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Multimedia Health Education

Disclaimer

This movie is an educational resource only and should not be used to manage your health. All decisions about the management of sinus problems must be made in conjunction with your Physician or a licensed healthcare provider.

Sinusitis

SECTION CONTENT


MULTIMEDIA HEALTH EDUCATION MANUAL

TABLE OF CONTENTS

Sinusitis

2 . Overview of Sinusitis

1 . Normal Nose Anatomy

3 . Treatment Options

a. Diagnosis

a. What is Sinusitis?

b. Symptoms

c. Causes and Risk Factors

b. Conservative Treatment

c. Surgical Introduction

d. Surgical Procedure

a. Introduction

b. Normal Nose Anatomy

e. Post Operative Precautions

f. Risks and Complications

INTRODUCTION


Nasal sinuses are hollow, air containing cavities in the skull behind the forehead and cheeks of the face. There are four pairs of sinuses and these are referred to as the paranasal sinuses. Sinusitis occurs when one or more sinuses become infected causing inflammation of the membranes that line the sinus cavity. Sinusitis is a common problem affecting millions of people around the world.

Sinusitis

In order to learn more about sinusitis, it is important to understand the normal anatomy of the nose.

Unit 1: Normal Nose Anatomy


Normal Nose Anatomy - External Nose

The nose is the most prominent structure of the face. It not only adds beauty to the face it also plays an important role in breathing and smell. The nasal passages serve as an entrance to the respiratory tract and contain the olfactory organs of smell.

Nasal Bones:

These are paired rectangular structures attached to the skull bone above and nasal cartilages below. The distal part of the bones is thinner and wider making it more prone for fractures after an injury.

Leteral Nasal Cartilages:

There are two pairs of nasal cartilages, the upper lateral and lower lateral cartilages. The nasal bones and the lateral nasal cartilages together form the External Nasal Pyramid or Vault.

(Refer fig.1)

(Refer fig.2)

(Refer fig.3)

(Fig.1)

Normal Nose Anatomy

(Fig.2)

Nasal Bones

(Fig.3)

Leteral NasalCartilages

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Our nose acts as an air conditioner of the body responsible for warming and saturating inspired air, removing bacteria, particles and debris, as well as conserving heat and moisture from

Normal Nose Anatomy


Normal Nose Anatomy - Internal NoseNasal Septum This is a vertical wall inside the nose that consists of cartilage in the front and bones in the back. The nasal septum divides the interior of the nose into two principal nasal cavities. It is seldom straight.

Middle Concha:

The middle concha is the most important of all conchae. The space it encloses is called the middle meatus.

Unit 1:

(Refer fig.4)

(Refer fig.6)

(Fig.4)

Nasal Septum

(Fig.5)

SuperiorConcha

(Fig.6)

MiddleConcha

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In the anteroinferior part of the nasal septum is a rich union of blood vessels called the little’s area. The nasal septum also forms an important support to the external nasal framework.

Superior Concha: This is a scroll or shelf like projection from the sidewall of the nasal cavity. It is the smallest of all conchae and is located high up in the nasal cavity. It overhangs a space or channel called the meatus.

(Refer fig.5)

The posterior ethmoidal sinuses open into the superior meatus. There is a shallow depression behind the superior meatus called Sphenothmoidal recess into which the Sphenoidal sinus opens.

The frontal, maxillary and the anterior ethmoidal sinuses open into the middle meatus.

Normal Nose Anatomy


Inferior Concha:

This is the largest of all concha and is a separate bone. Similar to the other concha, the space it envelops is called the inferior meatus. The nasolacrimal duct, which conveys tears to the nose from the eyes, opens in the inferior meatus.

Ethmoidal Sinuses:

These are paired sinuses located in between the eyes and nasal cavity. Each sinus consists of 4 – 18 air containing cavities – the ethmoidal air cells.

Unit 1:

(Refer fig.7)

Nasolacrimal Duct:

This is a duct that conveys tears from the eyes into the nose. It opens into the inferior meatus. Obstruction of this duct could lead to flooding of eyes with tears and watering of eyes.

Normal Nose Anatomy - Sinuses

There are four paired sinuses called Paranasal Sinuses. The paranasal sinuses consist of the following:

(Refer fig.8)

(Refer fig.9)

(Fig.7)

Inferior Concha

(Fig.8)

NasolacrimalDuct

(Fig.9)

EthmoidalSinuses

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These sinuses are present at birth and continue to grow until adolescence. The anterior air cells open into the middle meatus and the posterior group open into the superior meatus.

