FN: Sinusitis

Question 1

Pathophysiology

Answer 1

Viruses: mucosal oedema and reduced mucosal ciliary actions - mucus retention ± secondary bacterial infection

Acute: Pneumococus, Haemophilus, Morazella
CHronic: S. aureus, anaerobes

Question 2

Causes

Answer 2

• Majority are bacterial infection secondary to viral
• 5% secondary to dental root infections
  3. Diving/swimming in infected water
  4. Anatomical susceptibility: deviated septum, polyps
  5. systemic Disease
• PCD/Kartageners
• Immunodeficiency

Question 3

Symptoms

Answer 3

Pain:

• Maxillary (cheek/teeth)
• Ethmoidal (between eyes)
• worse in bending or straining

Discharge: from nose - post-nasal drip with foul taste
Nasal obstruction/congestion
Anosmia or cacosmia (bad smell w/o external source)
Systemic symptoms e.g. fever

Question 4

Imaging

Answer 4

Nasendoscopy ± CT

Question 5

Mx acute/single episode

Answer 5

Bed-rest decongestants, analgesia
Nasal douching and topical steroids
Abx (e.g. clartithromycin) of uncertain benefit

Question 6

Mx chronic/recurrent

Answer 6

Usually a structural or drainage problem
Stop smoking _ fluticasone nasal spray
Functional endoscopic sinus surgery - if failed medical therapy

Question 7

Complications

Answer 7

Mucoceles - pyoceles
Orbital cellultis/abcess
Osteomyeltitis e.g. staph in frontal bone
Intracranial infection
- meningitis, encephalitits
- Abscess
- Cavernous sinus thrombosis