AR And Rhinosinusitis

Question 1

1. OMC drains the
2. Post ethmoids drains into
   Sphenoid sinus drains into

Answer 1

1. Maxillary, ant ethmoid, frontal sinuses into middle meatus (common channel for sinus drainage)
2. Drains into superior meatus
3. Drains into sphenoethmoidal recess

Question 2

Symptoms of AR

Answer 2

2 or more sx lasts more than 1 hour for > 3 months
- sneezing
- runny nose
- itchy nose
- blocked nose

Question 3

AR physical examinations

Answer 3

Child: allergy shiner, allergy salute

Ant rhinoscopy:
- inferior turbinate: pale, hypertrophied
- clear stringy secretions

Nasal endoscopy
- Normal OMC
- Adenoids may be enlarged in children

Question 4

Ix of AR

Answer 4

• skin prick test
• serum specific IgE

Question 5

Tx of AR

Answer 5

• allergy avoidance
• pharmacotherapy; antihistamines, intranasal steroid sprays
• immunotherapy

Question 6

Symptoms of rhinosinusitis

Answer 6

2 or more nasal symptoms:

Must have either nose block or discharge
+/- facial pain
+/- anosmia/hyposmia
AND
Evidence of disease in OMC
OR
CT scan evidence of sinus involvement

Question 7

Classification of rhinosinusitis

Answer 7

Acute (<12 weeks)
- d/t infection (viral/bacteria)

Chronic (>12 weeks)

Question 8

History taking of acute rhinosinusitis

Answer 8

<12 weeks

Nose block, nasal discharge, facial pain (esp at frontal, maxillary; worse on stooping, hyposmia/anosmia)

Hx of preceding URTI

Question 9

Signs of potential acute bacterial rhinosinusitis

Answer 9

At least 3
- fever above 38
- double sickening
- unilateral ds
- severe pain
- raised ESR/CRP

Question 10

ARS
- PE
- IX
- Cx
- Tx

Answer 10

Pe
- facial tenderness
- discoloured discharge: unilat predominant
- nasal endoscopy: oedema, purulent discharge from OMC

Ix
- middle meatal swab culture and sensitivity
- CT scan

Cx
- orbital: preseptal and orbital cellulitis, intraorbital abscess
- intracranial: epidural empyema, brain abscess, meningitis
- osseous: osteomyelitis (potts puffy tumour)

Tx
W/o cx
- intranasal steroids
- nasal douching
- decongestants (oral and/or intranasal)
- oral antibiotics (if bacterial)

W/ cx
- admit
- intravenous antibiotics
- pharmacotherapy
- radiological imaging
- plan for surgery: endoscopic sinus surgery

Question 11

Clinical features of CRS
Ix crs

Answer 11

• middle aged
• nose block, nasal discharge, hyposmia/anosmia, facial pain/headache worse on stooping
• post nasal drip
• cacosmia, halitosis

Ix
- CT scan
- Biopsy

Tx
- intranasal steroid
- nasal douching
- medical polypectomy
- oral steroid (2-3 weeks)
- clarithromycin (6 weeks or more)
- surgery
- OMC obstruction
- eosinophilic CRS