Nose

Question 1

Acute Sinusitis

Answer 1

Affects frontal, maxillary, sphenoid or ethmoid sinuses
Caused by pneumococci, streptococci, Moraxella catarrhalis, Haemophilus influenza.
Persistent symptoms of an URI—worsen after one week
Facial pain and pressure, nasal congestion, purulent nasal discharge, teeth pain, eye pain, headache, +/- fever, bad taste/breath, eyelid or facial edema

Pain worse when laying down

Question 2

Complications of Acute Sinusitis

Answer 2

osteomyelitis, orbital infection, cavernous sinus thrombophlebitis, abcess, meningitis

Question 3

Acute Sinusitis (time frame)

Answer 3

Up to 3 weeks

Question 4

Subacute Sinusitis

Answer 4

3-12 weeks

Question 5

Chronic Sinusitis

Answer 5

> 12 weeks

Question 6

Assessment of Sinusitis

Answer 6

PE Tenderness of sinuses with palpation, erythematous nasal mucosa, diminished transillumination
Plain sinus x-rays have poor sensitivity and specificity; can show mucosal thickening, sinus opacification, air-fluid levels
CT scan or MRI are more sensitive
Nasal cultures have poor correlation

Question 7

Sinusitis Treatment

Answer 7

Amoxicillin-clavulanic acid 875 mg BID
Doxycycline or quinolone (Levaquin)
Macrolides, Bactrim, amoxicillin, & 2nd generation cephalosporins no longer recommended for empiric treatment due to resistance
Other symptomatic treatments include oral and topical decongestants, analgesics, warm compresses, nasal irrigation
Refer if treatment failure or chronic, recurring or unilateral symptoms

Question 8

Chronic sinusitis

Answer 8

Obstruction of drainage loss of ciliated epithelia
Persistent nasal congestion and discharge, headache
Staph aureus, H. Flu, pneumococcus, anaerobes
CT mucosal thickening; polyps, mucoceles, tumor
Antibiotics for 4-6 weeks; sinus irrigation; surgery

Recurrent sinusitis: > 3 episodes/year. Allergies?

Question 9

Epistaxis

Answer 9

Trauma, irritation, infection, tumor, HTN, bleeding disorder, cocaine
Kiesselbach’s plexus on anterior nasal septum
Treatment of anterior septal bleed: apply direct pressure over the nasal bridge, sit upright & forward, ice packs, phenylphrine, silver nitrate
May require packing and curettage.
Labs based on history: CBC, PT/PTT,
Sinus film
Prevention: moisturize, reduce local trauma

Question 10

Nasal Skin & Soft Tissue

Answer 10

Inspect these area for sun exposed risk
Basal cell carcinoma most common
Squamous cell and melanoma are rare

Bacterial Infection:
10% of healthy people carry staph aureus in the anterior nares
increased frequency in diabetics, dialysis, drug abusers
Mucopurcin 2% BID x 5days (Bactroban)