module 3 sinusitis, tumors, and polyps of the nose Flashcards
rhinosinusitis
symptomatic inflammation of the mucosal surface of the paranasal sinuses
subclassifications of rhinosinusitis
acute: resolves in less than 4 weeks
subacute: resolves within 4-12 weeks
chronic: continues beyond 12 weeks
Acute rhinosinusitis
inflammatory process of the paranasal sinuses caused by:
- viral
- bacterial
- fungal
- allergic
Usually proceeded by an acute viral respiratory infection which extends into the paranasal sinus cavities
Acute Bacterial rhinosinusitis usually caused by
streptococcus pneumoniae
HIB
moraxella catrrhalis
S. pneumonia
Acute rhinosinusitis s/s
Abrupt onset:
nasal congestion
purulent nasal discharge
dental pain
post-nasal drip
halitosis
ear fullness/otalgia
dec. smell
headache
fever
fatigue
chronic sinusitis
prolonged sinus infection that resist tx or recurrent acute infections
- anatomic abnormality
- immunocompromised
- continued irritant/allergen exposure
- incompletely treated bacterial or fungal infection
medical devices that can cause sinusitis
NG tube
intubated through nare
largest paranasal sinus
maxillary
maxillary anatomy and infections
ostium into nose is superiorly placed
- no gravity advantage
- infected secretions are forced into sinus cavity
bacterial sinusitis
- most often a complication of viral rhinosinusitis OR
- allergies
- dental infection
- fluid introduced into sinuses: diving, swimming
sinusitis r/t anatomic abnormalities
deviated septum
adenoidal hypertrophy
neoplasms
foreign body
ciliary dysfunction: CF
acute bacterial rhinosinusitis s/s
mucopurulent discharge
nasal obstruction
facial pain or pressure
- ARS s/s > 10 days or initial improvement followed by worsening of s/s
Chronic rhinosinusitis s/s
purulent nasal drainage
nasal obstruction: bilateral
facial pain or pressure
dec. or loss of smell
- > 12 weeks
frequent throat clearing
cough
INC. in:
- allergy s/s
- asthma
- eczema
rhinosinusitis physical exam
General inspection for facial:
- asymmetry
- periorbital edema
- cellulitis
Speech: hyponasal quality
Nasal turbinate:
- edema
- erythema
- discharge
- patency of nares
- septal deviation
- polyps
Transillumination
- inability to transilluminate indicates fluid in sinuses
Palpation and Percussion:
- frontal and maxillary sinuses
Pharynx:
- postnasal drip
- erythema
- lymphoid hypertrophy
Otic exam
- otitis media
Rx management of rhinosinusitis
antibiotic tx if s/s > 7 days
NSAIds
nasal saline
oral or topical decongestants
nasal steroids
complications of rhinosinusitis
quality of life
osteomyelitis
orbital infection
vision loss: pressure on optic nerve
invasive fungal sinusitis