Normal Nose Anatomy


Maxillary Sinus:It is the largest of all sinuses with a volume of about 15 ml. These are paired cavities located inside the face around the area of the cheeks. This sinus is also present at birth and continues to grow afterwards. The sinus opens into the middle meatus.

Frontal Sinus:

This is the last of the sinuses to develop. These are paired cavities located inside the face around the area of the forehead. The sinuses open into the middle meatus.

Unit 1:

(Refer fig.10)

(Refer fig.11)

Sphenoid Sinus:

These are also paired cavities located deep in the face behind the nose. Each sinus has a volume of about 7.5 ml. They open into a small recess behind the superior meatus.

(Refer fig.12)

(Fig.10)

MaxillarySinus

(Fig.11)

Frontal Sinus

(Fig.12)

SphenoidSinus

Sinusitis


What is Sinusitis? Sinusitis means your sinuses are infected or inflamed. Health experts usually divide sinusitis cases into:

Symptoms of Sinusitis

One of the most common symptoms of sinusitis is pain, and the location depends on which sinus is affected.

If you have a pain in your forehead over the frontal sinuses when you are touched, your frontal sinuses may be inflamed.

Unit 2: Overview of Sinusitis

Most people with sinusitis have pain or tenderness in several locations, and their symptoms usually do not clearly indicate which sinuses are inflamed.

In addition to the pain, people with sinusitis frequently have thick nasal secretions that are yellow, green, or blood tinged. Sometimes these secretions, referred to as post-nasal drip, drain in the back of the throat and are difficult to get rid of. Also, acute and chronic sinusitis are strongly associated with nasal symptoms such as a stuffy nose, as well as with a general feeling of fullness over the entire face.

Less common symptoms of sinusitis can include:Tiredness

Sinusitis

Acute cases, which last for 4 weeks or less

Subacute cases, which last 4 to 12 weeks

Chronic cases, which last more than 12 weeks and can continue for months or even years

Recurrent cases, which involve several acute attacks within a year

If your upper jaw and teeth ache, and your cheeks become tender to the touch, you may have an infection in the maxillary sinuses.

If you have swelling of the eyelids and tissues around your eyes, and pain between youreyes, you may have inflammation of the ethmoid sinuses that are near the tear ducts in the corner of your eyes.

Ethmoid inflammation also can cause a stuffy nose, a loss of smell,and tenderness when you touch the sides of your nose.

If you have earaches, neck pain, and deep achiness at the top of your head, you may have infection in the sphenoid sinuses, although these sinuses are less frequently affected.

Decreased sense of smell

Cough that may be more severe at night

Sore throat

Bad breath Fever


Overview of Sinusitis

Causes and Risk Factors

Causes of Acute SinusitisMost cases of acute sinusitis start with a common cold, which is caused by a virus. Colds can inflame your sinuses and cause symptoms of sinusitis. Both the cold and the sinus inflammation usually go away without treatment within 2 weeks. If the inflammation produced by the cold leads to a bacterial infection, however, then this infection is what health experts call acute sinusitis.

The inflammation caused by the cold results in swelling of the mucous membranes (linings) of your sinuses, and this can lead to air and mucus becoming trapped behind the narrowed openings of the sinuses. When mucus stays inside your sinuses and is unable to drain into your nose, it can become the source of nutrients (material that gives nourishment) for bacteria.

People who suffer from allergies that affect the nose (like pollen allergy, also called hay fever), as well as people who may have chronic nasal symptoms not caused by allergy, are also prone to develop episodes of acute sinusitis. The chronic nasal problems cause the nasal membranes to swell, and the sinus passages become blocked in a manner similar to that described for the common cold. The normally harmless bacteria in the nose and throat again lead to acute sinusitis.

Unit 2:

On rare occasions, acute sinusitis can result in brain infection and other serious complications if left untreated.

Rarely, fungal infections can cause acute sinusitis. Although fungi are abundant in the environment, they usually are harmless to healthy people because the human body has a natural resistance to fungus. However, in people whose immune system is not functioning properly, fungus, such as Aspergillus, can cause acute sinusitis. (Aspergillus is commonly found growing on dead leaves, stored grain, compost piles, or in other decaying vegetation.)

