[9] Chronic Rhinosinusitis Flashcards

1
Q

What is chronic rhinosinusitis?

A

When symptoms persist for >90 days with or without acute exacerbations

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2
Q

What are the three main types of chronic rhinosinusitis?

A
  • Without polyps
  • With polyps
  • Associated with fungal infection
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3
Q

What are the categories of causes of chronic rhinosinusitis?

A
  • Infective

- Chronic underlying problems

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4
Q

What organisms most commonly cause chronic rhinosinusitis?

A
  • Anaerobes
  • Gram -ve bacteria
  • S. aureus
  • Coagulase negative staph
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5
Q

What should all patients with suspected chronic rhinosinusitis receive?

A

Investigation for treatable underlying causes

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6
Q

What are the risk factors for chronic rhinosinusitis?

A
  • Allergic rhinitis
  • Asthma
  • Immunosuppression
  • Chronic dental infection
  • Presence of foreign body
  • Aspirin sensitivity
  • Wegener’s granulomatosis
  • Churg-Strauss syndrome
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7
Q

At least 2 of what symptoms must be present to be diagnosed with chronic rhinosinusitis?

A
  • 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
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8
Q

What other symptoms may be present in chronic rhinosinusitis?

A
  • Ear pain
  • Aching in upper jaw and teeth
  • Cough
  • Sore throat
  • Halitosis
  • Fatigue and irritability
  • Nausea
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9
Q

Which symptom is more common in chronic rhinosinusitis than in acute?

A

Loss of smell

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10
Q

Which symptom is more common in acute rhinosinusitis than in chronic?

A

Facial pain

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11
Q

What may be noted on examination?

A
  • Dull sinus ache
  • Nasal polyps
  • Mucosal inflammation
  • Nasal purulence
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12
Q

Are investigations usually required?

A

No, but look for polyps

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13
Q

What are the differentials for chronic rhinosinusitis?

A
  • Allergic rhinitis
  • Non-allergic rhinitis
  • Nasal polyps
  • Cystic fibrosis
  • Tumours
  • Turbinate dysfunction
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14
Q

What type of management is first line for chronic rhinosinusitis?

A

Medical

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15
Q

What is medical management used irrespective of in chronic rhinosinusitis for first line?

A

Polyps

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16
Q

What is the medical management of first instance chronic rhinosinusitis?

A
  • Nasal steroids
  • Good dental hygiene
  • Stop smoking
  • Manage risk factors
17
Q

What can be substituted for nasal steroids in severe cases of chronic rhinosinusitis?

A

Oral steriods

18
Q

What specialist management can be considered in uncontrolled chronic rhinosinusitis?

A
  • Antibiotics

- Endoscopic sinus surgery

19
Q

What are the indications for endoscopic surgery in chronic rhinosinusitis?

A
  • Complications
  • Anatomical variations causing obstruction
  • Allergic fugal disease
  • Very symptomatic despite medical management
20
Q

What is the most common complication of chronic rhinosinusitis?

A

Acute exacerbations

21
Q

What are the other complications of chronic rhinosinusitis?

A
  • Adenoiditis
  • Laryngitis
  • Orbital complications
  • Cavernous sinus thrombosis
  • Intracranial complications
  • Osteomyelitis
  • Mucocoele formation
  • Psychological problems associated with chronic pain and ill health
22
Q

What are the orbital complications of chronic rhinosinusitis?

A
  • Cellulitis

- Orbital abscess

23
Q

What are the intracranial complications of chronic rhinosinusitis?

A
  • Meningitis

- Abscess formation