[8] Acute Rhinosinusitis Flashcards
What is acute rhinosinusitis also known as?
Acute sinusitis
What is acute rhinosinusitis?
A symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal sinuses?
What is the time span of acute rhinosinusitis?
4 weeks or less
How many pairs of paranasal sinuses are there?
4
What are the names of the paranasal sinuses?
- Frontal
- Ethmoidal
- Maxillary
- Sphenoidal
Where does acute rhinosinusitis of the frontal sinuses cause pain?
The forehead
Where can acute rhinosinusitis of the ethmoidal sinuses cause pain?
- Between/behind the eyes
- Sides of the upper nose
What can ethmoidal acute rhinosinusitis be subdivided into?
Anterior and posterior
What separates anterior and posterior acute rhinosinusitis of the ethmoid sinus?
The basal lamella of the middle nasal concha
Where can acute rhinosinusitis of the maxillary sinuses cause pain?
Cheeks
Where can acute rhinosinusitis of the sphenoidal sinuses cause pain?
- Behind the eyes
- On top of head
- Over mastoid
- Back of head
What is acute rhinosinusitis typically precipitated by?
A recent URTI
What type of URTI typically preceeds acute rhinosinusitis?
Viral
What viruses can lead to acute rhinosinusitis?
- Rhinovirus
- Coronavirus
- Influenza
- Adenovirus
- RSV
- Metapneumovirus
What are the most common bacterial causes of acute rhinosinusitis?
- Strep pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
What are some less common causes of acute rhinosinusitis?
- Fungal invasion
- Chemical irritation
- Tooth infection
Who is more prone to fungal acute rhinosinusitis?
Immunocompromised patients
What can cause immunocompromisation?
- Diabetes
- AIDS
- Transplant patients
What chemicals can cause acute rhinosinusitis?
- Cigarette smoke
- Chlorine fumes
What are the risk factors for acute rhinosinusitis?
- Asthma
- CF
- Poor immune function
- GORD
How do most patients present with acute rhinosinusitis?
Non-resolving cold which may have a biphasic character
What is meant by the biphasic character of acute rhinosinusitis presentation?
The initial URTI settles and is then followed by further malaise due to sinusitis
What is meant by a non-resolving cold?
> 1 week of persistent symptoms or worsening symptoms over 4-5 days
What are the most common symptoms of acute rhinosinusitis?
- Pain over affected sinuses
- Pyrexia
- Purulent nasal discharge
How is acute rhinosinusitis pain described?
- Constant dull headache/facial pain
What can make the pain of acute rhinosinusitis worse?
Bending over or lying down
What are some other symptoms of acute rhinosinusitis?
- Ear pressure
- Aching in jaw and teeth
- Reduced sense of smell/taste
- Cough
- Halitosis
- Fatigue
- Fever
What can often indicate a bacterial cause of acute rhinosinusitis?
Symptoms beyond 10 days
What is the most common sign on examination?
Painful sinuses
How is acute rhinosinusitis typically diagnosed?
Clinically
What further investigations may sometimes be indicated in acute rhinosinusitis?
- ESR
- CRP
- X-ray
- USS
- Nasendoscopy
- CT
- MRI
- Sinus puncture
What are the differentials for acute rhinosinusitis?
- Allergic rhinitis
- Non-allergic rhinitis
- Common cold
- Migraine
- Adenoiditis
What is the typical treatment for acute rhinosinusitis?
Nothing - it’s typically self-limiting
What type of therapy is offered to patients with acute rhinosinusitis?
Symptomatic relief
Where are most cases of acute rhinosinusitis managed?
Primary care
What measures can be used to reduce symptoms?
- Analgesics e.g. paracetamol/ibuprofen
- Intranasal decongestants
- Nasal douching with warm saline
- Warm face packs
- Adequate fluids and rest
What are antibiotics preserved for in acute rhinosinusitis?
Severe or prolonged infections
When is hospital referral indicated for acute rhinosinusitis?
- Severe systemic infections
- Complications of sinusitis
- High risk patients e.g. immunocompromised
What are the potential complications of acute rhinosinusitis?
- Intracranial spread
- Orbital spread
- Osteomyelitis
- Cavernous sinus thrombosis
- Conversion to chronic sinusitis
What are the symptoms of intracranial spread?
- Severe frontal headache
- Frontal swelling
- Symptoms or signs of meningitis
- Focal neurological signs
What can orbital spread lead to?
Orbital cellulitis