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Most healthy people harbor bacteria, such as Streptococcus pneumoniae and Haemophilus influenzae, in the nose and throat, and the bacteria cause no problems. But when you have a cold, you tend to sniff or to blow your nose, and these actions cause pressure changes that can send bacteria inside the sinuses. If your sinuses then stop draining properly, bacteria that may have been living harmlessly in your nose or throat can begin to multiply in your sinuses, causing acute sinusitis.

In general, people who have reduced immune function (such as those with primary immune deficiency disease or HIV infection) or abnormalities in mucus secretion or mucus movement (such as those with cystic fibrosis) are more likely to suffer from sinusitis.


In chronic sinusitis, the membranes of both the paranasal sinuses and the nose are thickened because they are constantly inflamed. Most experts now use the term "chronic rhinosinusitis" to describe this condition, and they also recommend that the condition be divided into rhinosinusitis with or without nasal polyps. Nasal polyps are grape-like growths of the sinus membranes that protrude into the sinuses or into the nasal passages. Polyps make it even more difficult for the sinuses to drain and for air to pass through the nose.

The causes of chronic sinusitis are largely unknown. The condition often occurs in people with asthma, the majority of whom have allergies. It is possible that constant exposure to inhaled allergens that are present year-round, such as house dust mites, pets, mold (a kind of fungus), and cockroaches cause chronic inflammation of the nose and the sinuses.

An allergic reaction to certain fungi may be responsible for at least some cases of chronic sinusitis; this condition is called "allergic fungal sinusitis." At least half of all people with chronic rhinosinusitis do not have allergies, however.

Most health experts believe that chronic rhinosinusitis is not an infectious disease (like acute sinusitis). If you suffer frequent episodes of acute sinusitis, however, you may be prone to develop chronic rhinosinusitis. Other causes of chronic rhinosinusitis may be an immune deficiency disorder (for example, primary immune deficiency disease or HIV infection) or an abnormality in the quality of mucus produced by the respiratory system (cystic fibrosis).

Chronic Sinusitis

Another group of people who may develop chronic sinusitis are those with significant anatomic (structure) variations inside the nose, such as a deviated septum, that lead to blockage of mucus.

Overview of Sinusitis Unit 2:

Sinusitis


Diagnosis

Because your nose can get stuffy when you have a condition like the common cold, you may confuse simple nasal congestion with sinusitis. A cold, however, usually lasts about 7 to 14 days and goes away without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than a cold.

Your healthcare provider can usually diagnose acute sinusitis by noting your symptoms and doing a physical examination, which includes examining your nasal tissues. If your symptoms are vague or persist, your healthcare provider may order a computed tomography (CT) scan, a form of X-ray, to confirm that you have sinusitis.

Laboratory tests your healthcare provider may use to diagnose chronic sinusitis include:

Blood tests to rule out conditions associated with sinusitis, like an immune deficiency disorder

Conservative Treatment Options

After diagnosing sinusitis and identifying a possible cause, your healthcare provider can suggest various treatments.

Acute Sinusitis

If you have acute sinusitis, your healthcare provider may recommend:

Antibiotics to control a bacterial infection, if present

Even if you have acute sinusitis, your provider may choose not to use an antibiotic because many cases of acute sinusitis will end on their own. But if you do not feel better after a few days you should contact your provider again. You should use over-the-counter or prescription decongestant nose drops and sprays only for few days. If you use these medicines for longer periods, they can lead to even more congestion and swelling of your nasal passages.

Unit 3: Treatment Options

Sinusitis

A sweat test or a blood test to rule out cystic fibrosis

Tests on the material that is inside your sinuses to detect bacterial or fungal infection

Biopsy of the membranes (linings) of the nose or sinuses to determine the health of the cells lining these cavities

Pain relievers to reduce any pain

Decongestants to reduce congestion

If you have an allergic disease along with sinusitis, you may also need medicine to control allergies. This may include a nasal steroid spray that reduces the swelling around the sinus passages and allows the sinuses to drain. If you already have asthma and then get sinusitis, your asthma may worsen. You should stay in close touch with your healthcare provider to modify your asthma treatment if needed.


