Medicine Hack

  DEFINITION  Chronic sinusitis refers to inflammation the paranasal sinuses for a period of at least 12 weeks. The most important cause of chronic sinusitis is failure of acute infections to resolve.   PATHOPHYSIOLOGY  Acute infection destroys the normal ciliated epithelium, thus impairing drainage from the sinuses. There is pooling and stagnation of secretions in the sinuses which favours infections. Persistence of infection causes mucosal changes, such as loss of cilia, edema and polyp formation. We eventually have a vicious cycle.   CLINICAL FEATURES  Patients may complain of blocked nose, runny nose, headache and a reduced sense of smell (hyposmia). Foul-smelling discharge suggests anaerobic infection. Some people will also have nasal polyps.   TREATMENT  1) We should always search for underlying aetiological factors which obstruct sinus drainage and ventilation. 2) A work-up for nasal allergy may be required. 3) Culture and sensitivity of sinus discharge helps in t

Frontal sinuses (coronal and axial views) Ethmoidal sinuses Below is a sagittal section of the frontal and ethmoidal sinuses. Maxillary sinuses

Retropharyngeal abscess is a rare condition presenting in infants (<1 year of age). Clinical symptoms include fever and drooling.  As a result of the swelling within the posterior pharyngeal wall causing upper airway obstruction, the child will typically hold their neck in extension to assist breathing.  A lateral soft tissue neck radiograph taken with the neck held in extension is indicated if a retropharyngeal abscess is suspected. If it is positive, it will demonstrate air within the swollen retropharyngeal tissues, as shown by the x-ray above. A contrast enhanced computerized  tomography (CT) examination will confirm the diagnosis.