Rhinosinusitis

Dr. Indranil Pal

Professor & Head
Dept’t. of ENT & HNS
COMJNMH, WBUHS,
Kalyani, Nadia, WB.
Definition

 It is a group of disorders chacterised by the

inflammation of the mucosa of the nose and
paranasal sinuses.
Classification*
*(Rhinosinusitis task force of AAOHNS)

Acute 7 days to 4 weeks.

Subacute 4 weeks to 12 weeks.

Chronic More than 12 weeks.

Acute recurrent 4 or more episodes of ARS per year.

Acute Sudden worsening of CRS with return

exacerbation of to baseline after.
chronic
 Diagnosis (based on symptoms)*
*(Rhinosinusitis task force of AAOHNS)

Presence of at Least 2 Major or 1 Major and 2 Minor Symptoms

 Etiology
Host factors:
 Immotile cilia
 Concha bullosa
 Paradoxical turbinate.
 Septal spur.
 Immunocompromised states.
 Allergy.
 Neoplasms
 Etiology
Environmental factors:
 Infections.
 Trauma.
 Noxious chemical fumes.
 Iatrogenic – nasal packs, NG tubes,
surgeries.
 Medications.
Pathophysiology
 Typically after a viral infection.

Mucosal oedema.

Obstruction of sinus ostia

Stasis of secretions.

Hypoxic state in sinuses – lesser ciliary movement.

Thicker secretions.

Bacterial colonisation.

Probablity increased by the predisposing factors.

Pathophysiology

 Exudate rich in neutrophils.

 Viruses : Adeno, Rhino, Picorna,
Coxsackie, Echo.
 Bacteria : S. pneumoniae
H. influenzae
M. catarrhalis
S. aureus
 Diagnosis
 History.
 Clinical examination.
 Generally made empirically.
 Nasal endoscopy
 Microbiological study of :
maxillary sinus apirates
endoscopic guided middle meatal cultures
Diagnosis
 X ray of skull.
 CT scan of paranasal sinuses and nose.
 MRI.

Not recommended unless a complication

or an alternate diagnosis is suspected
Treatment (Medical)
 Usually self limiting.
 Analgesics.
 Decongestants: Topical
Systemic
 Steroids: Topical
Systemic
 Antibiotics: 7-10 days after onset of symptoms
or double sickening.
Treatment (Surgical)
 Antral wash/ lavage.
 Caldwel- Lucs sublabial antrostomy.
 External ethmoidectomy.
 Jansen- Horgans approach.
Treatment (Surgical)

 Frontal sinus trephining.

 Frontal sinus obliteration.
 Endoscopic sinus surgery –
Uncinectomy, middle meatal antrostomy,
ethmoidectomy.
Thank You