Treatment Options

Chronic Sinusitis

Healthcare providers often find it difficult to treat chronic sinusitis successfully. The two main forms of treatment that are used, nasal steroid sprays and long courses of oral antibiotics, alone or in combination, have not been rigorously tested in chronic sinusitis. Scientists need to do more research to determine what the best treatment is. Many healthcare providers also recommend using saline (saltwater) washes or sprays in the nose to help remove thick secretions and allow the sinuses to drain.

If you have severe chronic sinusitis, your healthcare provider may prescribe oral steroids, such as prednisone. Because oral steroids are powerful medicines and can have significant side effects, you should take them only when other medicines have not worked.

Surgical Introduction

When medicine fails, surgery may be the only alternative for treating chronic sinusitis. The goal of surgery is to improve sinus drainage and reduce blockage of the nasal passages. During surgery, which is usually done through the nose, the surgeon:

Functional Endoscopic Sinus Surgery or FESS is minimally invasive corrective surgery for chronic sinusitis. FESS is performed through the nose using an endoscope, a long, thin, tube which has a light and a video camera on the end. Images from the endoscope are magnified and projected on a TV screen enabling your surgeon to visualize internal structures in great detail.

Computer assisted endoscopic sinus surgery, also referred to as image-guided surgery (IGS), may be used to perform your sinus surgery. Image guided surgery systems utilize CT images of the patient’s anatomy to track the position of special surgical instruments during the procedure and assist the surgeon with precise targeting of internal structures. IGS enables the surgeon to perform a more thorough and precise surgery and has significantly improved the safety and effectiveness of the procedure.

Unit 3:

Sinusitis

Enlarges the natural opening of the sinuses Removes any polyps Corrects significant anatomic deformities that contribute to the obstruction

Endoscopic Sinus Surgery offers many benefits over the older surgery techniques of “open surgery” where an outside incision was required. Advantages of endoscopic surgery include:

Minimal soft tissue trauma Less pain Faster healing time Lower infection rateLess scarringUsually performed as outpatient day surgery


Treatment Options

Functional Endoscopic Sinus Surgery (FESS) is performed under sterile conditions in the operating room with the patient under general anesthesia or local anesthesia with sedation. This operation is usually performed as outpatient surgery enabling the patient to go home the same day.

Depending on your particular situation, your surgeon may perform additional procedures to offer you the best possible outcome for your situation.

These may include the following:

This is corrective surgery for a deviated nasal septum. The septum is the bony cartilage which divides the nose into two chambers. A deviated septum can interfere with breathing and predispose to sinus infections.

This is surgery to remove diseased tissue and bony partitions in the ethmoid sinuses.

This surgery involves revision to the inferior choncha or turbinate bone. The turbinates are responsible for warming, humidifying, and filtering inspired air and can cause blockage of the nasal passages.

Inferior Turbinoplasty:

Surgical Procedure

Ethmoidectomy:

Septoplasty:

Unit 3:

Sinusitis

Your surgeon will perform endoscopic sinus surgery through the nasal passages with no external incision. The nasal cavity is topically decongested and anesthetized with an injection.

An endoscope, a tiny, telescope with a light and lens on the end is advanced into the nasal passageway and the image magnified on a television screen. (Fig.13)

In computer assisted surgery, special instruments are used that are connected to a computer system where they are tracked according to the patients’ anatomy based on pre-operative CT scans. Using tiny bone cutting instruments and debriders, your surgeon will enlarge the sinus openings and remove any abnormalities blocking the sinuses such as polyps.

(Refer fig. 13 to 16)


If septoplasty is indicated for a deviated septum, an incision is made to the nasal septum inside the nose through one of the nostrils. The mucous membrane is lifted away from the septum The nasal septum is then reshaped into proper position straightening the septum.

Occasionally severely deviated portions of the septum are completely removed or repaired and replaced inside the nose. Mucous membranes are then returned to their normal position covering the nasal septum.

Treatment Options Unit 3:

(Fig.14)

Sinusitis

(Fig.15)

(Fig.16)

For an ethmoidectomy procedure, your surgeon will advance the endoscope into the ethmoid sinuses. Special instruments are used to remove diseased tissue and bony partitions to improve airway flow and decrease inflammation.

If the inferior turbinates are large and swollen your surgeon will perform an inferior turbinoplasty. Your surgeon will make an incision in the mucosal lining of the inferior turbinate. The underlying turbinate bone is carefully removed as well as any diseased tissue.

