Transcript Slide 1
DEAN VINOBA BHAVE UNIVERSITY HAZARIBAGH, JHARKHAND PRINCIPAL SINGHBHUM HOMOEOPATHIC MEDICAL COLLEGE, JAMSHEDPUR Homeopathy 4 Everyone – January, 2007 HISTORY OF SINUSITIS ANCIENT HINDU LITERATURE AS “NETI” 16TH CENTURY: ANATOMICAL DESCRIPTION BY IGARSIUS & CAESARIUS HIPPOCRATES IN 5TH CENTURY BC HEADACHE > DISCHARGE OF PUS “WAS ACCIDENTLY DISCOVERED DURING A TOOTH EXTRACTION” DUE TO CLOSE PROXIMITY OF SINUS AND NOSE, MAXIMUM CASE ARE HAVING RHINITIS WITH SINUSITIS, HENCE “RHINOSINUSITIS” IS THE MOST SUITABLE WORD NOW A DAYS These are air-filled, mucosallined cavities which develop in facial and cranial bones. The spaces communicate with the nasal airway. In lower animals with a more acute sense of smell, the sinuses are largely lined by olfactory epithelium. Reduce the weight of the skull. Provide insulation for the skull. Provide resonance for the voice. SINUSES FRONTAL BLACK CHECK ANT ETHMOID GREEN POST ETHMOID PURPLE MAXILLARY RED SPHENOID YELLOW GROUPS OF SINUSES FRONTAL Paired, in frontal bone. Posterior wall is adjacent to anterior cranial fossa. MAXILLARY Paired, in maxilla. Superior wall - floor of orbit. Medial wall - lateral wall of nose. Inferiorly related to tooth-bearing area of maxilla. ETHMOID Numerous cells in superior and lateral walls of nose, and in medial walls of orbits SPHENOID Paired, in sphenoid bone. F: FRONTAL M: MAXILLARY E: ETHMOID SINUS SP: SPHENOID PATHOPHYSIOLOGY Lined by respiratory epithelium Mucous blanket is in two layers: a superficial viscous layer and an underlying serous layer. Cilia beat in the serous layer, moving the blanket towards the natural ostia Normal function depends on patent ostia, ciliary function and quality of mucous PATHOPHYSIOLOGY Mucocilliary Clearance 700-800 times a minute, moving mucus at a rate of 9 mm/minute Ethmoidal Sinus is most important Obstruction of natural ostia Obstruction leads to hypooxygenation Hypooxygenation leads to ciliary dysfunction and poor mucous quality Ciliary dysfunction leads to retention of secretions PREDISPOSING FACTORS INFECTIOUS AGENTS AIR POLLUTION SMOKING SEPTAL DEVIATIONS TURBINATE HYPERTROPHY NASAL POLYPS ALLERGIC RHINITIS BRONCHIAL ASTHMA POOR IMMUNE RESPONSE PREGNANCY CILIARY DYSKINESIA CYSTIC FIBROSIS DIAGNOSIS ACUTE SUB ACUTE CHRONIC 1 – 4 weeks 4 – 12 weeks More than 12 weeks CLINICAL DIAGNOSIS MAJOR CRITERIA Facial pain / pressure Facial congestion / fullness Nasal obstruction / blockage Nasal discharge / Post nasal drip Hyposmia / anosmia MINOR CRITERIA Headache Fever Halitosis Fatigue Ear fullness / cough / dentaLpain 2 MAJOR OR 1 MAJOR AND 2 MINOR