Sinusitis: Definition, types, clinical manifestation, medical management, nursing management

Definition

Sinusitis is the inflammation of the paranasal sinuses and nasal cavity.
Sinusitis is classified by duration of symptoms as;
Acute(less than 4 weeks), subacute (4 to 12 weeks), chronic (more than 12weeks)

Acute Sinusitis

It is classified as bacteria or viral sinusitis. It is classified by four or more acute episodes a year.

Pathophysiology

Acute sinusitis usually follows a viral upper respiratory infection or cold. Normally, the sinus openings into the nasal passages are clear and infections resolve promptly.
However, if their drainage is obstructed by; deviated septum, nasal polyps or tumors, it could lead to sinus infection and progress to an acute suppurative process (causing purulent discharge)
Nasal congestion caused by inflammation, edema and transudation of fluid secondary to obstruction of the sinus cavities. This provides an excellent medium for bacterial growth.
Other conditions that can block the normal flow of sinus secretions include; abnormal structures of the nose, enlarged adenoids, trauma to the nose, tumors and the pressure of foreign objects.
Some people are more prone to sinusitis because exposure to environmental hazards such as paint, sawdust and chemicals may result in chronic inflammation of the nasal passages.

Clinical Manifestation

• Purulent nasal discharge
•  Nasal discharge
• Facial pains
• Cloudy or coloured nasal discharge and localised or diffuse headaches.

NB: The symptoms of AVRS and ABRS are similar with the exception of the duration. AVRS last for less than 10 days after onset of upper respiratory symptoms and do not worsen.

Assesment and Diagnosis

• History and physical examination ie. particularly the nose and the head. There may be tenderness to palpation over the infected sinus area.
• CT scan
• Sinus aspirate to confirm the diagnoses of frontal and maxillary sinusitis.

Medical Management

The goal of treatment of acute sinusitis is to shrink the nasal mucosa, relieve pain and treat infections

• Antibiotics are used for bacterial cases and nasal corticosteroids for acute inflammations. The antibiotic of choice is amoxicillin and an example of nasal corticosteroid used is beclomethasone.
• Saline lavage is an alternative treatment to oral antibiotic and has being effective in relieving symptoms and clearing the passage of stagnant mucus and reducing the likelihood of opportunist infections.
• Decongestants are also used to improve patency of the nasal passage and improve the drainage of the sinus.

Nursing Management

Patient teaching is an important aspect of nursing care for a patient with acute sinusitis

• Nurse instructs patient about methods to promote drainage of the sinus including humidification of air in the homes and warm compresses to relieve pain
• Nurse teaches the patient about early signs of infection and recommends preventive measures such as following healthy practices and avoiding contact with people with URI’S
• The nurse explains to the patient that severe headache and nuchal rigidity (stiffness of the neck or inability to bend the neck) are signs of complications

Complications

• Osteomyelitis
• Intracranial complications include; meningitis, brains abscess etc

Chronic Sinusitis

It is diagnosed when the patient has experienced 12 weeks or longer of two or more of the following symptoms; mucupurulent discharge, nasal discharge, nasal obstruction, facial pain and decreased sense of smell

Pathophysiology

Mechanical obstruction in the Ostia of the frontal, maxillary and anterior ethmoid sinus (ostiomeatal complex) is the usual cause of chronic sinusitis. Obstruction prevents the adequate drainage of the nasal passage resulting in accumulation of secretions and an ideal medium for bacterial growth.
Clinical Manifestations

• Impaired mucociliary clearance and ventilation
• Cough (because the thick constantly drips backwards into the nasopharynx)
• Chronic hoarseness
• Chronic headache in the periorbital area and facial pain
• Nasal discharge
• Decrease in smell of taste

Assesment and Diagnosis

• Health assessment focuses on onset and duration of symptoms
• Physical examination of the nose for any evidence of structural abnormality
• The frontal and maxillary sinuses are palpated and the patient is asked whether this produces tenderness
• Imaging studies such as x-ray, sinoscopy, ultrasound, CT scan and MRI may be used in diagnosis

Nursing Management

• Nurse instruct patient to; blow nose gently and use tissue to remove nasal discharge
• Increase fluid intake
• Applying local heat (hot wet packs)
• Elevating head of the bed to promote drainage of the sinus.

NB: The medical management and complications is the same as that of acute sinusitis.

References:

Smelter,S.C.,Bare,B.G.,Hinkle,J.L.,&Chever,K.H.(2010).Brunner and Suddarth’s textbook of medical-surgical nursing (12th ed.) .Philadephia:Lippincot Williams & Wilkins

 

Group presentation by:

Osei –Wusu Stanley
Pela Mabel
Asare Patience