Dissolvable sutures, splints and/or packing are placed inside the nose to minimize postoperative bleeding and a small gauze dressing is taped under the nose.

(Refer fig. 13 to 16)


Treatment Options Unit 3:

Post Operative Guidelines

Your surgeon will give you guidelines to follow depending on the type of surgery performed and the surgeon’s preference.

Common post-operative guidelines include:

Sinusitis

You will need someone to drive you home after surgery due to the drowsy effects of the anesthesia.

Your nostrils will be packed with sterile cotton gauze and will usually be removed before being discharged to home or at your follow up appointment the next day. The gauze dressing under the nose will need to be changed when wet and may be kept in place for a few days.

You will be given pain medications to manage your pain. Do not use aspirin or ibuprofen products as these can cause bleeding to occur.

Take all medications given to you as prescribed. These may include antibiotics, decongestants, or steroids.

Do not drink alcohol while taking antibiotics and pain medications.

Get plenty of rest. You should avoid strenuous activity as well as bending and lifting for 1-2 weeks after surgery as this may cause bleeding.

Sleep with your head elevated on extra pillows.

Sneeze with your mouth open so as not to dislodge the nasal packing.

Do not smoke as smoking delays healing and increases your risk of developing complications.

Risks and Complications

As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or specific to sinus surgery. Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete. Complications include:

Allergic reactions to medications Blood loss requiring transfusion with its low risk of disease transmission

Heart attacks, strokes, kidney failure, pneumonia, bladder infections

Complications from nerve blocks such as infection or nerve damage Serious medical problems can lead to ongoing health concerns, prolonged hospitalization,or rarely death.

Complications are rare after sinus surgery, but unexpected events can follow any operation. Your surgeon feels that you should be aware of complications that may take place so that your decision to proceed with this operation is taken with all relevant information available to you.


Possible complications following sinus surgery can include the following:

Bleeding Infection Numbness Meningitis Symptoms Recur

Report fever of 38.5 C or 101.0 F or higher. Report foul smelling, greenish yellow nasal drainage as well as increasing pain or unresolved vomiting to your surgeon. Antibiotics will be prescribed to treat the infection.

Numbness to the nose tip and upper teeth usually resolves in a few months but very rarely can persist.

Significant bleeding is uncommon. Report any abnormal bleeding to your surgeon.

Although extremely rare, a hole can occur between the sinuses and the brain and lead to leakage of CSF, cerebrospinal fluid. This can lead to a serious infection called Meningitis. If you have nasal drainage that looks like water it may be CSF and you should notify your surgeon immediately.

Most people have fewer symptoms and better quality of life after sinus surgery. In a substantial number of people, however, problems can recur after surgery, sometimes even after a short period of time.

Symptoms Recur:

Numbness:

Meningitis:

Infection:

Bleeding:

Treatment Options Unit 3: Treatment Options Unit 3:

Sinusitis


Treatment Options

Risks & Complications

Unit 3:

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(Refer fig.17)

(Fig.17)

Risk factors that can negatively affect adequate healing after surgery include:


SummaryA good knowledge of this procedure will make the stress of undertaking the procedure easier for you to bear. The decision to proceed with the procedure is made because the advantages of the procedure outweigh the potential disadvantages. It is important that you are informed of these risks before the procedure.

DisclaimerUnit 3:

Sinusitis

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Multimedia Health EducationSinusitis

DisclaimerContentUnit-1IntroductionNormal Nose Anatomy - External NoseNasal Bones Leteral Nasal Cartilages Internal Nose Nasal SeptumSuperior Concha Middle Concha Inferior Concha Nasolacrimal Duct Normal Nose Anatomy - Sinuses Ethmoidal SinusesMaxillary Sinus Frontal Sinus Sphenoid Sinus

Unit-2What is Sinusitis? Symptoms of Sinusitis Symptoms of Sinusitis - Page-2Causes and Risk FactorsCauses of Acute SinusitisChronic Sinusitis

Unit-3DiagnosisConservative Treatment Options Acute Sinusitis Chronic SinusitisSurgical IntroductionSurgical ProcedureSeptoplastyEthmoidectomyInferior TurbinoplastySurgical Procedure - Page-2Post Operative GuidelinesRisks and Complications Risks and Complications - Page-2BleedingInfectionNumbnessMeningitisSymptoms RecurRisks and Complications - Page-3Risks FactorsDisclaimer

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