Coass II-Pediatric Sinusitis Akhir
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Transcript of Coass II-Pediatric Sinusitis Akhir
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Ruspau Jakarta, 29-06-2006 1
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PEDIATRIC SINUSITIS PEDIATRIC SINUSITIS
ASNOMINANDAASNOMINANDA
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DEFINITION
• Acute rhinosinusitis
• Chronic rhinosinusitis
• Recurrent acute rhinosinusitis
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PATHOPHYSIOLOGY Sinusitis is the result of
inflammatory obstruction of the natural ostium of the sinuses.
An area that appears particularly prone to obstruction is the
ostiomeatal complex , which could result in a secondary bacterial
infection. Allergy is a commonly noted risk
factor for chronic sinusitis
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PATHOPHYSIOLOGY
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Ostium
Occlusion
Stagnation of secretion
Change in the composition and
pH of secretion
Change of the mucosal gas metabolism
Ciliary and epithelial damage
Inhibition of ventilation and drainage
Change of the host milieu Bacteria become
pathogenic
Inflamation of the lamina propria
Increased mucosal thickness
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DYNAMIC OF SINUSITISDYNAMIC OF SINUSITIS
Mucosal swelling
Viral infection Immune deficiency
Allergy
Acute sinusitis
Complications
Sinus ostium blockage
Anatomic predisposition
Subacute sinusitis
Chronic sinusitis
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The bacteria
1. Acute and recurrent rhinosinusitis - Streptococcus pneumoniae- Moraxella catarrhalis- Haemophilus influenzae- Staphylococcus aureus
2. Chronic rhinosinusitis- Stapylococcus aureus- Streptococcus pneumonia- Haemophilus influenzae- Pseudomonas aeruginosa- Peptostreptococcus Sp- Aspergilus Sp
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Differential Diagnosis
• Chronic sinusitis• Adenoid hypertrophy• Recurrent URTI (viral)• Allergies• Immune deficiencies
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DIAGNOSIS
Signs and Symptoms (the “Big Six”) • Purulent nasal discharge• Day and night cough• Nasal airway obstruction• Headache, irritability, or facial pain• Fever• Postnasal drip
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Physical Examination1. Only anterior rhinoscopy can be performed in
children.2. Visualize the middle turbinate and then the
middle meatus.3. A clear middle meatus does not ensure that
there is no sinus disease.4. Look for purulent discharge at the middle
meatus.5. Polyps are unusual in children
DIAGNOSIS
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Imaging Techniques1. Plain films2. Coronal CT scanning
DIAGNOSIS
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DIAGNOSIS
Caldwell
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DIAGNOSIS
Waters
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DIAGNOSIS
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COMPLICATION
1. Orbital - Orbital inflammation- Orbital cellulites- Subperiosteal abscess- Orbital abscess- Cavernous sinus thrombosis- Blindness
2. Intracranial- Meningitis- Epidural abscess- Subdural abscess- Acute, chronic brain abscess
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COMPLICATION
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Medical Management• Antimicrobial
1. Amoxicillin 5. Cefixime2. Amoxicillin-pot. calavulanate 6. Clindamycin3. Trimethoprim-sulf.methoxazole 7. Clarithromycin4. Cefuroxime axetil 8. Azithromycin
• Antihistamines• Oral or topical decongestants• Oral or topical steroid• Anti-inflamatory agents
MANAGEMENT
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Surgical Management1. Adenotonsillectomy2. Antral lavage3. Inferior meatal antrostomy4. Middle meatal antrostomy5. Anterior or anterior and posterior ethmoidectomy (FESS)
MANAGEMENT
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MANAGEMENT
OBSTRUKSI MEKANIK- ETIOLOGY- DECONGESTAN
ANTIBIOTIC
ANTIBIOTIC
- MUCOLITIC - IRIGATION - SURGERY
OSTIUM TERSUMBAT
INFEKSI CAMPUR
ANAEROB
O2 & CO2
SEKRET AKUMULASI SEKRET
PENURUNAN MUKOSILIER
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Relation of Age to Outcome After
Endoscopic Sinus Surgery in Children
Relation of Age to Outcome After
Endoscopic Sinus Surgery in Children
Hasan H RamadanArch Otolaryngol Head Neck Surg. 2003;129:175-177
Hasan H RamadanArch Otolaryngol Head Neck Surg. 2003;129:175-177
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TUJUAN STUDY
• Untuk menentukan apakah Operasi Sinus Endoskopi (FESS) pada anak-anak mempunyai suatu hasil lebih baik pada kelompok umur tertentu.
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DESAIN DAN METODA
• Studi Kohort pada Rumah Sakit Anak-anak.
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OBJEK PENELITIAN
• 99 anak-anak yg mengalami Operasi Sinus Endoskopi (ESS) antara Januari 1994 sampai Juni 1999
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HASIL PENELITIAN
• Angka keberhasilan FESS secara keseluruhan mencapai 82%.
• Anak-anak > 6 tahun, keberhasilan 89 % • Anak-anak < 6 th sekitar 73 %. • Dari 99 pasien, 11 orang (9 %) mengalami
operasi ulang. (9 orang < 6 th, dan 2 orang > 6 th)
• Dari 4 orang anak-anak yang < 3 th, sekitar 3 orang (75 %) dioperasi ulang.
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KESIMPULAN
•Operasi Sinus Endoskopik untuk sinusitis kronis pada anak-anak masih dalam tahap pengembangan.
•Keberhasilan prosedur ini sangat rendah pada anak-anak < 3 th, tetapi sangat baik pada anak-anak usia 6 th atau lebih.
•Operasi pada sembarang umur diperbolehkan menurut aturan jika terjadi komplikasi sinusitis kronis.
•Pada anak- anak yang < 6 th mungkin diperlukan operasi ulang lebih lanjut.
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