Sinusitis

Subject: Medical and Surgical Nursing II (Theory)

Overview

The moist air holes within the face's bones near the nose are known as sinuses. the ethmoid sinus, sphenoid sinus, frontal sinus, and maxillary sinus. The tissue lining the sinuses is inflamed or swollen. Sinuses typically contain air, but when they are clogged and filled with fluid, bacteria can flourish and lead to illness. It has a variety of sinusitis types, including acute, chronic, recurrent, subacute, and more. A viral upper respiratory tract infection (URTI) is the most typical cause of acute sinusitis. Sinus inflammation brought on by the viral infection can subside without medical intervention in less than 14 days. A secondary bacterial infection is identified if symptoms develop after 3 to 5 days, last longer than 10 days, or are more severe than those typically associated with a viral illness. Acute sinusitis may be more likely to occur if there is inflammation. It involves discomfort, nasal discharge, fever, soreness, nose bleeds, and agony. Acute sinusitis is treated with appropriate systemic therapy for the likely bacterial pathogens as well as adequate drainage of the involved sinus. Using surgical sinus puncture and irrigation methods, drainage can be accomplished.

Sinusitis

The moist air holes within the face's bones near the nose are known as sinuses.

Your sinuses are irritated if you have sinusitis. An infection or another issue might be the root of the issue. The tissue lining the sinuses is inflamed or swollen. Sinuses typically contain air, but when they are clogged and filled with fluid, bacteria can flourish and lead to illness.

Pathophysiology

A viral upper respiratory tract infection (URTI) is the most typical cause of acute sinusitis. Sinus inflammation brought on by the viral infection can subside without medical intervention in less than 14 days. A secondary bacterial infection is identified if symptoms develop after 3 to 5 days, last longer than 10 days, or are more severe than those typically associated with a viral illness. By generating sinus ostial obstruction, the inflammation might predispose to the development of acute sinusitis. The maxillary and anterior ethmoid sinuses are the most frequently affected sinuses in both acute and chronic sinusitis, although inflammation in any of the sinuses can result in blockage of the sinus ostia.

The ostiomeatal complex is a region of anatomy formed by the drainage of the front frontal, maxillary, and ethmoid sinuses into the middle meatus.

In response to the virus, the nasal mucosa secretes mucus and draws inflammatory mediators, including as white blood cells, to the lining of the nose, which enlarges and congests the nasal passages. The cilia, which move mucus and debris from the nose, become less effective as a result of the sinus cavity hypoxia and mucus retention, which fosters bacterial growth.

Chronic sinusitis can arise from mucus retention, hypoxia, and ostia blockage if acute sinusitis does not go away. As a result, mucosal hyperplasia, ongoing infiltration by inflammatory infiltrates, and potential nasal polyp development are encouraged.

Types of Sinusitis

There are different types of sinusitis, including:

Classification of Sinusitis by Duration:

  • Acute Sinusitis: A sudden onset of cold-like symptoms such as the runny nose and facial pain that does not go away after 10 to 14 days. Acute sinusitis typically lasts for 4 weeks or less.
  • Subacute Sinusitis: An inflammation lasting 4-8 weeks.
  • Chronic Sinusitis: A condition characterized by sinus inflammation symptoms lasting 8 weeks or longer.
  • Recurrent Sinusitis: Several attacks within a year.

Classification of Sinusitis by Location:

  • Maxillary: can cause pain or pressure in the maxillary area.
  • Frontal: can cause pain or pressure in the frontal sinus cavity.
  • Ethmoid: can cause pain or pressure between/behind the eyes and headaches.
  • Sphenoid: can cause pain and pressure behind the eyes, but often refers to the vertex or top of the head

Signs and Symptoms

Some of the primary symptoms of acute sinusitis include:

  • Facial pain/pressure.
  • Nasal stuffiness.
  • Nasal discharge.
  • Loss of smell.
  • Cough/congestion.

Additional symptoms may include:

  • Fever,
  • Bad breath,
  • Fatigue,
  • Dental pain.

