Infections nasosinusiennes de l'enfant et de l'adulte

Question 1

Rhinites aiguës infectieuse de l’adulte : “rhume banal”

• épidémiologie
• clinique
• durée évolution
• complications
• dg différentiel

Answer 1

INFECTIOUS RHINITIS OF THE ADULT:
=> epidemic, contagious, seasonal, viral (rhinovirus, influenzae, coronavirus)

=> weariness, heaviness, chills
THEN variable disorders of the rhino-pharynx (burning, dryness) and / or nasal cavity (pruritus, rhinorrhea)
Nasal obstruction, serous fluid discharge, colorless, blotches ++ little or no fever, frontal headache.
Rhino: red mucosa, hypertrophy of inferior cornets

2-3 J: attenuation, thicker flow, yellow-green
Then secretions become clearer, diminish and disappear with obstruction.

=> 5 to 20 days ++ (variable)

=> mostly benign evolution BUT risk:

• acute sinusitis
• meningeal syndrome
• ocular, cervico-mediastenal complications

=> Differential GD: allergic rhinitis ++ nasal obstruction, clear rhinorrhea and sneezing, no infectious factor

Question 2

Rhino-pharyngite de l’enfant

Answer 2

=> Noisy oral breathing with fever (38.5 ° C)
Clinic:
- mucopurulent anterior rhinorrhea
- Posterior rhinorrhoea with thick discharge on the posterior wall of the pharynx
- redness of the pharyngeal mucosa
- inflammatory and sensitive cervical lymphadenopathy

Question 3

TTT rhinite ou rhino-pharyngite aigue non compliquée :

Answer 3

Symptomatic ++
- washing of the nasal cavities with solutions close to sea water + muzzles
- analgesic if pain
- antipyretics if fever
\+/- nasal vasoconstrictors for adults

Question 4

Sinusites aiguës :

• définition
• physiopathologie
• germes

Answer 4

=> Definition: acute infection of the mucosa of one or more sinus cavities of viral or bacterial origin

=> Pathophysiology:

• airway or hematogenous nasal passages ++
• dental infection for maxillary sinuses

=> Sprouts: Pneumococcus, H. influenzae, Streptococcus, Staphylococcus, Moraxella Catarrhalis

Question 5

Sinusite maxillaire aiguë

• clinique
• rhinoscopie

Answer 5

+++ frequent
=> Clinic: during acute rhinitis with the appearance of unilateral orbital pain, pulsatile, especially in the evening with nasal obstruction, and thick discharge, fever

Symptoms :
° major : pain during pressure of the face, congestion, nasal obstruction, hyposmia/anosmia, fever
° minor : headache, asthenia, toothache, ear pain
=> Dg : 2 majors and 1 minor

=> Rhinoscopy: presence of pus on the middle meatus on the painful side

Question 6

3 arguments majeurs en faveur d’une sinusite aiguë maxillaire purulente : surinfection bactérienne

Answer 6

• persistence or increase in pain despite symptomatic treatment for 48 hours
• pain: unilateral, pulsatile, increase with head bent forward, evening and night
• increase rhinorrhea and purulence

=> Antibiotics ++

Question 7

Formes cliniques sinusites selon la topographie

Answer 7

FRONTAL SINUSITIS:
=> frontal seat, supra-orbital, radiating to the hemi-cranium, rhinorrhea and nasal obstruction

SPHENOIDAL SINUSITIS:
=> occipital, vertex or retro-orbital headaches

ETHMOIDITY: super-internal palpebral edema, painful, without pus with fever in young children ++
> Complication = form collected: with pus between the os planum and the periosteum (extraperiosteal) repressing the orbital content, painful exophthalmos, scanner ++, samples and antibiotics

Question 8

Classification aigue, subaigu, récidivante et chronique

Answer 8

> Acute : 10 days - 4 weeks

> Sub-acute : 4 - 12 weeks

> Acute recurrent sinusitis: more than 4 episodes / year

> Chronic sinusitis: more than 12 weeks with acute sur-infections
=> nasosinus polyposis ++ nasal cavity polyps ethmoidal starting point with bronchial hyperreactivity

Question 9

Formes hyperalgiques

Answer 9

Blocked sinusitis maxillary, frontal or sphenoidal
=> pain intensity ++ insomnia, no improvement after treatment
=> sinus punction :
- lower meatal lobe for maxillary sinusitis
- anterior frontal approach for frontal sinusitis
- endonasal approach for sphenoidal sinusitis

Question 10

Formes compliquées

Answer 10

• oculo-orbital complications: palpebral cellulitis, orbital abscess
• cerebro-meningeal complications: abscess, meningitis, empyema, thrombophlebitis
• bones : osteomyelitis

Question 11

Indications ATB

Answer 11

• purulent maxillary sinusitis
• if initial symptomatic treatment fails
• in case of complications
• maxillary sinusitis associated with a dental infection
• frontal, sphenoidal or ethmoidal sinusitis ++

Question 12

ATB recommandée

+ TTT symptomatique associé

Answer 12

=> Amoxicillin for 7 to 10 days

or if failure:

• amoxicillin + clavulanic acid
• C2G / C3G

=> Analgesics
=> Vasoconstrictors : local and systemic
=> Oral corticoid (blocked sinusitis)

Question 13

Specific allergic rhinitis

Answer 13

Symptomatic nasal disorder due to an Ig-E mediated inflammation of the nasal mucosa following exposure to an allergen (animals, pollen) ++ => production of histamine (type 1 allergic reaction)

Epidemiology : 20% of population in industrialized countries, polluted areas, cronic inflammation, more sensitive to allergens, genetic problem (people with higher number of Ig-E)

Diagnosis :

• clinical history, parents ++
• nasal fibroscopy
• in vivo prick test (first)
• eosinophil dosage in vitro (second)

Symptoms : nasal obstruction, pruritus, rhinorrhea, seasonal form
> Classification based on the duration of symptoms :
° intermittent < 4 days/week - < 4 weeks or persistent > 4 days/week - > 4 weeks
° mild : no limitation in daily activities
° moderate or severe : limitation and annoying symptoms

TTT :

• avoid exposure to the allergen
• anti/histaminic/cholinergic/leucotrienes
• vasoconstrictors
• corticosteroids
• specific immunotherapy