nursing

1. SINUSITIS
Manisha Mistry

2. Anatomy
• Paranasal Sinuses

3. Where are the
sinuses?
• Four pairs of paranasal sinuses
– Frontal-above eyes in forehead bone
– Maxillary-in cheekbones, under eyes
– Ethmoid-between eyes and nose
– Sphenoid-in center of skull, behind nose and
eyes

4. What are the
sinuses?
• The sinuses are hollow air- filled sacs lined by
mucous membrane. The ethmoid and
maxillary sinuses are present at birth. The
frontal sinus develops during the 2nd year and
the sphenoid sinus develops during the 3rd year.

5. What are the sinuses? (cont’d)
• Sinuses have small orifices (ostia) which open
into recesses (meati) of the nasal cavities.
• Meati are covered by turbinates (conchae).
• Turbinates consist of bony shelves
surrounded by erectile soft tissue.
• There are 3 turbinates and 3 meati in each
nasal cavity (superior, middle, and inferior).

6. What is sinusitis?
• An acute inflammatory process involving one or
more of the paranasal sinuses.
• A complication of 5%-10% of URIs in children.
• Persistence of URI symptoms
>10 days without improvement.
• Maxillary and ethmoid sinuses are most
frequently involved.

7. How Does Sinusitis
Develop?
• Usually follows rhinitis, which may be viral
or allergic.
• May also result from abrupt pressure changes
(air planes, diving) or dental extractions or
infections.
• Inflammation and edema of mucous
membranes lining the sinuses cause
obstruction.
• This provides for an opportunistic bacterial
invasion.

8. Development (cont’d)
• With inflammation, the mucosal lining of the sinuses
produce mucoid drainage. Bacteria invade and pus
accumulates inside the sinus cavities.
• Postnasal drainage causes obstruction of nasal
passages and an inflamed throat.
• If the sinus orifices are blocked by swollen mucosal
lining, the pus cannot enter the nose and builds up
pressure inside the sinus cavities.

9. Predisposing Factors
• Allergies, nasal deformities, cystic fibrosis,
nasal polyps, and HIV infection.
• Cold weather
• High pollen counts
• Day care attendance
• Smoking in the home
• Reinfection from siblings

10. Acute or Chronic Sinusitis?
• Acute Sinusitis – respiratory symptoms last
longer than 10 days but less than 30 days.
• Sub acute sinusitis – respiratory symptoms
persist longer than 30 days without
improvement.
• Chronic sinusitis – respiratory symptoms last
longer than 120 days.

11. Etiology of Sinusitis
70% of bacterial sinusitis is caused by:
• Streptococcus pneumoniae
• Haemophilus influenzae
Other causative organisms are:
• Staphylococcus aureus
• Streptococcus pyogenes,
• Gram-negative bacilli

12. Complications of Sinusitis
• Orbital cellulitis or abscess
• Meningitis
• Brain abscess
• Intractable wheezing in children with asthma
• sinus thrombosis
• Subdural empyema

13. Subjective Symptoms of
Sinusitis
• History of URI or allergic rhinitis
• History of pressure change
• Pressure, pain, or tenderness over sinuses
• Increased pain in the morning, subsiding in the afternoon
• Malaise
• Low-grade temperature
• Persistent nasal discharge, often purulent
• Postnasal drip
• Cough, worsens at night
• Mouthing breathing, snoring
• History of previous episodes of sinusitis
• Sore throat, bad breath
• Headache

14. Clinical Presentations of Sinusitis
• Periorbital edema
• Cellulitis
• Nasal mucosa is reddened or swollen
• Percussion or palpation tenderness over
a sinus
• Nasal discharge, thick, sometimes yellow
or green
• Postnasal discharge in posterior pharynx
• Difficult transillumination
• Swelling of turbinates
• Boggy pale turbinates

15. Pale, Boggy Turbinates

16. Diagnostic Tests
• Imaging studies, such as sinus
radiographs, ultrasonograms, or CT
scanning – indicated if patient is
unresponsive to 48 hours of antibiotics
and if the patient has a toxic appearance,
chronic or recurrent sinusitis, and chronic
asthma.
• Laboratory studies, such as culture of sinus
puncture aspirates.

17. Pharmacological Plan of Care
• Adults:Paracetamol 500mg Tid 5 days
• Amoxycillin 500mg BID 10 days
• Ofloxacin 400mg BID for 10 days
• (penicillin allergy)
• Salt water gargle

18. Patient Education
• Avoid allergy triggers,antihistamine or nasal
corticosteroids
• Eat fruits & vegetables,
• Reduces stress,
• Wash hands and maintain hygiene.
• Avoid smoke and pollution hydration