Chronic rhinosinusitis Flashcards
Definition
Sinusitis persisting longer than 2 wks, despite repeated antibiotic and decongestant therapy.
Causes
- The most common complication of acute sinusitis
- the s/s of inflammation persist for > 8–12 weeks
- likely to be associated with factors that impair drainage via the osteomeatal complex, including nasal polyps.
Features
Postnasal drip with cough, esp. at night
May arise from chronic infection or allergy.
May be associated with nasal polyps and vasomotor rhinitis,
- but is frequently associated with a structural abnormality of the upper airways
It does not usually cause pain unless an acute infection intervenes.
Clinical features of chronic sinusitis
Vague facial pain
Offensive postnasal drip
Nasal obstruction
Toothache
Malaise
Halitosis
Pain from paranasal sinuses
Infection of the paranasal sinuses may cause localised pain.
Localised tenderness and pain may be apparent with frontal or maxillary sinusitis.
Sphenoidal or ethmoidal sinusitis causes a constant pain
- behind the eye or behind the nose,
- often accompanied by nasal blockage.
Treatment
The acute or chronic attack is treated as for the acute attack but with 14 days of antibiotics.
Amoxycillin 500 mg (o) 8 hourly for 10–14 days,
- possibly for longer periods of 3–6 weeks 5
Consider decongestant spray (e.g. xylometazoline)
- for max 5 days
If an allergic basis (pale, swollen mucosa),
- intranasal corticosteroids.
Steam inhalations three times daily, with
- Friar’s balsam or menthol
- best is menthol co APP inhalation
Nasal saline sprays
Vitamin C (sodium ascorbate) 2–4 g daily
- a powder can be obtained and mixed with orange juice
If the above therapies are ineffective
a mechanical saline sinus irrigation procedure to remove stagnant mucus.
Surgical drainage may be necessary by atrial lavage or frontal sinus trephine.
Refer urgently if
- for surgical drainage, if there is no response to the above regimen. It benefits chronic recurrence with mechanical blockage
- those with orbital or facial cellulitis
