ENT

Question 1

Sinusitis Sx

Answer 1

•	Nasal obstruction
•	Increased discharge
•	Changes in smell
•	Facial pain/pressure
•	Cough (in children)
Nb Acute vs chronic
•	Chronic: persistence of 2 or more Sx >12weeks duration

Question 2

Sx suggestive of Bacterial Sinusitis

Answer 2

discolored discharge
severe localized pan (usually unilateral)
fever
raised CRP/ESR
\+/-‘double sickening’

Question 3

Management of Acute Sinusitis

Answer 3

• supportive (analgesia, nasal saline irrigation, nasal decongestant)
o Saline irrigation: boil water, cool to body temp, aim delivery system at 45 deg towards outer eye
o NO benefit to Abx in viral
• Acute bacterial RS: amoxicillin 5 days

Question 4

Chronic Sinusitis

Answer 4

> 12weeks Sx duration
2 types:
o CRS with nasal polypsis (CRSwNP)
o CRS without (CRSsNP)

Mx:
• Trial 8 weeks of:
o nasal steroids &
o saline irrigation (BD)
• If nasal polyps present ADD:
o burst of oral prednisolone (25mg for 5 days, then 12.5mg for 5 days)
• Surgical: if failed medical therapy: FESS

Question 5

Red flags for sinusitis

Answer 5

• Orbital- painful opthalmoplegia, diplopia, proptosis, decreased vision (use ishihara), perorbital swelling
• Intercranial: altered neurology, meningism
• Osseous
For IMMEDIATE referal to ENT