Final - Chronic RS

Question 1

Chronic RS is inflammation of the sinuses and nasal passages for more than ______

Answer 1

3 months

Question 2

Chronic RS has a history of 2 or more (4 things)

Answer 2

PODS
– facial Pain-pressure-fullness
– nasal Obstruction/congestion
– mucopurulent Drainage
– sense of Smell decreased

Question 3

Hyposmia

Answer 3

Impaired smell is common due to epithelial

inflammation impairing CN I transmission

Question 4

Chronic RS Evidence of sinus mucosal disease on rhinoscopy:

Answer 4

purulent drainage, edema, erythema of nasal mucosa, +/- polyps

Question 5

Whatleads to impaired ciliary action + mucosal swelling blocks sinus ostia
decreased mucous drainage in Chronic RS

Answer 5

Chronic inflammation

• accumulation/stasis of mucous promotes secondary bacterial or fungal growth

Question 6

ChronicRS risk factors (7 things)

Answer 6

• Chronic allergies
• Immunologic deficiency
• Structural abnormalities of the upper airway
• Dental infection (maxillary sinuses)
• Metabolic abnormalities (aspirin sensitivity)
• Smoking cigarettes
• Vitamin D deficiency

Question 7

What are the three subtypes of Chronic RS?

Answer 7

1. CRS without polyps
2. CRS with polyps (bilateral is the norm)
3. Allergic fungal rhinosinusitis

Question 8

Which subtype of CRS is

• most common: 60-65% of CRS causes
• fever uncommon > may be a series of recurrent infections rather than just one persistent infection

Answer 8

CRS without polyps

Question 9

Which subtype of CRS is

~ 25%

• harder to treat, increased recurrence rate
• bilateral is the norm

Answer 9

CRS with polyps

Question 10

Which subtype of CRS is

• Most common in Southwest U.S.
• Aspergillus species and black molds implicated (Often colonization rather than invasive infection of sinuses)
• Evidence of IgE-mediated allergy to fungi required to make diagnosis

Answer 10

Allergic fungal

Question 11

What are diagnostic for CRS

Answer 11

Imaging: non-contract CT sinuses

Refer to ENT for nasal endoscopy

Question 12

What do you do with nasal endoscopy?

Answer 12

• look for polyps (or tumor) blocking Ostia

- obtain tissue samples to guide dx/tx

Question 13

Paranasal/nasal cancer is (rare OR common), and it is good to exclude if an adult patient presents with new onset (unilateral OR bilateral) nasal obstruction/polyp and Epistaxis (Especially if any associated changes in vision or cranial nerve deficits)

Answer 13

Very rare

Unilateral

Question 14

CT of sinuses provides best radiographic evidence of _____

Answer 14

Inflammation

Can also see sinus opacification, air-fluid level, or mucosal thickening

Question 15

With allergic fungal CRS, CT sinuses often show _______opafication

Answer 15

Heterogenous

Question 16

What are home care (4 things) and chiropractic care (3 things) options for conservative CRS treatment?

Answer 16

Home care for symptoms:
– nasal saline irrigation
– nasal steroid spray
– manage pain
– treat allergies if co-factor PLUS

Chiropractic care:
– Sinus percussion/lymph drainage, spinal manipulation
– Nasal specific treatment
– Argyrol treatments

Question 17

Argyrol is ___ silver protein solution and is a strong ____. How do you administer it?

Answer 17

10%
Antimicrobial

Soak cotton swabs and place in nasal passage ways to irritate the nasal mucosa and increase sinus drainage

Question 18

What is the max application of argyrol? What happens with over-use of argyrol?

Answer 18

Max three applications

Permanent skin, mucous membrane discoloration

Question 19

If there is no improvement with max 4 weeks of conservative care, what are the 2nd level treatments?

Answer 19

• refer to PCP or ENT for medical management (oral steroid course, 3-4 weeks of antibiotics)
• if symptoms persist despite medical tx, referral t ENT for balloon dilation or surgical evaluation

Question 20

WHat is complicated Rhinosinusitis

Answer 20

Infection can extend beyond the nasal/sinus passages into surrounding soft tissue and bone

Very serious potential for blindness and/or death > to emergency department if complication suspected

Question 21

What are the Red Flags for Complicated rhinosinusitis (6 things)

Answer 21

1. High or persistent fever
2. Severe facial / dental pain
3. Periorbital edema, erythema
4. Visual complaints (CN II)
5. Decreased extra-ocular muscle movement (CN III, IV, & VI)
6. Mental status: dull / obtunded

Question 22

soft tissue infection anterior or posterior to
the orbit but not invading structures, vision
not affected

complicated rhinosinusitis

Answer 22

Periorbital edema/cellulitis

Question 23

Pus collection in the orbit. Patient may have limitation of extraocular movements, exophthalmos, and visual changes

complicated rhinosinusitis

Answer 23

Orbital abscess

Question 24

osteomyelitis of the frontal bone with the
development of a subperiosteal abscess. swelling on the forehead or scalp

complicated rhinosinusitis

Answer 24

Pott’s puffy tumor

Question 25

Infection spreads from nose/sinuses into a vein
and causes septic thrombosis of the cavernous sinus

Sudden onset of high fever and deep pain in the eyes with ophthalmoplegia (palsies of CNIII, IV, & VI), ptosis, proptosis, chemosis

Life threatening!!! ___% mortality even with treatment

Complicated rhinosinusitis

Answer 25

Cavernous sinus thrombosis

30%

Question 26

Any symptoms or signs of infectious spread beyond sinus/nasal cavities = complicated rhinosinusitis = you should ________

Answer 26

Send to the emergency department