Chronic rhinosinusitis

Question 1

What is it?

Answer 1

an inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer

Question 2

predisposing factors

Answer 2

atopy: hay fever, asthma
nasal obstruction e.g. Septal deviation or nasal polyps
recent local infection e.g. Rhinitis or dental extraction
swimming/diving
smoking

Question 3

features

Answer 3

facial pain: typically frontal pressure pain which is worse on bending forward

nasal discharge: usually clear if allergic or vasomotor. Thicker, purulent discharge suggests secondary infection

nasal obstruction: e.g. ‘mouth breathing’
post-nasal drip: may produce chronic cough

Question 4

Mx

Answer 4

avoid allergen

intranasal corticosteroids

nasal irrigation with saline solution

Question 5

Red flags

Answer 5

unilateral symptoms

persistent symptoms despite compliance with 3 months of treatment

epistaxis