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ENT
o
SINUS
-
HEADACHE
Frontal
Sphenoid
Ethmoid
Pain in orbital area
o
o
Complications of SINUSISTIS
Mucocoele
Orbital complications
NASAL POLYPS
Associated with allergy, cystic fibrosis,
Samters triad
o Samters triad asthma, nasal polyps,
aspirin intolerance
Originate at the lateral nasal wall/middle
meatus
Usually bilateral
Usually common in adults >20y/o
No gender predilection
Symptoms of nasal obstruction, rhinorrhea and
sinus facial syndrome
3 important factors
o Chronic recurrent mucosal
inflammation
o Abnormal vasomotor responses
o Mechanical problems related to
interstitial edema
Blockage to ostiomeatal
complex
Major basic protein from eosinophils damage
the BM allowing prolapse of the lamina propria
Mygind: histamine release
May occlude sinus ostia and drainage to
produce acute or chronic sinusitis
Benign disease, more of inflammatory
o Grows massively and can press on the
area
Sinuscopy
o Instances when doing biopsy
Diagnostic Examination
Paranasal Sinus X-ray
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Waters view
o Maxillary sinus
o Air-fluid level, mucosal thickening or
opacification
CT scan
o Acute: recurrent 4x
o Chronic: structural abnormalities
Management of Sinusitis
Antimicrobials
o Beta lactams
Topical nasal steroids
o Useful for recurrent acute or chronic
sinusitis, allergic rhinitis
o Nasonex momethasone
Antibiotics
o Acute: 7-14days
o Chronic: 3-4weeks
Topical decongestants
o Severe nasal obstruction (3-5days)
o Oxymethazoline-dixine
Topical steroids and anti-histamines
o Allergic background
Treatment failures
Non-compliance
Lack of drainage
Persistence of predisposing factors
Resistant organisms
Surgical options
Maximum medical treatment
Antral irrigation
Functional endoscopic sinus surgery
Caldwell-luc procedure
*polyps: very high recurrence rate, highly sensitive to
steroids
Endoscopic sinus Surgery
Chronic sinusitis with failed medical therapy
Nasal polyps or other mass lesions
Structural abnormalities
Management of Nasal Polyps
No permanent cure
Treatment complicated by high rate of
recurrence
Medical and surgical treatment are
complementary
Underlying factors should be identified and
eliminated
Medical treatment
o Decongestant
o Antibiotics
ENT
Main line:
Methylprednisone oral
Momethasone furoate
topical
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