Acute Sinusitis

Acute Sinusitis
Presentation by:Michael E. Prater, MD
Francis B. Quinn, MD

ANATOMY

* There are four paired paranasal sinuses, the maxillary, ethmoid, frontal and sphenoid sinuses
* “Anterior” and “posterior” sinuses
* Lining of the sinuses is pseudostratified, columnar epithelium (respiratory epithelium) which is continuous with the nasal epithelium
* The muocsa secretes a mucous which traps bacteria
* The mucous is naturally extruded through sinus ostia to be expectorated or swallowed
* The drainage of the maxillary and frontal sinuses follows a circular pattern through the natural ostia

The Ethmoid Sinus
The Maxillary Sinuses
Frontal Sinus
Sphenoid Sinuses
Pathophysiology of Sinusitis

* Lined by respiratory epithelium
* Mucous blanket is in two layers: a superficial viscous layer and an underlying serous layer.
* Cilia beat in the serous layer, moving the blanket towards the natural ostia
* Normal function depends on patent ostia, ciliary function and quality of mucous
* Most important pathologic process in disease is obstruction of natural ostia
* Obstruction leads to hypooxygenation
* Hypooxygenation leads to ciliary dysfunction and poor mucous quality
* Ciliary dysfunction leads to retention of secretions
* Local factors can impair ciliary function. Cold air “stuns” the epithelium, resulting in retained secretions. Dry air dessicates the blanket.
* Anatomical factors, ie, polyps, tumors, foreign bodies and rhinitis, block the ostia
* Kartagener’s Syndrome (immotile cilia syndrome)
* Acute sinusitis is defined as disease lasting less than one month
* Subacute sinusitis is defined as disease lasting 1 to 3 months
* Chronic sinusitis is defined as disease lasting more than three months, and is usually due to inadequately treated acute or subacute disease
* Acute sinusitis and subacute sinusitis are treated medically
* Chronic sinusitis is considered irreversible by medical therapy alone, and it is currently believed oxygenation of the sinuses through opening of the ostia is the primary treatment

History and Physical Exam

* Acute sinusitis presents as pain over infected areas, with or without headache
* Pain to palpation is common with anterior sinusitis, but is usually absent with the posterior sinuses
* Posterior sinuses present as bitemporal or vertex headaches
* Fever, malaise, nasal discharge present
* Chronic sinusitis usually seen with a mucopurlent discharge, but fever is usually not present
* Acute sinusitis is often imposed on chronic disease
* Note any facial edema, tenderness, mucosal edema, septal perforations and deviations
* Diagnosis is primarily clinical, but radiographs can be used
* Transillumination of the sinuses can sometimes be used, but due to differences in sinus size and patency , these tests are not reliable
* Antral lavage can be performed in select cases where the diagnosis is in doubt

Acute Bacterial Sinusitis
Acute Fungal Sinusitis
Complications: Mucoceles
Complications: Orbital
Complications: Cavernous Sinus Thrombosis
Complications: Intracranial
Radiology
Radiology: Plain Films

Acute Sinusitis.ppt