Sinusitis Complications - Dr.Anup

8/8/2019 Sinusitis Complications - Dr.Anup

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OTORHINOLARYNGOLOGY

SYMPOSIUM

DEPARTMENT OF ENT

CHENGLEPET MEDICAL COLLEGE


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OVERVIEW OF SINUSITIS COMPLICATIONS

INTRACRANIAL COMPLICATIONS

ORBITAL COMPLICATIONSVASCULAR COMPLICATIONS

OSTEOMYELITIS

ASTHMA

LOSS OF SMELL AND TASTE


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COMPLICATIONS OF SINUSITIS

CAVERNOUS SINUS THROMBOSIS

MENINGITIS


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Cavernous sinus communicates with the valveless facial veins,Cavernous sinus communicates with the valveless facial veins,

pterygoid plexus, lateral sinus, IJV.pterygoid plexus, lateral sinus, IJV.


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CAVERNOUS SINUS THROMBOSIS

NASAL SINUSES

ORBIT AND EYEBALL

DANGER TRIANGLE OF FACE


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CLINICAL HISTORY

NON SPECIFIC

MID FACE INFECTION,FURUNCLE IS COMMON

HEADACHE

SHARP,PROGRESSIVELOCALISED TO OPTHALMIC AND MAXILLARY N

ORBITAL PAIN AND FULLNESS

BLURRED VISION-DIPLOPIA

PERIORBITAL OEDEMA

UNILATERAL BECOMIN BILATERAL IN 24-48HRS


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PHYSICAL FINDINGS

1. PERIORBITAL OEDEMA

2. LATERAL GAZE PALSY

3. PTOSIS, MYDRIASIS AND EYE MUSCLE WEAKNESS

4. CHEMOSIS

5. EXOPHTHALMOS AND OPTHALMOPLEGIA

6. SLUGGISH PUPIL RESPONSE AND DEC. VISUAL ACUITY


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1. HYPER OR HYPOAESTHESIA OF V1,V2 BARNCHES OF V TH

NERVE

2. APPEARANCE OF SIGNS IN CONTRALATERAL EYE

3. NUCHAL RIGIDITY AND BRUDZINSKI SIGNS

4. SEPSIS- CHILLS ,FEVER ,SHOCK


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TREATMENT

Critical medical emergency

Intravenous antibiotics

Cefotaxime 1.5 to 2 g IV q4h

Metronidazole 15 mg/kg load followed by 7.5 mg/kg IV q6hvancomycin in methicillin resistant organisms

Remove septic focus from sinuses

Steroids-hydrocortisone

ANTICOAGULATION

Based on limited observation, anticoagulation may be beneficial after

exclusion of hemorrhagic complications by CT scan. [1] [2] [13]

Anticoagulation is thought by some to be dangerous in patients with

bilateral CST and/or concurrent intracranial hemorrhage.


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PROGNOSIS

100 % mortality prior to antimicrobials

30 % now

Morbidity-1/6 th have decreased vision

-half of them have cranial nerve deficits


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Acute purulent infection within subarachnoid space

Bacterial meningitis commonly

Mostly spreads from the ethmoid and sphenoid sinuses


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EPIDEMIOLOGY

Strep.pneumoniae 50 %

N.meningiditis-25%

Group b streptococci-15 %

Listeria monocytogenes-10%


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1. bacterial colonisation

2. Transport across epithelial cells3. Transport in blood stream

4. Intraventricular choroid plexus

5. S.pneumoniae-affinity for cerebral capillary endothelium

6. CSF-decreased leucocytes,complement and IG

7. Host immune response

8. Bacterial degradation products are released9. Inflammatory reaction

10.purulent

PATHOGENESIS


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CLINICAL PRESENTATION

Classical triad-fever,headache,nuchal rigidity

Seizures-focal or generalised

Raised ICP features-Kernigs sign and brudzinskis sign

Maculopapular rash


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DIAGNOSISclinical diagnosis

blood and csf cultures can be taken

Lumbar spinal puncture

aseptic precaution sCT and Fundoscopy prior to CSF tap

l3 and l4 vertebrae for 4 to 6 cms

CSF escapes at the rate of 1drop/sec

if pressure is raised it escapes as a jet


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CSF findings

Increased opening pressure

WBC count> 1000 per cu.mm

DLC count predominance of polymorphonuclear lymphocytes

Protein- mild to marked elevation

CSF glucose is decreased


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TREATMENT

Start empirical antibiotic therapy wit cephalosporins & metroinidazole

1. Specific antimicrobial therapy

2. Pneumococcal-cephalosporins & vancomycin

3. Listeria-ampicillin &gentamycin4. Staphylococcal-vancomycin &nafcillin

5. Gram ve bacteria-3rd generation cephalosporins

6. Meningococcal-penicillin&ampicillin

ADJUNCTIVE THERAPY

Dexamethasone To decrease ICP

-tilt head at 30 to 45

-intubate

-hyperventilate

-iv mannitol


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