3鼻窦炎英文版

sinusitisAnatomyofthenasalsinusesAnteriorsinus:maxillarysinusfrontalsinusanteriorethmoidalsinusTheyallopeninthemiddlemeatus.Posteriorsinus:posteriorethmoidalsinus:openinthesuperiormeatussphenoidsinus:openinsphenoethmoidalrecessoverviewSinusitishasbeendefinedasaninflammationofthemucousmembraneofthesinuses.twotypes-acutesinusitisandchronicsinusitis.AcutesinusitisAcuteinflammationofsinusmucosaThiscommonlyfollowsacold.Thesinusmostcommonlyinvolvedisthemaxillaryfollowedinturnbyethmoid,frontalandsphenoid.Multisinusitis:Pansinusitis:AetiologyofsinusitisingeneralExcitingcausesNasalinfectionSwimminganddivingTraumaDentalinfectionPredisposingcauseslocalObstructiontosinusventilationanddrainage1、nasalpacking2、deviatedseptum3、hypertrophicturbinates4、nasalpolypi5、oedemaofsinusostiaduetoallergyorvasomotorrhinitis6、benignormalignantneoplasmGeneralEnvironment:atmosphericpollution,smoke,dustPoorgeneralhealthnutritionaldeficienciessystemicdisorders(diabets,immunedeficiencysyndromes)BacteriologyViralinfection------bacterialinvasionpneumococci,streptococci,H.influenzaeAnaerobicorganismsandmixedinfectionsPathologyofsinusitisAcuteinflammationofsinusmucosacauseshyperaemia,exudationoffluid,outpouringofpolymorphonuclearcellsandincreasedactivityofserousandmucousglands.Dependingonthevirulenceoforganisms,defencesofthehostandcapabilityofthesinusostiumtodraintheexudates,thediseasemaybemild(none-suppurative)orsevere(suppurative)Initially,theexudateisserous;lateritmaybecomemucopurulentorpurulent.Severeinfectionscausedestructionofmucosallining.Failureofostiumtodrainresultsinempyemaofthesinusanddestructionofitsbonywallsleadingtocomplications.AcutemaxillarysinusitisAetiologyMostcommonly,itisviralrhinitiswhichspreadstoinvolvethesinusmucosa.Thisisfollowedbybacterialinvasion.Divingandswimmingincontaminatedwater.Dentalinfectionsareimportantsourceofmaxillarysinusitis.TraumaClinicalfeaturesClinicalfeaturesdependonseverityofinflammatoryprocessandefficiencyofostiumtodraintheexudates.Closedostiumsinusitisisofgreaterseverityandleadsmoreoftentocomplications.Constitutionalsymptomsconsistoffever,generalmalaiseandbodyache.Theyaretheresultoftoxaemia.HeadachePainTendernessRednessandoedemaofcheek.NasaldischargePostnasaldischargeDiagnosisX-raysorCTscan:anopacityorafluidlevelintheinvolvedsinus.TreatmentMedicalAntimicrobialdrugsAmpicillinoramoxicillinErythromycinordoxycyclineorcotrimoxazoleβ-lactamase-producingstrainsofinfluenzaemaynecessitatetheuseofamoxicillin/clavulanicacidsparfloxacinNasaldecongestantdrops1%ephedrinesteroidsAsnasalspraysAvoidlong-termsystemicsteroidsSteaminhalationSteamaloneprovidessymptomaticreliefandencouragesinusdrainage.Inhalationshouldbegiven15to20minutesafterdecongestionforbetterpenetration.AnalgesicsParacetamolHotfomentationLocalheattotheaffectedsinusisoftensoothingandhelpsintheresolutionofinflammation.SurgicalAntralpunctureandirrigationMostcasesofacutemaxillarysinusitisrespondtomedicaltreatment.Antralpunctureandirrigationisrarelynecessary.Itisdoneonlywhenmedicaltreatmenthasfailedandonlyundercoverofantibiotics.complicationsChronicsinusitisOsteomyelitisofthemaxillaOrbitalcellulitisorabscessAcutefrontalsinusitisAetiologyUsuallyfollowsviralinfectionsofupperrespiratorytractfollowedlaterbybacterialinvasion.Entryofwaterintothesinusduringdivingorswimming.Externaltraumatothesinus.Oedemaofmiddlemeatus,secondarytoassociatedmaxillaryorethmoidsinusinfection.ClinicalfeaturesFrontalheadacheTendernessOedemaofuppereyelidwithsuffusedconjunctivaandphotophobia.NasaldischargeTreatementMedicalThisissameasforacutemaxillarysinusitis:antimicrobials,decongestion,analgesics,steroid.Placingapledgetofcottonsoakedinavasoconstrictorinthemiddlemeatus,onceortwicedaily,helpstorelieveostialoedemaandpromotessinusdrainageandventilation.Ifpatientshowsresponsetomedicaltreatmentandpainisrelieved,treatmentiscontinuedforfull10daysto2weeks.SurgicalTrephinationoffrontalsinus.Ifthereispersistenceofpainorpyrexiainspiteofmedicaltreatmentfor48hours,orifthelidswellingisincreasing,frontalsinusisdrainedexternally.ComplicationsOrbitalcellulitisOsteomyelitisoffrontalboneMeningitis,extraduralabscessorfrontallobeabscess.Chronicfrontalsinusitis.AcuteethmoidsinusitisAetiologyAcuteethmoiditisisoftenassociatedwithinfectionofothersinuses.Ethmoidsinusesaremoreofteninvolvedininfantsandyoungchildren.ClinicalfeaturesPainOedemaoflidsNasaldischargeSwellingofthemiddleturbinateTreatmentMedicaltreatmentisthesameasforacutemaxillarysinusitis.Visualdeteriorationandexophthalmosindicateabscessintheposteriororbitandmayrequiredrainageoftheethmoidsinusesintothenose.ComplicationsOrbitalcellulitisandabscessVisualdeteriorationandblindnessduetoinvolvementofopticnerve.Cavernoussinusthrombosis.Extraduralabscess,meningitisorbrainabscess.AcutesphenoidsinusitisAetiologyIsolatedinvolvementofsphenoidsinusisrare.Itisoftenapartofpansinusitisorisassociatedwithinfectionofposteriorethmoidsinuses.ClinicalfeaturesHeadache:occiputorvertexPostnasald