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General Practice > ENT - Sinusitis > Flashcards

ENT - Sinusitis Flashcards

1
Q

Acute rhinosinusitis causes

A

Viral
Post-viral
Acute bacterial

lasts <4 weeks

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2
Q

Post-viral acute rhinosinusitis

A

An increase of symptoms after 5 days, or persistence of symptoms after 10 days

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3
Q

Acute bacterial rhinosinusitis

A

Generally preceded by a viral or post-viral rhinosinusitis

Discoloured discharge
Severe localised pain with unilateral predominance
Double sickening - deteriorates after a period of illness

Can be treated with amoxicillin for 5 days

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4
Q

Acute rhino sinusitis symptoms

A

nasal obstruction, discharge, changes in smell, facial pain/pressure and cough (in children)
facial pain worse when bending forward and can radiate to the teeth

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5
Q

Acute rhinosinusitis management

A

supportive therapies - analgesia, nasal saline irrigations and nasal decongestants
intranasal steroids for 7-14 days may be used if symptoms persist

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6
Q

Complications of acute rhinosinusitis

A

Orbital involvement

  • painful ophthalmoplegia, diplopia, proptosis and decreased visual acuity
  • loss of green/red colour differentiation

Intracranial complications

  • acute onset confusion or impaired consciousness
  • meningism

IMMEDIATE REFERRAL to an ENT specialist

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7
Q

Diagnostic Criteria (European Position Paper on Rhinosinusitis)

VIRAL

A

ADULT ACUTE RHINOSINUSITIS
sudden onset of 2 or more Sx
One being either nasal blockage/congestion/obstruction or nasal discharge
Plus facial pain/pressure or reduction/loss of smell

ADULT CHRONIC RHINOSINUSITIS
Presence of 2 or more Sx for >12 weeks
One being either nasal blockage/congestion/obstruction or nasal discharge
Plus facial pain/pressure or reduction/loss of smell

PAEDS ACUTE RHINOSINUSITIS
sudden onset of 2 or more Sx
Nasal blockage/congestion/obstruction, discoloured nasal discharge or cough

PAEDS CHRONIC RHINOSINUSITIS
Presence of 2 or more Sx for >12 weeks
One being either nasal blockage/congestion/obstruction or nasal discharge
Plus facial pain/pressure or cough

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8
Q

Red flags for rhinosinusitis

A

unilateral symptoms
bleeding
cacosmia - perceived malodourous smell
signs of meningitis - neck stiffness, photophobia
altered neurology
frontal swelling
Any orbital involvement - diplopia, decreased visual acuity, painful opthalmoplegia, peri-orbital oedema and erythema, globe displacement

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9
Q

Diagnostic Criteria (European Position Paper on Rhinosinusitis)

BACTERIAL

A 
At least 3 of: 
Discoloured, purulent nasal discharge 
Severe localised pain 
Fever >38
Elevated ESR/CRP 
Double sickening
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10
Q

Chronic rhinosinusitis assessment

A

Ensure meets the criteria
History of allergic symptoms should be explored and formal allergy testing can be considered through RAST

Anterior rhinoscopy to determine the presence or absence of polyps

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11
Q

Chronic rhinosinusitis treatment

A

Trial of topical steroids and nasal irrigations for at least 8 weeks

Topical steroids through nasal spray OR adding diprosone OV cream or budesonide respells to the nasal irrigation rinse once a day

Nasal saline irrigation twice daily

If nasal polyposis - burst of oral steroids - prednisone 25mg MANE for 5 days then 12.5mg for 5 days then cease

If allergic - RAST serology - non sedating antihistamines and referral to immunologist if severe and allergic symptoms uncontrolled by simple measures

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12
Q

Surgical management of chronic rhinosinusitis

A

When medical therapy fails

Current approach is functional endoscopic sinus surgery (FESS) to remove polyposis when present, and ventilation of sinus cells

Refer to ENT when

  • failed medical therapy
  • unsure of the diagnosis
  • unilateral symptoms
  • bleeding
  • crusting
  • orbital symptoms
  • severe frontal headache
  • frontal swelling
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13
Q

Samter’s triad

A

Presence of NSAID sensitivity, asthma and chronic sinusitis with nasal polyps

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14
Q

Chronic rhinosinusitis symptoms

A

Facial pain/pressure/congestion/fullness
Nasal obstruction/blockage
Nasal discharge/postnasal drip

Hyposmia/anosmia 
headaches 
halitosis 
fatigue 
dental pain 
cough 
ear pressure

referred pain:

  • maxillary sinus - cheek/dental
  • ethmoid sinus - between eyes
  • frontal sinus - forehead
  • sphenoid sinus - vertex pain
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15
Q

When to request a CT

A

When:
the diagnosis is uncertain
the patient is not responding to expected medical treatment
surgery is planned as per ENT specialist

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16
Q

Etiology of chronic rhinosinusitis

A 
Bacterial infection 
Rhinitis allergic or non allergic (smoking) 
Anatomical factors 
Immunodeficiencies 
Ciliary disorders (cystic fibrosis) 
Bacterial biofilms 
fungi 
Other metabolic derangements - aspirin sensitivity

General Practice (4 decks)

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