and bilateral maxillary
sinusitis chronic
PHYSICAL EXAMINATIONS

General condition Good, not anemic. Height: 160cm Weight: 60kg

Vital signs Normal

Inspection External nose normal

Palpation No edema & crepitation, tenderness in left & right cheek,


tenderness on left & right orbital roof

Otoscopy Normal

Faringoscopy Normal

Anterior rhinoscopy Hyperemic nasal mucosa, congestion nasal turbinate,secrete in


bilateral og middle meatus & nasal cavity

Lab examination Hb 14g/dl, leucocytes 12 600 g%

CXR Normal
Definisi
Radang mukosa sinus paranasalis
Berlangsung lebih dari 3 bulan
Etiologi
Anaerobic microorganism
Peptostreptococcus
Gram negative bacili
Staphylococcus aureus
Fungal infection
Aspergillus
Faktor prediposisi
Sumbatan mekanis
Kelainan anatomi
Penurunan ventilasi sinus
Kegagalan drainase
Nasal polip
Pengobatan yang tidak memadai ketika fase
akut
Alergi, defisiensi imunitas tubuh
Polusi dan zat kimia
Symptoms and signs of smelling
disturbance
Symptoms:
Hiposmia
Hiperosmia
Anosmia
Parosmia
Dysosmia
Signs:
Decrease appitite
Add more spice/ flavouring to foos
Weight loss
Symptoms and signs
(2 major criteria/1 major +2 minor)
Major Minor
Sinus/ facial pain Headache
Nasal obstruction Tooth pain
Purulent discharge Fever
Smell disturbace Ear pain
Post nasal drip Productive cough
Halitosis
Pathogenesis Of Chronic Sinusitis
Negative Transudate
Etiology
pressure
(Infection) (serous)
increase

Osteomeatal Obstruct of
Bacterial
complex ostium
infection
edema paranasal

Swollen of
Purulent
nasal mucous Immobile cilia
discharge
membrane
a) Nasal congestion
Obstruction of nasal sinus

Impaired ventilation of ostiomeatal


unit

Hampers drainage of sinus system

Swollen of mucosa

Edema

Breathing obstruction
b) Postnasal drip
Obstruction or
stenosis of the
sinus

Impaired
ventilation of the
osteomeatal unit

Hampers drainage
of the dependent
sinus system

Nasopharyngeal
drainage
(postnasal drip)
c) Smelling reduced

Secondary Hyperproduction Swelling of


infection by of mucus lining mucosal
bacteria up the receptor membrane

Reduces sense of Nasal congestion


Block airways
smelling or obstruct
d) Headache
Obstruction of the sinus

Prevent normal mucus drainage

Congestion of the sinus openings

Feeling of pressure

Can cause headache when the pressure build up extremely


Principle of management
Membuka sumbatan kompleks ostio-
meatal(KOM)
Mempercepat penyembuhan
Mencegah komplikasi
Mencegah perubahan menjadi kronik
Management
Pharmacotherapy
Broad spectrum antibiotics(4-6weeks)
Amoxicilin-clavulanat
Moxifloxacin(if allergic to penicilin)
cefuroxime
Corticosteroid nasal spray-prednison
Decongestant
Operative
Nasal antral window
Caldwell-Luc
Intracranial ethmoidectomy
Fronto-ethma-sphenoidectomy
Functional endoscopic sinus surgery(FESS)
Education
Prognosis

Bonum/ good
Avoid allergens and prompt tratment
Prone to relaps
Vigorous preventive regimen is essential
Categories
Type I One sinus involved
Simple chronic infective sinusitis
sinusitis >1 sinuses
Type II multisinusitis
Mixed infective allergic All sinuses
vasomotor chronic
sinusitis pansinusitis
Differential diagnosis
Sinusitis akut
Polip hidung
Hipertrofi concha nasalis
Tumor jinak(fibroma)
Tumor ganas