CHRONIC SINUSITIS

GROUP 9
 Case review
• Male, 18 y/o
• Smelling reduced ( 6 months ago)
• Nasal congestion
• Thick & sometime smelly mucus that are ingested into the throat
• Headache
• No sneezing & nasal itching
• Previous history of same disease
• No family history of atopy

• Diagnosis:
Bilateral anterior ethmoidal sinusitis, left posterior ethmoidal
sinusistis, bilateral frontal sinusitis and bilateral maxillary sinusitis
chronic
 PHYSICAL EXAMINATIONS

General condition Good, not anemic. Height: 160cm Weight: 60kg

Vital signs Normal

Inspection External nose normal

Palpation No edema & crepitation, tenderness in left & right cheek,

tenderness on left & right orbital roof

Otoscopy Normal

Faringoscopy Normal

Anterior rhinoscopy Hyperemic nasal mucosa, congestion nasal turbinate,secrete in

bilateral og middle meatus & nasal cavity

Lab examination Hb 14g/dl, leucocytes 12 600 g%

CXR Normal
 Definisi
• Radang mukosa sinus paranasalis
• Berlangsung lebih dari 3 bulan
 Etiologi
• Anaerobic microorganism
– Peptostreptococcus
• Gram negative bacili
– Staphylococcus aureus
• Fungal infection
– Aspergillus
 Faktor prediposisi
• Sumbatan mekanis
– Kelainan anatomi
– Penurunan ventilasi sinus
– Kegagalan drainase
– Nasal polip
• Pengobatan yang tidak memadai ketika fase akut
• Alergi, defisiensi imunitas tubuh
• Polusi dan zat kimia
Symptoms and signs of smelling disturbance

• Symptoms:
– Hiposmia
– Hiperosmia
– Anosmia
– Parosmia
– Dysosmia
• Signs:
– Decrease appitite
– Add more spice/ flavouring to foos
– Weight loss
 Symptoms and signs
(2 major criteria/1 major +2 minor)
• Major • Minor
– Sinus/ facial pain – Headache
– Nasal obstruction – Tooth pain
– Purulent discharge – Fever
– Smell disturbace – Ear pain
– Post nasal drip – Productive cough
– Halitosis
Pathogenesis Of Chronic Sinusitis
Negative Transudate
Etiology
pressure
(Infection) (serous)
increase

Osteomeatal Obstruct of
Bacterial
complex ostium
infection
edema paranasal

Swollen of
Purulent
nasal mucous Immobile cilia
discharge
membrane
a) Nasal congestion
Obstruction of nasal sinus

Impaired ventilation of ostiomeatal

unit

Hampers drainage of sinus system

Swollen of mucosa

Edema

Breathing obstruction
b) Postnasal drip
Obstruction or
stenosis of the
sinus

Impaired
ventilation of the
osteomeatal unit

Hampers drainage
of the dependent
sinus system

Nasopharyngeal
drainage
(postnasal drip)
 c) Smelling reduced

Secondary Hyperproduction Swelling of

infection by of mucus lining mucosal
bacteria up the receptor membrane

Reduces sense of Nasal congestion

Block airways
smelling or obstruct
d) Headache
Obstruction of the sinus

Prevent normal mucus drainage

Congestion of the sinus openings

Feeling of pressure

Can cause headache when the pressure build up extremely

 Principle of management
• Membuka sumbatan kompleks ostio-
meatal(KOM)
• Mempercepat penyembuhan
• Mencegah komplikasi
• Mencegah perubahan menjadi kronik
 Management
• Pharmacotherapy
– Broad spectrum antibiotics(4-6weeks)
• Amoxicilin-clavulanat
• Moxifloxacin(if allergic to penicilin)
• cefuroxime
– Corticosteroid nasal spray-prednison
– Decongestant
• Operative
– Nasal antral window
– Caldwell-Luc
– Intracranial ethmoidectomy
– Fronto-ethma-sphenoidectomy
– Functional endoscopic sinus surgery(FESS)
• Education
 Prognosis

• Bonum/ good
– Avoid allergens and prompt tratment
• Prone to relaps
– Vigorous preventive regimen is essential
 Categories
• Type I • One sinus involved
– Simple chronic infective – sinusitis
sinusitis • >1 sinuses
• Type II – multisinusitis
– Mixed infective allergic • All sinuses
vasomotor chronic
– pansinusitis
sinusitis
 Differential diagnosis
• Sinusitis akut
• Polip hidung
• Hipertrofi concha nasalis
• Tumor jinak(fibroma)
• Tumor ganas