S I N U S I T I S

H. Helmi M. Lubis Dr, Sp.A(K)

H. Ridwan M. Daulay Dr, Sp.A(K)
Gabriel Panggabean Dr, Sp.A
Wisman Dr, Sp.A
Sinusitis is a bacterial infection of the paranasal
sinuses
Infection occur in any of the paranasal sinuses
as they develop
Ethmoid & maxillary sinuses are present at birth
Sphenoidal & frontal sinuses are not
significantly developed until 5 6 yrs
Sinus disease in post pubertal adolescent is
similar to that in adults
Definition
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Most common cause (90%) :
S. pneumonia, H. influenza, M. catarrhalis,
S. aureus, S. pyogenes
Etiology
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Mucosa is covered by mucous blanket
Flow of mucous is propelled toward
ostia, and then nasopharynx
Mucus contain IgA, IgG, IgM, and
lysozime
Paranasal sinuses usually sterile
Damage mucociliary function
inoculation pathogens infection
Pathophysiology
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Children : as complication of common cold
Infection inflammation damage nasal
ciliary epithelial cells bacterial
colonizing
Predisp : - respiratory allergy
- dental infection/extraction
- defects of ciliary function
- cystic fibrosis
- immunodeficiency
- anatomy
- swimming
- drying of mucosa
Pathophysiology
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Heralded by failure of common cold symptoms to
resolve after 10 days
Main symptom is rhinorrhea, purulent
Fever > 39
0
C, cough, pain, headache, periorbital
swelling (ethmoid), vomiting
Acute : unilateral ; chronic : bilateral
Common in boys
Preschool children : maxillary & ethmoid sinuses
Clinical manifestation
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Orbital infection
Meningitis
Osteomyelitis
Cavernous sinus thrombosis
Abscess of epidural, subdural, or brain
Complication
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Nasal culture careful technique
Blood : - BSR, band neutrophils
Imaging of the sinuses
Sinus R > 10 d symptoms, > 1 years old
USG
CT Scan : - plain film equivocal/negative
- chronic/recurrent disease
- complications are suspected
Investigation
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Primary treatment : antibiotic
started before the results of investigation are known
Amoxicillin : S. pneumonia, H. influenza, M.
catarrhalis
-lactamase producing (H. influenza, M. catarrhalis) :
amoxicillin-clavulanate sodium, trimethoprim-
sulfamethoxazole, cefaclor
Brisk response : 3 4 days
Satisfactory : 10 days
Response is slower : 1 month
Bacterial complication : hospitalized & give parenteral
antibiotic iv cefuroxime
Management
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Vasoconstrictive drug ?
Topical rebound vasodilatation
- only there is considerable pain
- no more than 3 days
Surgical : - rarely in children
- lack of response to maximal
medical therapy
- continuing symptoms
- neurologic complications
Management
S I N U S I T I S