SINUSITIS

INFLAMMATION
OF
THE
SINUSES.
The
reaction
of
the
components of the sinuses to
the infectious process is the
same as in the nasal cavities.
The changes vary with the
stage of the disease, and are
classified as early and late
stages.
The symptoms usually become
evident during the late stages
of the disease.

ACUTE SINUSITIS
1- EARLY STAGE
The acute reaction of the sinuses usually
follows an acute stage of rhinitis, most often of
viral or allergic origin.
During the acute phase of rhinitis, the
edematous nasal mucosa around the drainage
foramen of the sinuses closes the opening of
the air sinuses. The large amount of mucus
accumulates inside the sinus cavities and forms
a mucocele that provides an adequate medium
for the growth of microbacteria and fungi.
The histological changes during the acute
phase of the disease are the same as the ones
occurring in the nasal mucosa during acute
rhinitis. There is edema and congestion of the
soft tissue of the sinuses that is infiltrated with
acute inflammatory cells.

2- LATE STAGE
With the secondary invasion of the sinuses by
microbacteria and fungi (usually a mixed flora),
a chronic form of the disease may develop.
The content of the sinuses becomes
mucopurulent or frankly purulent.
Suppurative sinusitis is a severe condition that
requires prompt treatment since the possibility
of the spread of the infectious process to the
cranial cavity is always a dreaded complication.
The histopathologic changes include heavy
inflammatory infiltrate of the mucosa, edema
and congestion of the soft tissue and in severe
cases complete necrosis of the mucosal lining.
Severe complications including massive
necrosis, mucosal atrophy and involvement of
the bone structures may result.

Fungal sinusitis

Fungal infection, most often fungal

sinusitis, are rarely spontaneous, they
usually
complicate
a
pre-existing
condition, and are often nosocomial
Mucormycosis caused by the MUCOR a
fungus of the Phycomycetes group is the
most commonly found in acidotic diabetic
patients,
in
immunocompromized
patients, and in patients with chronic
debilitating diseases. It is often life
threatening and is characterized by the
formation of a black crust covering
necrotic tissue in the nasal cavities and
specially the sinuses.
Other fungi like the Candida, Aspergillus
and the Rhinosporidia have been
responsible for the infection, but are less
commonly seen.

Adenoids
Pharyngeal tonsils, or Nasopharyngeal tonsils

Adenoids are a mass of lymphoid tissue

situated at the very back of the nose, in the
roof of the nasopharynx, where the nose
blends into the mouth.
Definition: Hyperplasia of the lymphoid
tissue in the posterior pharynx, wall due to
persistent infection.
Pathology:
(1) The adenoid tissue is inflamed and
enlarged. Microscopically lymphoid tissue
shows
hyperplasia
and
chronic
inflammatory cells.
(2) Nasal obstruction leading to mouth
breathing.
(3) Repeated attacks rhinitis, sinusitis, otitis
media and bronchitis due to the persistence
of the septic focus.

Complications of adenoid
Adenoid face: Open mouth,
absence of nasolabial folds, short
upper lip, protruding central upper
incisors.
Enlarged adenoids, or adenoid
hypertrophy, can become nearly the
size of a ping pong ball and
completely block airflow through
the nasal passages.
They can obstruct airflow and
inhalation occurs instead through
an open mouth.
Adenoids can also obstruct the
nasal airway enough to affect the
voice without actually stopping
nasal airflow altogether.