Sinusitis Management

Preliminary Examination

  • Sinusitis is a common condition.

  • It is usually under-diagnosed in adults and children.

  • Accurate diagnosis depends on an accurate history, naso endoscopic examination and when necessary, a CT scan of the sinuses.

Endoscopy - Flexible

Endoscopy - Rigid

CT Scan Evaluation by Dr Stanley

  • A preliminary examination is done and a local anaesthetic spray is applied to the nasal cavity.

  • A videoscope naso endoscopic examination can be done with a flexible naso endoscope with live video screening so that the patients can visualise the condition themselves. A new video-scope with higher definition images are now used for diagnostic purposes.

  • A rigid naso endoscopic examination can also be performed for diagnosis and therapy.

Types of Sinusitis Treatment

Dental Cause

Dental cause for sinusitis

Infected mal-positioned dental implant causing maxillary sinusitis

  • This patient has sinusitis from infected dental implants in the floor of the maxillary sinuses.

  • Treatment is directed at the removal of implants and clearance and drainage of the sinuses.

Dental Sinusitis - Apical Tooth Infection

  • Sinusitis from an infected root of a molar tooth eroding into the maxillary antrum.

  • The affected tooth has to be removed and the sinuses drained and medically treated.

Frontal Sinus Mucocele

Frontal Sinus Mucocele

Frontal Sinus Mucocele on CT Scan

  • This is the result of obstruction of the frontal sinus outflow tract resulting in backup of secretions and expansion of the frontal sinus walls.

  • The mucocele has eroded into the orbit causing eye complications i.e. proptosis.

  • An external procedure is warranted here to drain the frontal sinus.

Fungal Maxillary Sinusitis

Fungal Maxillary Sinusitis with Radiological Concretions – Charcot-Leylum Crystals

  • CT Scans of the sinuses can demonstrate radiological calcifications from Charcot-Leyden crystals seen as calcifications in the sinus cavity.

  • In this instance, surgical intervention is mandatory as medical treatment will not clear the fungal ball in the sinuses.

  • Medical treatment alone will not clear fungal ball sinusitis.

  • An Endoscopic Sinus procedure is the treatment of choice.

Fungal Sphenoid Sinusitis

Fungal Sphenoid Sinusitis

  • Another fungal ball with calcification in the left sphenoid sinus.

  • An endoscopic sphenoidectomy is necessary.