SINUSITIS

Fakhri Mubarok 1510211033

SINUSITIS
 Inflamasi mukosa sinus
paranasal
 Umumnya dipicu o/
rinitis → rinosinusitis
 Penyebab utama:
selesma (common cold)
 Istilah:
 Multisinusitis
 Pansinusitis
 Paling sering terkena:
 Sinus etmoid dan
maksila
 ETIOLOGI

 Nasal infections. Sinus mucosa

is a continuation of nasal
mucosa and infections from nose
can travel directly by continuity
or by way of submucosal
lymphatics. Most common cause of
acute sinusitis is viral rhinitis
followed by bacterial invasion.

 Trauma. Compound fractures or penetrating injuries of sinuses—frontal,

maxillary and ethmoid—may permit direct infection of sinus mucosa.
 Dental infections. This applies to maxillary sinus. Infection from the
molar or premolar teeth or their extraction may be followed by acute
sinusitis.
Gray's Anatomy
The Anatomical
Basis of Clinical
Practice, 40th Ed
; hal 519
FAKTOR PREDISPOSISI
 LOCAL
 Obstruction to sinus ventilation and drainage. Normally,
sinuses are well-ventilated. They also secrete small amount
of mucus, which by ciliary movement, is directed towards the
sinus ostia from where it drains into the nasal cavity. Any
factor(s) which interfere with this function can cause sinusitis
due to stasis of secretions in the sinus. They are:
a) Deviated septum
b) Hypertrophic turbinates
c) Oedema of sinus ostia due to allergy or vasomotor rhinitis
d) Nasal polypi
e) Benign or malignant neoplasm.
  Stasis of secretions in the nasal cavity. Normal secretions of
nose may not drain into the nasopharynx because of their
viscosity (cystic fibrosis) or obstruction (enlarged adenoids,
choanal atresia) and get infected.
 Previous attacks of sinusitis. Local defences of sinus mucosa
are already damaged.
 GENERAL
 Environment. Sinusitis is common in cold and wet climate.
Atmospheric pollution, smoke, dust and overcrowding also
predispose to sinus infection.
 Poor general health. Recent attack of exanthematous fever
(measles, chickenpox, whooping cough), nutritional deficiencies
and systemic disorders (diabetes, immune deficiency syndromes).
 Swimming and diving. Infected water can enter the sinuses
through their ostia. High content of chlorine gas in swimming pools
can also set up chemical inflammation.
EPIDEMIOLOGI
 Paling banyak ditemukan di seluruh dunia,
terutama di daerah yg berpolusi tinggi
 Iklim yg lembab, dingin, dgn konsentrasi pollen yg
tinggi
 Sinus maksila → insidensi terbesar
 Perempuan lbh banyak memiliki episode sinusitis
akut drpd pria
 Sekret menjadi
PATOFISIOLOGI purulen

Multiplikasi
Bakteri menginvasi bakteri
nasofaring
Media yg baik u/
Faktor kemotaktik pertumbuhan
bakteri

Inflamasi akut mukosa sinus Transudasi serosa

Pelepasan mediator2 kimiawi Terjadi tekanan negatif

dlm rongga sinus
Histamin Bradikinin Prostaglandin

Demam Silia tidak dapat Ostium

Vasodilatasi tersumbat
bergerak
Permeabilitas
Hiperemi kapiler Edema
Mukosa yg berhadapan
meningkat akan saling bertemu
KLASIFIKASI DAN MIKROBIOLOGI
 Sinusitis Akut
> 4 minggu
 Bakteri utama:
 Streptococcupneumoniae
 Haemophyllus inflenzae
 Moraxella catarrhalis

 Sinusitis Subakut
4 minggu – 3 bulan
 Sinusitis Kronis
> 3 bulan
GEJALA KLINIS DAN PENGOBATAN
 Keluhan utama :
 Hidung tersumbat disertai nyeri/rasa tekanan pd muka
dan ingus purulen yg sering kali turun ke tenggorok
(post nasal drip)
 Gejala sistemik → demam & lesu

