Ehab Taha Yaseen Objectives To keep in mind for the rest of your life that facial pain is not the main symptoms in chronic sinusitis Hence patient present with facial pain as the their chief complaint are usually not have chronic sinusitis ID: 1014588
Download Presentation The PPT/PDF document "Chronic sinusitis Prof." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. Chronic sinusitisProf. Ehab Taha Yaseen
2. ObjectivesTo keep in mind for the rest of your life that facial pain is not the main symptoms in chronic sinusitisHence, patient present with facial pain as the their chief complaint are usually not have chronic sinusitis 2. Usually present with other nasal features or ear and throat symptoms3. The main type of surgery (FESS)
3. DefinitionBetter termsTypes Specific (TB, Fungal, etc…)Non specific 2 typesSimple (infective) (repeated acute rs)Mixed type (infective and VMR) usually there is predisposing factor as obstruction of sinus ostia
4. Pathology:Edema Polyposischronic inflammatory cellular infiltrationfibrosis of submucosa multiple small abscesses metaplasia and glandular hypertrophy.
5. Symptoms:Postnasal or nasal discharge. Nasal obstructionRecurrent pharyngitis (sore throat).Headache.Anosmia or cacosmiaCoughEustachian obstruction are common secondary effectsConstitutional symptoms are usually mild or absent.
6. Signs: often unremarkable and non-specific, you may see (endoscopy is important tool ) polypsseptal deviationsigns of allergic rhinitis (extrinsic rhinitis) vasomotor rhinitis (intrinsic rhinitis)postnasal dripgranular pharyngitisyou may notice bad smellfeatures of Eustachian obstruction.
7. Investigations:Endoscopy (again)CT scan is the gold standard investigationTo prove the diagnosisLooking for predisposing factors (anatomical variation or pathological findings) To address the anatomy (if surgery is decided) To exclude the presence of complications (especially orbital and intracranial complications)
8. Treatment:Medical: for 4-6 weeks, this will include:Antibiotics are given orally and should cover both aerobic, anaerobic, gram positive and gram negative bacteria e.g. amoxicillin + metronidazol or amoxicillin + calvulonic acid.Steroids as nasal spray Antihistamines especially when there is allergy.Analgesic usually not needed.Surgical : treatment is indicated when there is failure of medical treatment, and these may include:Intranasal antrostomy. (obsolete)Caldwell – Luc operation. (only one indication)Internal and external ethmoidectomy. (obsolete)Internal ethmoidectomy. (obsolete)external fronto – ethmoidectomy. (obsolete)frontal sinus obliteration. (obsolete)Sphenoid surgery is usually part of surgery on the other sinuses.Functional endoscopic sinus surgery (FESS).
9. The gold standard operation nowadays is the FESS:Aims of FESS are toRemove diseased mucosa, polyps, bones and widen sinus ostia Restore sinus ventilationRestore normal mucocilliary clearanceWhat are the indications of FESSChronic rhinosinusitis after failure of medical therapyRecurrent acute rhinosinusitis (more than 3 attacks per year in the presence of predisposing anatomical variation) Chronic Specific Sinusitis ( Fungous infection)Usually due to aspergilli, common in immune compromised patients as diabetic or uraemic patients. Treated by evacuation surgery and systemic antifungal agents as amphotericin B.
10. Case35 y old man seeking advice to remove his tonsils because of recurrent infection that affect his QOL. How you will approach the diagnosis in this patient?HistoryExaminationInvestigationTreatment