Chronic Sinusitis Flashcards
What are sinuses?
Air-filled spaces in the bones around the nose, in continuity with the nasal cavity
What lines the sinuses?
Ciliated mucosa
How can viral infections cause secondary bacterial sinusitis?
Mucosal oedema ad decreased cilia actions leading to mucus retention
What are the symptoms of sinusitis?
Pain - maxiallary or ethmoidal - worse on bending Discharge from nose Nasal obstruction/congestion Anosmia/cacosmia Systemic symptoms
What is a differential diagnosis for the symptoms in sinusitis?
Migraine TMJ dysfunction Neuralgias Cervical spine disease Temporal arteritis Herpes zoster
What are the factors that can lead to bacterial sinusitis?
Direct spread Odd anatomy ITU causes Systemic causes Biofilms
Where can infection directly spread from to infect the sinuses and cause sinusitis?
Dental root
Diving/swimming in infected waters
What odd anatomy makes bacterial sinusitis more likely?
Septal deviation
Large ethmoidal bulla
Polyps
Large uncinate processes
How can a stay in ITU cause bacterial sinusitis?
Mechanical ventilation
Recumbancy
Use of NG tubes
What systemic things can cause bacterial sinusitis?
Kartagener’s syndrome
General debility
Immunodeficiency
How do biofilms cause bacterial sinusitis?
Denude mucosal cells of cilia and goblet cells
What tests are usually done in sinusitis?
Usually none.
CRP/ESR for bacterial
Endoscopy + CT if chronic or if plannign surgery
What is the treatment for acute sinusitis?
Usually self-limiting
If an episode of acute sinusitis is not self-limiting, what treatments are available?
Nasal douching and topical steroids/decongestants
PenV for a week
(Pen allergic = doxycycline for 1 week)
What are the management options for chronic/recurrent episodes of sinusitis?
Identity and treat underlying cause
Long course antibiotics (3-4 weeks)
Steroid nasal spray (beclometasone) for 3 months
If antibiotics fail, refer for FESS (Functional endoscopic sinus surgery)
Balloon catheter dilation of paranasal sinus ostia
Smoking cessation
What things can be tried post-surgery in chronic sinusitis?
High-volume, low-pressure rinsing of surgical cavity
Suction clearing
Fluticasone nasal spray
What are the complications from chronic sinusitis?
Mucoceles may become infected pyoceles
Orbital cellulitis/abscess - EMERGENCY
Osteomyolitis
Intracranial infection
What are the causes of chronic sinusitis?
Nasal allergy Growth in nasal passage Foreign body insertion Facial injury/surgery Congenital abnormalities CF Immunodeficiency Fungal infections (rare) Pregnancy Kartagener's syndrome Tumours Smoking Diabetes Sniffing drugs Previous injury to nose/cheeks
What are the persisting symptoms in chronic sinusitis due to?
Poor drainage
Build-up of mucus in sinus
Inflammatory changes to sinus lining
Flare-up of infection
