PENYAKIT INFEKSI

HIDUNG
BAGIAN ILMU THT-KL
FAK. KEDOKTERAN
UNIVERSITAS YARSI
THE RESPIRATORY SYSTEM
• Respiratory tract
• Nose
• Pharynx upper respiratory tract
• Larynx
• Trachea
lower respiratory tract
• Bronchi
THE NOSE 鼻
External nose:
• Root of nose
• Back of nose
• Apex of nose
• Alae of nasi

Nasal cavity –divided into

two halves by

Nasal septum
Two parts:
• Divided by limen nasi 鼻阈
• Nasal vestibule
• Proper nasal cavity
Boundaries
• Roof－cribriform plate of
ethmoid
• Floor－hard palate
• Medial wall－nasal septum
• Lateral wall
• Nasal conchae: superior,
middle and inferior
• Nasal meatus: superor, middle
and inferior
• Sphenoethmoidal recess
KOMPLEKS OSTEO-MEATAL (KOM)

•Struktur kompleks & rumit: tdk ada

konsensus definisi deskripsi anatomi
yg tegas ttg batas dan tepi

•Unit fungsional serambi depan

etmoid anterior yg mrpk jalan u/
drenase & ventilasi sinus frontal,
maksila & etmoid ant

•Patofisiologi - penyebab rinogenik

sinusitis
Remove the middle nasal conchae
• Semilunar hiatus
• Ethmoidal infundibulum
• Ethmoidal bulla
 THE PARANASAL SINUSES AND THEIR
SITE OF DRAINAGE INTO THE NOSE

Name of sinus Site of drainage

Frontal sinus Middle meatus via infundibulum

Maxillary sinus Middle meatus through semilunar hiatus

Sphenoid sinus Sphenoethmoidal recess

Ethmoidal sinuses
anterior group Middle meatus
posterior group Superior nasal meatus
 Frontal sinus
Ethmoidal sinuses
Sphenoid sinus

Maxillary sinus
KOMPLEKS OSTEO-MEATAL (KOM)

•Struktur kompleks & rumit: tdk ada

konsensus definisi deskripsi anatomi
yg tegas ttg batas dan tepi

•Unit fungsional serambi depan

etmoid anterior yg mrpk jalan u/
drenase & ventilasi sinus frontal,
maksila & etmoid ant

•Patofisiologi - penyebab rinogenik

sinusitis
 VIRAL RHINITIS (COMMON
COLD)

Up to 7-10 times/year 2-5

times/year
 Acute viral rhinitis or
“common cold”

Induced by respiratory viruses

(Approximately 200 different strains of viruses

• Incubation period of 1-4 days

• Usually lasts 5-7 days

0.5-2% will progress Most patients do not

to acute bacterial need antibiotic
infection treatment
 ANAMNESIS

RINITIS SINUSITIS/RINOSINUSITIS

Obstruksi Hidung Obstruksi Hidung

Ingus / PND Ingus / PND

+ ±
Bersin Nyeri wajah
Hidung Gatal Hiposmia / Anosmia
ACUTE RHINOSINUSITIS (ARS)
Common cold

ARS should be consider after a viral URTI, when the

symptoms worsened after 5 days, are present for longer
than 10 days, or out of proportion to those seen with most
viral infection
 RHINOSINUSITIS – CLINICAL
DEFINITION
Rhinosinusitis (including nasal polyps) is an
inflammation of the nose and the paranasal sinuses.

Allergic
Rhinitis Rhinosinusitis
Mucosal
inflammation

Nasal
Polyps
 RHINOSINUSITIS – DIAGNOSIS
• Two or more symptoms:
• Discharge: anterior/ post nasal drip
• Blockage/congestion
At least one
• Facial pain/pressure
• Reduction or loss of smell

• And endoscopic signs:

• Polyps, and/or
• Mucopurulent discharge from middle meatus and/or
• Oedema/mucosal obstruction primarily in middle meatus

• And/or CT changes
• Mucosal changes within ostiomeatus complex and/or sinuses
 SEVERITY OF THE DISEASE
How troublesome are your symptoms of rhinosinusitis?

• MILD: VAS 0-3 (Common cold)

• MODERATE: VAS >3-7 (No fever, no severe facial pain)
• SEVERE: VAS >7-10 (>38C of fever, severe
unilateral facial pain)
 RHINOSINUSITIS
- A VERY COMMON ILLNESS WITH A
SUBSTANTIAL HEALTH CARE IMPACT

Acute Chronic
 <12 weeks  >12 weeks
 Complete resolution  No complete resolution
of symptoms of symptoms
DIAGNOSIS
Mucosal Reversibility
Acute
CRITERIA TIME After adequate
episode
Medicamentous Th/
Acute <12 weeks < 4x/ year Normal /reversible
Rhinosinusitis
Chronic >12 weeks > 4x/ year Irreversible
Rhinosinusitis
Acute
Rhinosinusitis
Chronic Rinosinusitis
Acute Reccurens
Rhinosinusitis
Acute Exaserbation of
ChronicRhinosinusitis
12 weeks
 RISK OR ASSOCIATED FACTORS
FOR ARS