Signs and Symptoms of Chronic Sinusitis

  • Facial congestion/fullness,
  • A nasal obstruction/blockage,
  • Fever,
  • Nasal discharge/discolored postnatal.

Additional symptoms of chronic sinusitis may include:

  • Headaches,
  • Bad breath,
  • Fatigue,
  • Dental pain.

Treatment

  • Nasal irrigation may help with symptoms of chronic sinusitis
  • Decongestant nasal sprays containing for example oxymetazoline may provide relief, but these medications should not be used for more than the recommended period. Longer use may cause rebound sinusitis
  • Other recommendations include applying a warm, moist cloth to the affected area several times a day; drinking sufficient fluids in order to thin the mucus; and inhaling
  • Antibiotics: The vast majority of cases of sinusitis is caused by viruses and will, therefore, resolve without antibiotics. However, if symptoms do not resolve within 10 days, amoxicillin is a reasonable antibiotic to use first for treatment with amoxicillin/clavulanate (Augmentin) is being indicated when the patient's symptoms do not improve on amoxicillin like doxycycline, are used in patients who are allergic to penicillin
  • Corticosteroids: For unconfirmed acute sinusitis, intranasal corticosteroids have not been found to be better than placebo either alone or in combination with antibiotics. For cases confirmed by radiology or nasal endoscopy, treatment with corticosteroids alone or in combination with antibiotics is supported. The benefit, however, is small
  • Surgery: Surgery should only be considered for those patients who do not experience sufficient relief from optimal medication
    • Maxillary antral washout
    • FESS (functional endoscopic sinus surgery )
    • Ballon sinoplasty
    • Caldwell- Luc radical antrostomy

Reference

  • Brunner and Siddhartha's Medical-surgical Nursing, 9th edition
  • MedicineNet. 1996. 2017 http://www.medicinenet.com/sinusitis/article.htm
  • Medline Plus. 05 January 2017 https://medlineplus.gov/sinusitis.html 
  • Mandal, G.N. Textbook of Adult Nursing. Kathmandu: Makalu Publication House, 2013.
  • Web MD. 2005. 2017 http://www.webmd.com/allergies/sinusitis-and-sinus-infection
  • Williams and Wilkins, The Lippincott manual of Nursing practice, 7th edition, International student edition, 2001.
Things to remember
  • The tissue lining the sinuses is inflamed or swollen. Sinuses typically contain air, but when they are clogged and filled with fluid, germs can flourish and lead to infection. The tissue lining the sinuses is inflamed or swollen. Sinuses typically contain air, but when they are clogged and filled with fluid, germs can flourish and lead to infection.
  • Sinus inflammation brought on by the viral infection can subside without medical intervention in less than 14 days.
  • By causing sinus ostial blockage, the inflammation can predispose to the development of acute sinusitis.
  • In response to the virus, the nasal mucosa secretes mucus and draws inflammatory mediators, including as white blood cells, to the lining of the nose, which enlarges and congests the nasal passages.
  • The following are your options for medical drainage:
  • oral alpha-adrenergic vasoconstrictors for 10–14 days, such as pseudoephedrine and phenylephrine
  • topical vasoconstrictors, such as oxymetazoline hydrochloride, for no more than three to five days
Questions and Answers

Treatment of acute sinusitis consists of providing adequate drainage of the involved sinus and appropriate systemic treatment of the likely bacterial pathogens. Drainage can be achieved surgically with sinus puncture and irrigation techniques. Options for medical drainage are as follows:

  • Oral alpha-adrenergic vasoconstrictors (eg, pseudoephedrine, and phenylephrine) for 10-14 days

  • Topical vasoconstrictors (eg, oxymetazoline hydrochloride) for a maximum of 3-5 days

Antibiotic treatment is usually given for 14 days. Usual first-line therapy is with one of the following:

  • Amoxicillin, at double the usual dose (80-90 mg/kg/d), especially in areas with known Streptococcus pneumoniae resistance

