⦁ Paranasal sinuses are a group of 4
paired air filled spaces that surround
the nasal cavity.
1. Frontal sinus
2. Ethmoid sinus
3. Sphenoid sinus
4. Maxillary sinus
⦁ They reduce the weight of the skull
and they humidify the inspired air.
⦁ Sinusitis is an inflammation of the mucus
membrane of the Paranasal sinuses.
⦁ Pansinusitis is infection of more than one
⦁ Rhinosinusitis is referred to
inflammatory disease of the
⦁ It is a common condition and a
complication of 5%-10% of URIs in children.
⦁ It affects 1 in 8 adults per year.
ON THE BASIS OF
ON THE BASIS OF DURATION
Frontal sinusitis Acute sinusitis( infection
lasts up to 4 weeks)
Ethmoid Sinusitis Subacute sinusitis ( lasts
between 4 -12 weeks)
Maxillary sinusitis Chronic sinusitis( more
than 12 weeks)
Viral infection: 90% of sinusitis. Rhinovirus, coronavirus.
Bacteria: Streptococcus pneumoniae ,H Influenza others,
Pollutants: Chemical/irritants may trigger the build of
URIs such as common cold
Deviated nasal septum
Smoking and Intranasal cocaine.
Tonsillar and adenoid hypertrophy.
Pregnancy, hormonal changes with puberty.
Iatrogenic factors such as mechanical ventilation, NG
tubes, nasal packing etc.
Common sign and symptoms are
Fever, sore throat, headache, facial
pain and pressure, malaise.
In more advance cases the symptoms
are Anosmia, Nasal congestion and
discharge, halitosis etc.
Maxillary sinusitis: Pain in the upper jaw.
Frontal sinusitis: Pain in the forehead.
Ethmoid sinusitis: Pain over nasal bridge.
Sphenoid sinusitis: Pain over the occiput or vertex.
⦁ History taking
⦁ Physical examination
⦁ Watchful waiting: If sinusitis less than 10 days
without symptom then viral . More than 10 days
⦁ X ray finding conforms.
⦁ CT scan.
⦁ Sinus radiography shows opacification of the
sinus, thickened mucous membrane.
⦁ Culture and sensitivity test
⦁ Treatment depends on the how long
condition lasts. Most acute cases resolves
⦁ In most of the sinusitis antibiotics are not
recommended because viral causes.
⦁ Symptomatic treatment is given to the
Antibiotics are not prescribed routinely , because
many cases of sinusitis are viral.
First line therapy at most centers is amoxicillin for
Antibiotic therapy- Amoxyclav 625 mg(Amoxycillin
500 mg + clavulamic acid 125 mg).
⦁ Mucolytic agents such as Guaifenesin
and Saline lavage used to decrease the
duration of sinus infections.
⦁ Pseudoephedrine and Phenylephrine
can be used for 10 to 14 days.
⦁ These drugs allow the restoration of
normal mucociliary function and
⦁ These are contraindicated in clients
with Cardiovascular diseases and
⦁ The main objective of FESS is to reestablish
the sinus ventilation and Mucociliary
⦁ It is an outpatient surgical procedure using
⦁ Small fiberoptic endoscopes are passed
through the nasal cavity and into the sinus.
⦁ It allows the direct visualization of the
sinuses in order to remove diseased tissue
and to enlarge sinus Ostia.
⦁ Possible complications includes nasal
bleeding, pain, scar formation.
⦁ After FESS , nasal packing may be inserted
to minimize nasal bleeding.
⦁ It is a surgical procedure performed to
remove diseased mucosa from the
sphenoidal or ethmoidal sinus.
⦁ A small incision is made over the ethmoidal
sinus on the lateral nasal bridge and the
diseased mucosa is removed .
⦁ Nasal and ethmoidal packing then inserted.
⦁ Maxillary antrostomy is a surgical procedure
to enlarge the opening (ostium) of the
maxillary sinus. This allows for further
surgical intervention within the maxillary
sinus cavity as well as improved sinus
⦁ Caldwell-luc antrostomy —also known
as Radical antrostomy— is an operation to
remove irreversibly damaged mucosa of
the maxillary sinus.
⦁ It is done when maxillary sinusitis is not
cured by medication or other non-invasive
⦁ The approach is mainly from anterior wall of
⦁ Warm compresses apply in the sinus
⦁ Increase fluid intake
⦁ Educate the patient to avoid cold
⦁ Promote good oral hygiene
⦁ Avoid smoking
⦁ Avoid blowing nose.
⦁ For the first 24 hours after sinus surgery
,observe the client for nasal bleeding, respiratory
distress, orbital and facial edema.
⦁ Explain the client to engage in minimal physical
exercise, avoid strenuous activity.
⦁ Teach the client to sneeze only with the mouth
⦁ Nasal saline spray may be started 3 to 5 days
after the surgery to moisten the mucosa.
⦁ A nasal drip pad is taped beneath the nares to
absorb drainage after nasal or sinus surgery.
⦁ Risk for infection related to disease
⦁ Ineffective breathing pattern related
to nasal congestion/discharge
⦁ Altered comfort related to facial
fullness, nasal discharge.
⦁ Hyperthermia related to inflammation