 Gejala lain :
 Sakit kepala
 Hiposmia/anosmia
 Halitosis
 Post nasal drip
 Sinusitis Maksila Akut
 Clinical features depend on (i) severity of inflammatory
process and (ii) efficiency of ostium to drain the exudates.
 Closed ostium sinusitis is of greater severity and leads more
often to complications.
 Constitutional symptoms. It consist of fever, general malaise and
body ache. They are the result of toxaemia.
 Headache. Usually, this is confined to forehead and may thus be
confused with frontal sinusitis.
 Pain. Typically, it is situated over the upper jaw, but may be referred
to the gums or teeth. For this reason patient may primarily consult a
dentist. Pain is aggravated by stooping, coughing or chewing.
Occasionally, pain is referred to the ipsilateral supraorbital region and
thus may simulate frontal sinus infection.
 Redness and oedema of cheek.
Commonly seen in children. The
lower eyelid may become puffy.
 Nasal discharge. Anterior
rhinoscopy/nasal endoscopy
shows pus or mucopus in the
middle meatus. Mucosa of the
middle meatus and turbinate may
appear red and swollen.
 Postnasal discharge. Pus may be
seen on the upper soft palate on
posterior rhinoscopy or nasal
endoscopy.
TREATMENT
 Antimicrobial drugs. Ampicillin and
amoxicillin are quite effective and
cover a wide range of organisms.
Erythromycin or doxycycline or
cotrimoxazole are equally effective
and can be given to those who are
sensitive to penicillin.
 Nasal decongestant drops. One per
cent ephedrine or 0.1% xylo- or
oxymetazoline are used as nasal drops
or sprays to decongest sinus ostium and
encourage drainage.
 Steam inhalation. Steam alone or
medicated with menthol or Tr.
Benzoin Co. provides symptomatic
relief and encourages sinus drainage.
Inhalation should be given 15–20 min
after nasal decongestion for better
penetration.
 Analgesics. Paracetamol or any
other suitable analgesic should be
given for relief of pain and
headache.
 Hot fomentation. Local heat to the
affected sinus is often soothing and
helps in the resolution of
inflammation
 Sinusitis Frontal Akut
 Frontal headache. Usually severe and localized over
the affected sinus. It shows characteristic periodicity.
 Oedema of upper eyelid with suffused conjunctiva
and photophobia.
 Nasal discharge. A vertical streak of mucopus is
seen high up in the anterior part of the middle meatus.
 Nyeri pd dahi/seluruh kepala
 Sinusitis Etmoid Akut
 Acute ethmoiditis is often associated with infection of other
sinuses. Ethmoid sinuses are more often involved in infants and
young children.
 CLINICAL FEATURES
 Pain. It is localized over the bridge of the nose, medial and
deep to the eye. It is aggravated by movements of them eye ball.
 Oedema of lids. Both eyelids become puffy and swollen. There
is increased lacrimation. Orbital cellulitis is an early complication
in such cases.
 Nasal discharge. On anterior rhinoscopy, pus may be seen in
middle or superior meatus depending on the involvement of
anterior or posterior group of ethmoid sinuses.
 Swelling of the middle turbinate.
 Sinusitis Sfenoid Akut
 Biasanya jarang; berhubungan dgn sinusitis etmoid
podterior
 Gambaran Klinis:
 Nyeri →dirasakan pd verteks, oksipital, belakang bola
mata, dan daerah mastoid
 Pos nasal discharge → hanya dapat dilihat pd rhinoskopi
posterior → pus dpt dilihat dr atap posterior nasofaring
dan konka
DIAGNOSIS
 Berdasarkan anamnesis, px fisik, dan px penunjang
 Px fisik dgn rinoskopi anterior dan posterior, px
naso-endoskopi → sangat dianjurkan
 Tanda khas
 Adanya pus pd meatus medius → sinusitis maksila,
etmoid anterior, dan frontal
 Adanya pus pd meatus superior → sinusitis etmoid
posterior dan sfenoid
 Px penunjang:
 Foto polos → posisi Waters, PA, dan lateral →
umumnya hanya mampu menilai kondisi sinus2 besar
 CT-scan
 Px Transiluminasi
 Px Mikrobiologi dan Tes Resistensi
 Sinoskopi
 Dilakukan dgn pungsi menembus dinding medial sinus
maksila melalui meatus inferior
 Dgn alat endoskop
 Selanjutnya, dapat dilakukan irigasi sinus u/ terapi
Gray's Anatomy The
Anatomical Basis of
Clinical Practice, 40th
Ed ; hal 550
Gray's
Anatomy The
Anatomical
Basis of
Clinical
Practice, 40th
Ed ; hal 551
Gray's
Anatomy The
Anatomical
Basis of
Clinical
Practice, 40th
Ed ; hal 551
Gray's
Anatomy
The
Anatomica
l Basis of
Clinical
Practice,
40th Ed ;
hal 551
TERAPI
 Tujuan:
 Mempercepat penyembuhan
 Mencegah komplikasi
 Mencegah perubahan mjd kronik
 Prinsip:
 Membuka sumbatan di KOM shg drainase dan ventilasi
sinus2 pulih secara alami
 Antibiotik dan dekongestan
 U/ menghilangkan infeksi
 Yang dipilih → golongan penisilin
 Alternatif: amoksisilin-klavulanat/jenis sefalosporin
generasi ke-2
 Diberikan selama 10-14 hari
 Analgetik
 Mukolitik
 Steroid oral/topikal
 Pencucian rongga hidung dgn NaCl
 Pemanasan (diatermi)
 Antihistamin

 Tindakan Operasi → Bedah sinus endoskopi

fungsional (BSEF/FESS)
KOMPLIKASI
 Kelainan orbita  Kelainan intakranial
 Disebabkan o/ sinus  Kelainan yg timbul:
paranasal yg berdekatan  Meningitis
dgn mata (orbita) →
 Abses
paling sering: sinusitis
ekstradural/subdural
etmoid-frontal-maksila
 Abses otak
 Kelainan yg timbul:
 Trombosis sinus
 Edema palpebra
kavernosus
 Selulitis
orbita
 Abses subperiostal
 Abses orbita
 Trombosis sinus
kavernosum
 Osteomielitis dan Abses Subperiostal
 Paling sering timbul akibat sinusitis frontal dan
biasanya ditemukan pd anak2
 Pd osteomielitis sinus maksila dpt timbul fistula
oroantral/fistula pd pipi
 Kelainan paru → spt bronkitis kronik dan
bronkiektasis
REFERENSI
 Supardi EA, Iskandar N, Bashiruddin J, Restuti RD. Buku Ajar Ilmu Kesehatan
Telinga Hidung Tenggorok Kepala & Leher. 7th ed. Jakarta: FKUI; 2015
 Gray's Anatomy The Anatomical Basis of Clinical Practice, 40th Ed
 P. L. Dhingra, Shruti Dhingra-Diseases of Ear, Nose and Throat_ & Head
and Neck Surgery-Elsevier India (2014)
Thank
You…
