[9] Chronic Rhinosinusitis Flashcards
What is chronic rhinosinusitis?
When symptoms persist for >90 days with or without acute exacerbations
What are the three main types of chronic rhinosinusitis?
- Without polyps
- With polyps
- Associated with fungal infection
What are the categories of causes of chronic rhinosinusitis?
- Infective
- Chronic underlying problems
What organisms most commonly cause chronic rhinosinusitis?
- Anaerobes
- Gram -ve bacteria
- S. aureus
- Coagulase negative staph
What should all patients with suspected chronic rhinosinusitis receive?
Investigation for treatable underlying causes
What are the risk factors for chronic rhinosinusitis?
- Allergic rhinitis
- Asthma
- Immunosuppression
- Chronic dental infection
- Presence of foreign body
- Aspirin sensitivity
- Wegener’s granulomatosis
- Churg-Strauss syndrome
At least 2 of what symptoms must be present to be diagnosed with chronic rhinosinusitis?
- Thick, coloured nasal or post-nasal discharge
- Nasal obstruction or congestion
- Pain, tenderness and swelling around the eyes, cheeks, nose or forehead
- Reduced smell and taste in adults or cough in children
What other symptoms may be present in chronic rhinosinusitis?
- Ear pain
- Aching in upper jaw and teeth
- Cough
- Sore throat
- Halitosis
- Fatigue and irritability
- Nausea
Which symptom is more common in chronic rhinosinusitis than in acute?
Loss of smell
Which symptom is more common in acute rhinosinusitis than in chronic?
Facial pain
What may be noted on examination?
- Dull sinus ache
- Nasal polyps
- Mucosal inflammation
- Nasal purulence
Are investigations usually required?
No, but look for polyps
What are the differentials for chronic rhinosinusitis?
- Allergic rhinitis
- Non-allergic rhinitis
- Nasal polyps
- Cystic fibrosis
- Tumours
- Turbinate dysfunction
What type of management is first line for chronic rhinosinusitis?
Medical
What is medical management used irrespective of in chronic rhinosinusitis for first line?
Polyps
