ENT - Sinusitis

Question 1

What is sinusitis?

Answer 1

Sinusitis refers to inflammation of the paranasal sinuses in the face, often accompanied by inflammation of the nasal cavity, also called rhinosinusitis

Either acute < 12 weeks
Chronic > 12 weeks

Question 2

What are the paranasal sinuses?

Answer 2

The paranasal sinuses are hollow spaces within the bones of the face, arranged symmetrically around the nasal cavity

Question 3

What is the function of the paranasal sinuses?

Answer 3

They produce mucous and drain into the nasal cavities via holes called ostia

Question 4

What can block the drainage of the sinuses?

Answer 4

Blockage of the ostia prevents drainage of the sinuses, resulting in sinusitis

Question 5

What are the paranasal sinuses?

Answer 5

• Frontal sinuses above the eyebrows
• Maxillary sinuses either side of the nose below the eyes
• Ethmoid sinuses in the ethmoid bone in the middle of the nasal cavity
• Sphenoid sinuses in the sphenoid bone at the back of the nasal cavity

Question 6

What are common causes of sinusitis?

Answer 6

• Infection, particularly following viral upper respiratory tract infections
• Allergies, such as hayfever (with allergic rhinitis)
• Obstruction of drainage (e.g., due to a foreign body, trauma, or polyps)
• Smoking

Question 7

What are the typical symptoms of acute sinusitis?

Answer 7

• Nasal congestion
• Nasal discharge
• Facial pain or headache
• Facial pressure
• Facial swelling over the affected areas
• Loss of smell

Question 8

What examination findings may be present in acute sinusitis?

Answer 8

• Tenderness to palpation of the affected areas
• Inflammation and oedema of the nasal mucosa
• Discharge
• Fever
• Other signs of systemic infection (e.g., tachycardia)

Question 9

What distinguishes chronic sinusitis from acute sinusitis?

Answer 9

Chronic sinusitis involves a similar presentation but with a duration of more than 12 weeks and may be associated with nasal polyps

Question 10

What investigations may be used for persistent symptoms of sinusitis?

Answer 10

• Nasal endoscopy
• CT scan

Question 11

What management is recommended for patients with sinusitis symptoms lasting up to 10 days?

Answer 11

NICE recommends not offering antibiotics as most cases are caused by a viral infection and resolve within 2-3 weeks

Question 12

For patients with sinusitis symptoms not improving after 10 days, what are the recommended options?

Answer 12

• High dose steroid nasal spray for 14 days (e.g., mometasone 200 mcg twice daily)
• A delayed antibiotic prescription if worsening or not improving within 7 days (phenoxymethylpenicillin first-line)

Question 13

What are the management options for chronic sinusitis?

Answer 13

• Saline nasal irrigation
• Steroid nasal sprays or drops (e.g., mometasone or fluticasone)
• Functional endoscopic sinus surgery (FESS)

Question 14

What is a common misuse of steroid nasal sprays?

Answer 14

If the user tastes the spray at the back of their throat, it means it has gone past the nasal mucosa and will not be as effective

Question 15

Describe the correct technique for using a steroid nasal spray.

Answer 15

• Tilt the head slightly forward
• Use the left hand to spray into the right nostril, and vice versa
• Do NOT sniff hard during the spray
• Very gently inhale through the nose after the spray

Question 16

What is Functional Endoscopic Sinus Surgery (FESS)?

Answer 16

FESS involves using a small endoscope inserted through the nostrils and sinuses to remove or correct any obstructions to the sinuses

Question 17

What must patients have before undergoing FESS?

Answer 17

Patients need a CT scan before the procedure to confirm the diagnosis and assess the structures