• Bacterial infection
• Ciliary impairment
• Allergy (?)
• Laryngopharyngealreflux (?)
• Helicobacterial Pylori infection (?)
RISK OR ASSOCIATED FACTORS FOR CRS
• Ciliary impairment
• Allergy
• Asthma
• Immunocompromised state
• Genetic factors
• Pregnancy and endocrine state
• Local host factors
• Micro-organisms (bacteria, fungi)
• Osteitis – the role of bone
• Environment
• Iatrogenic factors
PREDISPOSING FACTORS OF CRS IN
CHILDREN
• Nasal obstruction

• Passive smoking

• No protective effect of breast-feeding

• More common in children with tonsillities or

otitis media (immunological deficiencies)

• Urban atmospheric pollution (Sao Paulo study,

1000 schoolchildren, Sih T, 1999)

• Mucociliary dysfunction (eg, CF)

SINUSITIS AKUT

Post nasal drip di Post nasal drip di orofaring

nasofaring
TREATMENT SCHEME FOR PRIMARY CARE FOR ADULTS
WITH ARS
SINUSITIS KRONIS DENGAN
POLIP NASI
Polip nasi  terapi
pilihan:
kortikosteroid intranasal.

Derajat polip:
Derajat 0  tidak ada polip
Derajat 1  polip terbatas di meatus medius
Derajat 2  polip sdh keluar dari meatus medius
Derajat 3  polip masif, sdh memenuhi kav.nasi
TERAPI MEDIK SINUSITIS
KRONIS:
ANTIBIOTIK DAN DEKONGESTAN
• Antibiotik :
Lini ke 2 pd sinusitis akut 
• Amoksisilin klavulanat / ampisilin sulbaktam
• Sefalosporin generasi ke 2

Diberikan selama 7 hari :

Perbaikan + : teruskan sp 10-14 hari
Perbaikan - : ganti antibiotik  7 hari lagi
atau kultur / tes resistensi
TERAPI PENUNJANG:
• Dekongestan oral / topikal
• Kortikosteroid oral / topikal
• Mukolitik
• Irigasi sinus, cuci hidung, Proetz

Antihistamin tidak rutin diberikan krn efek

anti-kolinergik AH generasi 1 akan
mengentalkan sekret  drenase sulit.

• Bila ada alergi: antihistamin generasi 2

FOLLOW UP:
Periksa setelah 7 hari :
 Perbaikan + : teruskan sp 10-14 hari
 Perbaikan - : evaluasi 
• sinoskopi

• naso-endoskopi
• CT Scan

Hasil evaluasi ada obstruksi KOM 

Rencanakan bedah (BSEF / konvensional)
PASIEN KANDIDAT BSEF:
INDIKASI HARUS TEPAT DAN PERSIAPAN
CERMAT.
INDIKASI BSEF :

• Sinusitis kronis menetap setelah terapi medik adekuat

• Sinusitis akut berulang di lokasi yg sama
• Episode sinusitis berulang > 2 minggu
• Polip sinonasal
• Misetoma sinus & sinusitis alergi jamur
• Keln. anatomi menyebabkan gangguan drenase di KOM
• Mukokel
• Ada komplikasi sinusitis ke orbita / intrakranial
• Revisi kegagalan BSEF
SINUSITIS DENTOGEN

• Sinusitis  infalamasi mukosa sinus paranasal

• Sinus maksila dan etmoid >>
• Sinus maksila (Antrum Highmore) dekat akar gigi rahang atas  Sinusitis
Dentogen
SINUSITIS DENTOGEN

• Penyebab sinusitis kronik

• Dasar sinus maksila adalah prosesus alveolaris tempat akar gigi rahang atas
• Infeksi apikal akar gigi, inflamasi jaringan perodontal : perkontinuitatum,
hematogenik, dan perilimfatik
SINUSITIS DENTOGEN

• Khas : sinusitis maksilaris unilateral, dengan ingus purulen dari satu sisi
hidung, napas berbau (halitosis)
• Gejala: hidung tersumbat, nyeri tekan daerah pipi unilateral, ingus purulen,
post nasal drip, demam, riw. Sakit gigi
SINUSITIS DENTOGEN

• Anamnesis
• Pemeriksaan Fisik
• Nasoendoskopi
• Radiologik: rontgen
Sinus paranasal (SPN)
posisi waters, CT Scan
SINUSITIS DENTOGEN

• Tatalaksana
 antibiotik (anaerob)
 irigasi sinus maksila
 operasi BSEF (bedah sinus endoskopik fungsional)
 konsul Gigi & Mulut  fokus infeksi , fistula oroantral
SINUSITIS DENTOGEN