Lecturenotes

Rhinorrhea-Sinusitis Syndrome
  • 학습목표
    1. 비루의 감별을 이해한다.
    2. 뇌척수액성 비루의 원인과 진단 및 치료원칙을 이해한다.
    3. 부비동염의 정의와 발병기전을 이해한다.
    4. 부비동염의 진단과 치료원칙을 이해한다.
    5. 부비동염의 호발원인균주을 이해한다.
    6. 소아부비동염의 임상경과를 이해한다.
    7. 비성 합병증의 기전과 치료원칙을 이해한다.

  • Rhinorrhea - Sinusitis Syndrome
    * Case Presentation
 21-year old man suffering from URI followed by proptosis
        CC) eyelid swelling, right
			     Onset) 2 days ago
        PI) URI-like symptoms for a week
            fever, eye pain, lid swelling
        PE) inflamed swollen nasal mucosa 
            active purulent discharge
            cheek & lid, tender swelling
            proptosis, diplopia, 
            EOM, limited

  • Differentiation of Rhinorrhea
    1. character of rhinorrhea
      1. Purulent
      2. Non-purulent
        • mucoid
        • watery
        • bloody
    2. laterality of Rhinorrhea
      1. Bilateral
      2. Unilateral
        • odontogenic
        • fungal
        • antrochoanal polyp
        • inverted papilloma
        • malignancy

  • CSF Rhinorrhea
    1. history of trauma
    2. handkerchief test - Halo sign
    3. sugar test
    4. tracer - fluorescein, isotope
    5. metronizamide CT
    6. tau-transferrin

  • Definition of Sinusitis
    inflammatory changes in sinuses
    Acute vs Chronic sinusitis
    1. Pathogenesis
      1. ostial patency
        - blocked ventilation & drainage
      2. mucociliary function
                  - impaired mucociliary activity        * immotile cilia syndrome
              & quality of secretion		   * mucovisidosis
        
         → stasis of secretion
         → secondary bacterial infection

    2. Diagnosis of Sinusitis
      1. Symptoms
        • acute - pain
        • chronic - rhinorrhea
      2. Rhinoscopy or endoscopy
        pus drainage from sinus ostia
      3. Radiology
        • air fluid level
        • opacity
        • mucosal swelling
          * Water's & Caldwell's view

    3. Treatment of Sinusitis
      1. Acute sinusitis - medical Tx
        • antibiotics
        • analgesics
      2. Chronic sinusitis - surgical Tx
        • improve sinus ventilation & drainage
        • remove irreversible mucosa

      >
    4. Bacteriology & Antibiotics Bacteriology & Antibiotics
      Bacteria Antibiotics
      Acute S. pneumoniae, S. aureus S. pyogenes, H. influenza amoxicillin, cefaclor
      ChronicBacteroide, ananerobesH. influenza, S. viridance augmentin, quinolonebactrim, erythromycin,bactrim


  • Sinusitis in Children
    1. Symptoms
      • rhinorrhea
      • obstruction
      • cough
    2. Factor
      • allergy
      • adenoid vegitation
    3. Treatment
        conservative Treatment assurance to parents

  • Complication of Sinusitis
    1. Classification
      1. osteomyelitis
      2. orbital complication>
      3. intracranial complication
    2. Route of spread
      1. direct extension
      2. retrograde thrombophlebitis
      3. bacteremia
    3. Signs of Complications
      1. persisted headache
      2. chills and high fever
      3. pain in eye
      4. swelling of lid or cheek
      5. blurred vision
      6. diplopia, proptosis
      7. ICP increased signs
        nausea, vomiting, convulsion
    4. Treatment of Complications
      1. Hospitalization
      2. High dose antibiotics
      3. Early surgical drainage
        - pus under pressure
    경상대학교 의과대학 이비인후과 강의록목차
    최종 수정일 : 1997. 5. 30. ....... 최초 게재일 : 1997. 5. 20.