Acute Etmoiditis

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ACUTE ETMOIDITIS


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Defnisi

Ethmoiditis adalah ineksi dari sinus-sinusethmoid, yang erentuk se!ertisarangleah terdiri dari sel-sel udara yang

erkum!ul antara ka"um nasal dan orita Akut ethmoiditis iasanya timul dari

!enyearan ineksi dari sinus-sinuslain#Ethmoiditis meru!akan kasus yang $arangdan da!at ter$adi !ada semua umur


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Etiologi

Ethmoiditis sering meru!akan kom!likasi dariineksi saluran naas atasse!erti in%uen&a

'angguan drainase karena sumatan ostium

da!at $uga men$adi !enyeanya se!erti !oli!,enda asing, anormalitas anatomi )se!ertise!tumde"iasi*, tumor, imunoko!romise,trauma, gangguan letak saluran 'IT,dananormalitas dari motilitas silia mukosa

Ineksi !ada gigi $uga da!at meru!akan okalineksidan menyear terutama melalui!emuluh darah


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aktor resiko untuk ter$adinyaethmoiditis


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Stre!to+o++us !neumoniae

aemo!hilus in%uen&ae

Sta!hylo+o++us aureus

Stre!to+o++us !yogenes


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Ethmoiditis


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Signs sym!toms

.ain lo+ali&ed o"er the ridge o thenose, medial and dee! to the eye

Oedema o the li! oth eyelids e+ome

!u/y and s0ollen 1asal dis+harge on anterior rhinos+o!y,

!us may seen in the middle and su!eriormeatus de!ending on the in"ol"ement o

anterior or !osterior grou!s o ethmoidsinuses

S0elling o the middle turinate


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ealthy sinuses "sin%ammation sinuses


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Treatment


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Treatment

2 ma3illary sinusitis

4isual disturan+e and e3o!htalmus as+ess in the !osterior orit

Drainage o the ethmoid sinuses into the

nose E3ternal ethmoide+tomy

5ess


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Com!li+ation


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5ungal sinusitis

Fungi are eukaryotic organismscomprising of moulds, yeasts,mushrooms and other similar

organisms. Among this group oforganisms only about 0.1% arehuman pathogens. The termmycosis is used to dene diseasescaused by fungi.


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E!idemiology

Fungal infections of nose and sinusesare getting common these days. ithincreasing incidence of !"# and otherdiseases like diabetes $hich compromisehost immunity it is no $onder that theincidence of fungal infections inolingnose and para nasal sinuses is on therise. "n "ndia the incidence of fungalsinusitis in immuno competent patientsis also sho$ing a rise. This particularfact need to be studied f


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Classif+ation

Acute fulminant inasie sinusitis

&hronic inasie fungal sinusitis

'ranulomatous inasie fungalsinusitis

Fungal ball

Allergic fungal rhino sinusitis


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Acute fulminant invasive sinusitis: The$hole duration of illness in these

patients is (ust less than ) $eeks. Thesepatients are mostly immunocompromisedindiiduals. The reduced immunity couldery $ell be a result of

a. *iabetes mellitus

b. A"*+

c. "mmunosuppressie medicines

d. alignancy causing immunesuppression


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The fungus commonly associated $iththis infection belongs to ucoraceaefamily or Aspergillus family. "f ucor isinoled then the lesion is

angioinasie and destroys both boneand soft tissue. -atients belonging tothis group hae high mortality rate./tensie surgical debridement of the

lesion $ith remoal of necrotic tissueshould be performed and must befollo$ed $ith intraenous antifungalmedication i.e. amphotericin


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Chronic invasive fungal sinusitis: Thiscondition is also kno$n as ongranulomatous chronic inasie fungal

sinusitis. This condition commonly a2ictspatients $ith diabetis mellitus. This disorderis characterised by lo$ grade in3ammation$ith tissue necrosis. There is ery littleascular inasion.

'ranuloma formation $hich is common inthese patients re4uires an appropriate cellmediated immune response $hich is commonin diabetics.The duration of this disease is longer than )$eeks 5more than 6 $eeks in some cases7.

8rbital e/tension is common, causingproptosis. These patients can be managedby $ide surgical debridement, follo$ed bysystemic intraenous antifungal drugs likeamphotericin .


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Granulomatous invasive fungal sinusitis:This condition is also kno$n as "ndolent

fungal sinusitis. These patients hae anintact cell mediated immune reponse.&lincially it is irtually impossible todistinguish it from non granulomatousfungal sinusitis. !istopathology $ill clinchthe diagnosis. The intact immune system of

the patient limits the inasion to thesupercial mucosa. 'ranulomas could beseen surrounding the fungal elements thuspreenting their deeper inasion. Thegranulomas could be seen surrounded by

multinulceated giant cells, eosinophils etc.+urgical debridement alone is su9cient tocure these patients. Their intact immunesystem takes oer from no$ on.


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Fungal Ball: These mycetomas commonlypresent as unilateral opacication of

ma/illary or sphenoid sinus. The ethmoidsand frontal sinuses are ery rarelyinoled. These patients are usuallyimmunocompetent $ithout eidence ofatopy. The fungal ball is composed oftightly packed hyphae often fromAspergillus, Alternaria and -. boydii.Treatment is mostly surgical remoal ofthe fungal mass combined $ith

$idenening of ostium there by increasingthe entilation of the sinuses. Antifungaldrugs are not indicated in these patients.


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Allergic fungal sinusitis: Thesepatients hae a combination of nasalpolyposis, crust formation associated

$ith positie sinus cultures foraspergillus. :obson 51;


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ent=s criteria for the diagnosis ofallergic fungal sinusitis>1. *emonstrable type "

hypersensitiity to fungi?. asal polyposis@. :adiological ndings 5!eterodensemass lesion7

). -resence of eosinophilic mucinmi/ed $ith non inasie fungus. -ositie fungal stain B fungal culture


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Acute Etmoiditis

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