colds and rhinosinusitis

Question 1

what is rhinosinusitis (RS)

Answer 1

rhinitis refers to inflm of nasal passages and sinusitis to inflm of the paranasal sinuses

Question 2

RS which sinuses are affected from superior to inferior

Answer 2

the paranasal sinuses=frontal, ethmoid, (i think the sphenoid is included. it is posterior to the ethmoid), maxillary

Question 3

what are paranasal sinuses

Answer 3

o Paranasal sinuses are air sacs that develop around nasal cavity, are lined with ciliated epithelium, have openings (ostia) that drain into nasal cavity

Question 4

patho of rhinosinusitis

Answer 4

o Normally: each sinus lined with mucosal surface continuous with nasal passages; active mucociliary clearance mechanisms moves fluid and micoorganisms out of sinuses and into nasal cavity; also with IR, this helps keep sinuses sterile.

lower O2 content in sinuses facilitates growth of organisms, impaired local defences, and alters fx of immune cells

Question 5

et rhinosinusitis

Answer 5

 Causes have to do with anything that obstructs ostia
 Most commonly, develops when viral upper resp infection or allergic rhinitis obstructs ostia and impairs mucociliary clearance mechanism
 Can also be caused by nasal polyps obstructing sinus openings (facilitating infection)  these can be self-perpetuating because constant irritation from infecton can also facilitate polyp growth
 Changes in barometric pressure (such as in air travel) may lead to impaired sinus ventilation and clearance of secretions
 Swimming, diving, abuse of nasal decongestants cause sinus irritation and impaired drainage

Question 6

dx of rhinosinusitis

Answer 6

 Dx: usually based on symptom hx and physical exam including inspection of nose and throat
 Headache d/t sinusitis must be differentiated from other types of headache – bending over, coughing or sneezing usually exacerbates this headache
 Px findings in acute cases: turbinate edema, nasal crusts, purulence of nasal cavity, failure of transillumination of maxillary sinuses
 Sinus radiographs and CT scan may be used (usually if chronic or to exclude complications)
 MRI reserved for cases of suspected neoplasm’s or fungal sinusitis

Question 7

tx of rhinosinusitis

Answer 7

o Depends on cause
o Antibiotics, topic corticosteroids, mucolytic agents, symptom relief
o Antibiotics usually reserved for if symptoms persist for more than 7 days (usually viral improved by this time), if are 2 or more signs of acute bacterial rhino, or those with severe symptoms
o Antihistamines not recommended (dry secretions)
o Non-pharmcologic: saline nasal sprays, nasal irriation, mist humidification
o Possible sx to remove polyp or other obstruction

Question 8

what complic can arise from rhinosinusitis

Answer 8

o Can lead to intracranial and orbital complications b/c of sinuses’ proximity to brain and orbital wall
o Intracranial complications seen most often with infection of frontal and ethmoid sinuses
o Orbital complications can range from edema of eyelids to orbital cellulitis and subperiosteal abscess formation
o Signs of intracranial complications = facial swelling over involved sinus, abnormal extraocular movements, protrusion of eyeball, periorbital edema, or changes in mental status

Question 9

is the common cold viral or bact

what part of the body does it affect

Answer 9

viral affects URT

Question 10

• The major groups of microbes responsible for common cold

Answer 10

o Assoc with number of viruses (not single or set of “cold viruses” as previous thought). Most common = rhinoviruses, parainfluenza viruses, respiratory synccytial viruses, conoavirueses, and adenoviruses
o Kind of viruses likely to cause cold depends on type of year, age, and prior exposure
o Rhinoviruses most common cause of cold in those 5-40yrs

Question 11

modes of transmission for common cold

Answer 11

o Spread rapidly
o Children are major reservoir
o Finger most common source of spread
o Nasal mucosa and conjunctive surgace of eyes most common portals of entry
o Incubation for 5 days, most contagious for 3 days after onset of symptoms
o Hand washing most important preventative measure (much more important than spread through air)

Question 12

summary of mnfts for common cold

Answer 12

o Begins with dryness and stuffiness in nasopharynx
o Soreness occurs in pharynx and larynx
o Mucous membranes of upper resp tract become erythmatous (red), edematous (swollen) and bathed in secretions (leading to rhinnorhea)
o Headache and general malaise, chills, fever, exhaustion

Question 13

efficacy/inefficacy of OTC remedies for c. cold

Answer 13

o Self-limiting so rest and antipyretic meds usually all that’s needed
o OTC remedies do not show evidence of shortening duration of the cold
o Antihystamines popular to dry secretions, but this can worsen cough and may cause dizziness, drowsiness, and impaired judgement
o Decongestant drugs cause vasoconstriction in swollen nasal mucosa to reduce this swelling….must be careful b/c can cause rebound swelling or systemic vasoconstriction (dangerous if have htn, hyperthyroidism, heart disease, etc)
o Vit C and zinc shown to be beneficial in some studies, questionable in others
o Ginseng (few studies) may be effective in enhancing IR, decreasing incidence and severity of cold
o Echinacea has some evidence of being effective in shortening duration and decreasing severity of symptoms in adults

Question 14

how is rhinosinusitis divided/classified

Answer 14

acute
subacute
chronic

Question 15

causative agents for rhinosinusitis

Answer 15

 Acute can be viral, bacterial or of mixed viral-bacterial origin
 Acute bacterial rhinosinusitis most commonly results from Haemophilusinfluenze or Streptococcus pneumoniae
 Chronic: anaerobic organisms including Peptostreptocuccus, Fusobacterium, and Prevotella tend to predominate, alone or along with aerobes including Streptocussusspecies or Staphylococcus aureus
 If immunocompromised, sinuses may become infected with gram-negative and opportunitistic fungi (can be fatal in these cases)