5: Sinuses Flashcards
Name the 4 sinuses.
- Frontal
- Ethmoid
- Sphenoid
- Maxillary
Sinuses radiographically present at birth (2).
- Maxillary
2. Ethmoid
Frontal sinuses are anatomically present by ______ and radiographically present by _____.
Anatomically = 1 year Radiographically = 3-7 years
Sphenoid sinuses are anatomically present by ______ and radiographically present by _____.
Anatomically = 4-5 years Radiographically = 9 years
Which sinus develops last?
Sphenoid
7 s/s of sinusitis.
- Cold that abates then returns.
- Second “sickening.”
- Purulent nasal discharge.
- Morning or nocturnal cough.
- Periorbital edema (more common in children).
- Fever (without cause).
- Malodorous breath.
How do you identify bacterial vs viral sinusitis (3)?
- 10+ days.
- Severe symptoms/high fever (39+) and purulent nasal discharge or facial pain lasting 3-4 days at beginning.
- Onset of worsening symptoms or new onset of fever, headache, or increased nasal discharge following URI that lasted 5-6 days and initially improved (double sickening).
How do you examine the sinuses (4)?
- Look for edema.
- Palpate frontal and maxillary sinuses.
- Do a full ENT exam.
- If headaches are present or patient is very sick, consider neuro exam.
What is the most common cause of viral sinusitis?
Adenovirus
What are the most common causes of bacterial sinusitis (3)?
- Strep pneumoniae
- H. influenza
- Moraxella catarrhalis
When are x-rays needed with sinusitis (3)?
- If clinical findings suggest sinusitis, x-rays are not needed.
- If symptoms consistent with orbital, intracranial, or soft-tissue abscess, x-rays are needed.
- Facial swelling, unresponsive to treatment after 48 hours, toxic appearance, chronic/recurrent, chronic unresponsive asthma indicate need for x-rays, ultrasonograms, or CT scans.
How long do you treat bacterial sinusitis (2)?
- Child - 10-14 days.
2. Adult - 5-14 days (if responding slowly, add 7 days).
Failure for sinusitis to respond to ABX within 48 hours, suggests what (3)?
- Resistant organism
- Complications
- Missed diagnosis
ABX therapy may be up to 21 days in acute sinusitis, and up to _____ in chronic.
6 weeks
What is the treatment for uncomplicated mild/moderate sinusitis in adults and children?
Adults = Augmentin 500-875 mg PO BID x 5-14 days Children = Augmentin 45 mg/kg/day divided BID
What is the treatment for uncomplicated mild/moderate sinusitis with 1 or more risks for ABX resistance in adults and children?
Adults = Augmentin 875 mg PO BID x 14 days Children = Augmentin 90 mg/kg/day divided BID
What is a common side effect of Augmentin?
Diarrhea
The addition of clavulanate improves coverage for _____-resistant conditions.
Ampicillin-resistant
Use high dose Augmentin in these situations (7).
- High endemic rates of PNS S. pneumoniae
- Severe infx (systemic toxicity with fever 39+ and threat of suppurative complications)
- Daycare
- Under 2/over 65
- Recent hospitalization
- ABX use within past month
- Immunocompromised
What are non-PCN options for sinusitis (3)?
- Doxy
- Respiratory quinolone (Levo or Moxi)
- 3rd gen cephalosporine (Cefixime or cefpodoxime) + clinda
Supportive care for viral sinusitis (4).
- Pain management (Ibuprofen/Tylenol)
- Intranasal steroids
- Antihistamines/decongestants (not recommended by IDSA)
- Saline irrigation
What are complications of sinusitis (4)?
- Orbital cellulitis
- Cavernous sinus thrombosis
- Subdural empyema
- Brain abscess
What are signs of orbital cellulitis secondary to ethmoiditis (4)?
- Swelling/erythema of eyelids
- Proptosis
- Decreased EOMs
- Altered vision