  • Clarithromycin

  • Azithromycin

Second-line antibiotic should be considered for patients with any of the following:

  • Residence in communities with a high incidence of resistant organisms

  • Failure to respond within 48-72 hours of commencement of therapy

  • Persistence of symptoms beyond 10-14 days

The most commonly used second-line therapies include the following:

  • Amoxicillin-clavulanate

  • Second- or third-generation cephalosporins (eg, cefuroxime, cefpodoxime, cefdinir)

  • Macrolides (ie, clarithromycin)

  • Fluoroquinolones (eg, ciprofloxacin, levofloxacin, moxifloxacin)

  • Clindamycin

Antibiotic selection with respect to previous antibiotic use and disease severity is as follows:

  • Adults with mild disease who have not received antibiotics: Amoxicillin/clavulanate, amoxicillin (1.5-3.5 g/day), cefpodoxime proxetil, or cefuroxime is recommended as initial therapy.

  • Adults with mild disease who have had antibiotics in the previous 4-6 weeks and adults with moderate disease: Amoxicillin/clavulanate, amoxicillin (3-3.5 g), cefpodoxime proxetil, or cefixime is recommended.

  • Adults with moderate disease who have received antibiotics in the previous 4-6 weeks: Amoxicillin/clavulanate, levofloxacin, moxifloxacin, or doxycycline is recommended.

It is caused by inflammation or swelling of the sinus tissue. Sinuses are normally filled with air, but when they become blocked and filled with fluid, germs can grow and cause infection.

The most common cause of acute sinusitis is a viral upper respiratory tract infection (URTI). The viral infection can cause sinus inflammation, which usually resolves without treatment in less than 14 days. A secondary bacterial infection is diagnosed when symptoms worsen after 3 to 5 days or persist for more than 10 days and are more severe than those seen with a viral infection. By causing sinus ostial blockage, the inflammation can predispose to the development of acute sinusitis. Although inflammation in any of the sinuses can result in sinus ostia blockage, the maxillary and anterior ethmoid sinuses are the most commonly involved sinuses in both acute and chronic sinusitis. The anterior ethmoid, frontal, and maxillary sinuses drain into the middle meatus, forming the ostiomeatal complex.

The nasal mucosa responds to the virus by producing mucus and recruiting inflammatory mediators, such as white blood cells, to the nasal lining, resulting in nasal congestion and swelling. The cilia, which move mucus and debris from the nose, become less efficient as a result of the sinus cavity hypoxia and mucus retention, creating an environment for bacterial growth.

If acute sinusitis does not resolve, chronic sinusitis can develop due to mucus retention, hypoxia, and ostia blockage. This encourages mucosal hyperplasia, the continued recruitment of inflammatory infiltrates, and the development of nasal polyps.

The most common cause of acute sinusitis is a viral upper respiratory tract infection (URTI). The viral infection can cause sinus inflammation, which usually resolves without treatment in less than 14 days. A secondary bacterial infection is diagnosed when symptoms worsen after 3 to 5 days or persist for more than 10 days and are more severe than those seen with a viral infection. By causing sinus ostial blockage, the inflammation can predispose to the development of acute sinusitis. Although inflammation in any of the sinuses can result in sinus ostia blockage, the maxillary and anterior ethmoid sinuses are the most commonly involved sinuses in both acute and chronic sinusitis. The anterior ethmoid, frontal, and maxillary sinuses drain into the middle meatus, forming the ostiomeatal complex.

The nasal mucosa responds to the virus by producing mucus and recruiting inflammatory mediators, such as white blood cells, to the nasal lining, resulting in nasal congestion and swelling. The cilia, which move mucus and debris from the nose, become less efficient as a result of the sinus cavity hypoxia and mucus retention, creating an environment for bacterial growth.

If acute sinusitis does not resolve, chronic sinusitis can develop due to mucus retention, hypoxia, and ostia blockage. This encourages mucosal hyperplasia, the continued recruitment of inflammatory infiltrates, and the development of nasal polyps.

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