5 - ENT - Rhinology - Rhinosinusitis - RS, Acute RS Flashcards
what is RS - how far may it spread?
inflammatory process of nasal and sinus mucosa
may involve whole upper resp tract
RS - associated symptoms
nasal congestion/obstruction
discharge or post nasal drip
facial pain/pressure
impaired smell
classification of lengths of RS
acute = <4 weeks subacute = 4-12 weeks chronic= >12 weeks
Acute RS (ARS) - likelihood of sinus’ involvement
most commonly maxillary, then ethmoid, frontal, sphenoid
ARS - usual cause and pathology
follows viral URTI (cold) > mucosal hyperaemia and oedema > prevents sinus drainage > stasis and secondary bact infection
- worsening Sx after 5 d suggests bact infection
ARS - other causes
direct spread eg dental
ventilation, NG tubes
abnormal anatomy
immdeff, Kartegeners syndrome
ARS clinical features
nasal congestion/obstruction discharge or post nasal drip facial pain/pressure impaired sense of smell malaise, pyrexia, more severe pain in bact infection
ARS - investigations??
rarely needed
-XR may show sinus opacification or fluid level
ARS - DDx?
common cold, allergic/non-allergic rhinitis, adenoiditis
ARS mgmt - 5 key things
analgesia steam inhalation and nasal douching decongestants - a-adrenergic agents steroid drops ABs in severe/persistent
decongestants - dont what???
dont use for >5 days - risk of rebound congestion due to habituation
ARS - indications for surgery?
progressive pain not responsive to ABs,
complications (see deck with complications of infective sinusitis)
