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Sinustis

Pn Justina Ganggot
KKS Ogos 2008

Locating the Sinuses

Learning objectives
1.
2.
3.
4.
5.
6.

Define sinusitis
State the etiology of sinusitis
State the clinical manifestations of sinusitis
State the diagnostic investigations of sinusitis
State the management of client with sinusitis
State the complications of sinusitis

Define sinusitis

Adalah inflamasi pada satu atau lebih sinus


paranasal.

Ia lazimnya disebabkan oleh jangkitan yang


merebak dari hidung. Organisma yang biasa
terdapat ialah streptococci, S. pneumoniae,
Haemophilus influenza dan staphylococci

etiology of sinusitis

Sekatan pada sinus oleh:

gigi patah yang memasuki ke dalam sinus maksilari


rhinitis
Berenang / menyelam
nasal polyps
deviated septum
direct trauma

Jangkitan salur pernafasan atas (URTI)

clinical manifestations of sinusitis

Sakit dan tenderness di bahagian sinus yang terlibat.


Lebih sakit jika membongkok ke hadapan

apabila sinus maksilari terlibat, tekanan dan rasa sakit di pipi.


Sinus di frontal yang terlibat menyebabkan sakit dan tendrness di
lower forehead.
Infeksi pada ethmoid sinus menyebabkan sakit di reto-orbital dan di
bahagian atas lateral hidung.
Jika sinus sphenoid terlibat, menyebabkan kesakitan di oksiput, verteks
dan tengah kepala.

Nasal congestion disebabkan discaj yang purulent


Susah bernafas
Nasal mukosa menjadi merah dan edematous
Sakit kepala
Demam
Malaise

Very Important symptoms include the following:


Facial pain or pressure
Facial congestion or fullness
Nasal obstruction
Thick & discolored drainage
Change in taste or smell

diagnostic investigations of sinusitis


Transilumination

dilakukan di dalam bilik gelap

menggunakan penlight
Frontal sinuses akan di illuminated dengan meletakkan penlight di bawah
superior orbital ridge mata dan melindungi cahaya dengan tangan.

Red glow akan kelihatan di atas kawasan sinus frontal

Untuk illuminated sinus maksilari - penlight akan diletakkan di mulut

pesakit
Red glow akan kelihatan di bawah mata. sinus terlibat akan
menjadi lebih gelap dari yang lain.
Radiologic test.

Sinus terlibat akan kelihatan cloudy atau opaque


Fluid level dikenalpasti
(biasanya sinus translucent kerana dipenuhi dengan udara)

CT Scan

- Mengesan perubahan inflammatory pada sinus

management of client with sinusitis


Farmakologi
1. Broad spectrum antibotik

- ampicillin

- amoxicillin (pilihan pertama)

- untuk infeksi bacteria


Augmentin *
Unysin *
* Bagi yang alergi pada penicillin

Trimethoprin Sulphamethoxazole ( bactrim )


Cephalexin
Cefroxime
Cefaclor

selama 2 minggu untuk mengelak kejadian berulang.

2. Terapi antibiotic melalui intravena diberikan jika


pesakit tidak respon dengan oral antibiotic.
3. Oral atau topical degongestions (nasal spray)
- contohnya : pseudoephedrine
: phenylephrine
: Afrin *
Decongestant diambil untuk melegakan kongesi
Diambil jam sebelum pengambilan nasal steroid
spray untuk kurangkan mucosal edema dan
menggalakkan sinus drainage.

4. Antihistamine
- untuk mengurangkan nasal congestion
5. Steroid spray
- budesonide
- beclomethasone

complications of sinusitis

1.

Intracranial Complications The frontal, ethmoid and


sphenoid sinuses are
separated from the
intracranial cavity by a layer
of bone (Figure 1). If the
infection passes through this
bone it may infect the tissue
and fluid that lines the brain,
causing "meningitis". In
even more severe cases the
infection may spread to the
brain itself causing an
"abscess", or collection of
pus. These problems are life
threatening and require
prompt and aggressive
treatment.

2.

Orbital Complications
- The frontal, maxillary,
ethmoid and sphenoid
sinuses sit immediately
above, below, between and
behind the eyes, respectively
(Figure 2). For this reason,
infections of any of the
sinuses may spread to the
orbit, causing a wide
spectrum of complications
from mild inflammation of the
eyelid to abscesses with
possible blindness.

3.

Vascular Complications - The carotid artery and


cavernous sinus are two large vascular structures
that border the sphenoid sinus. Infections that involve
either of these structures may lead to aneurysms or
infected blood clots in the intracranial cavity, both
of which are potentially fatal.

4.

Asthma - A number of patients suffer from both


asthma and chronic sinusitis and, for these
individuals, flare-ups of the sinusitis can lead to
asthma attacks. Many studies have shown that
resolving the sinus condition will result in dramatic
improvement of the asthma.

5.

Loss of Smell and Taste - Sinusitis may diminish the senses of


smell and taste, since the two are interconnected. This may be
either temporary or permanent, depending on the nature of the
injury. In most cases, the cause is poor airflow to the olfactory
nerve (which detects odors) and by improving the nasal airway
the senses of smell and taste improve. This is particularly true
in patients who suffer from nasal polyps. However, in some
cases chronic sinusitis may permanently injure these nerve
endings.

6.

Osteomyelitis - Some recent studies suggest that bone


becomes actively involved during a chronic sinus infection,
making the infection more difficult to treat. This may even
cause the destruction of bone that leads to the intracranial and
intraorbital complications discussed above.

Prevention
Take these steps to reduce your risk of sinusitis:

Reduce risk of upper respiratory infections. Minimize contact


with people who have colds. Wash your hands frequently with
soap and water, especially before your meals. Get a flu shot
every year.
Avoid cigarette smoke and polluted air. Tobacco smoke and
air contaminants can irritate and inflame your lungs and nasal
passages.
Use a humidifier. If the air in your home is dry, such as it is if
you have forced hot air heat, adding moisture to the air may help
prevent sinusitis. Be sure the humidifier is clean and free of
mold.
Limit alcohol use. Consumption of alcohol can cause sinus
passages to swell.

Self-care

Steam your sinus cavities. Drape a towel over your head as you
breath in the steam from a bowl of hot water. Keep the steam
directed toward your face. Or take a hot shower, breathing in the
warm, moist air.
Take decongestants. These over-the-counter medications may
help reduce congestion.
Apply warm compresses. Place warm, damp towels around your
nose, cheeks and eyes to ease facial pain.
Drink plenty of fluids. Dilute mucous secretions and promote
drainage by consuming additional fluids.
Avoid alcohol. Consumption of alcohol can worsen the swelling
of the lining of the sinuses and nose.

Thank you