Nose and Paranasal Sinuses - Exam 4 Flashcards
______ forms the medial wall the nasal cavity
______ forms the lateral wall
septum
turbinates
______ Runny nose
_____ Symptoms of a “cold”; describes the inflammation of the mucous membranes lining the nasal cavity, usually with nasal discharge
______ Symptomatic disorder of the nose characterized by itching, nasal discharge, sneezing, and nasal airway obstruction
Rhinorrhea
coryza
rhinitis
______ Symptomatic inflammation of the nasal cavity and paranasal sinuses
______ Induction of rhinitis symptoms after allergen exposure by an IgE-mediated immune reaction; accompanied by inflammation of the nasal mucosa and nasal airway hyperreactivity
Rhinosinusitis
Allergic Rhinitis
What is the correct term for an URI? What is the tx? How common is it?
Acute viral rhinosinusitis
self-limiting aka no tx
most frequent acute illness
How is an URI transmitted? How is it NOT transmitted? How long does it last? When are you most contanigous?
hand contract
droplet
contaminated fomites aka surfaces
NOT transmitted via saliva
10-14 days, 21 days in kids
Peak viral shedding occurs on the 2nd and 3rd day of illness
What risk factors can increase severity of URI s/s?
Underlying chronic diseases
Congenital immunodeficiency disorders
Malnutrition
Cigarette smoking
Rhinitis
Nasal congestion
Runny nose
Sneezing
Sore or scratchy throat
Cough
Malaise
Headache
Fever - less common in adults
Conjunctivitis
Lung examination is clear
TMs may have fluid but no infection
What am I? What are the 3 highlighted ones?
What are the 2 important PE findings?
URI: Upper respiratory tract infection
S/S:
Rhinitis
Nasal congestion
Runny nose
PE:
Lung examination is clear
TMs may have fluid but no sign of infection
What is the tx for URI?
treatment aimed at the s/s:
NSAIDS/Acetaminophen
Fluids
Nasal saline irrigation
Oral decongestants
Nasal decongestants - limited to a few days
NO ABX!!!!!
When you are born you have ____ and _____ sinuses.
maxillary and ethmoid
Around age 2-5 you start developing the ____ sinus
Around age 12 start developing the ____ sinus
What age are your sinuses fully developed?
sphenoid
so total sinuses include: maxillary, ethmoid and sphenoid
frontal
so now have all 4: maxillary, ethmoid, sphenoid and frontal
fully developed at 20
What is the MC sinus infected? ____ is the most common precursor
maxillary
viral URI
Cystic fibrosis pts tend to develop ______
nasal polyps
What are the top 3 pathogens for acute bacterial rhinosinusitis? ____ is the most cause of dental infections
Strep pneumon
H. influ
M. catarrhalis
anaerobes
What is the pathophys behind acute bacterial sinusitis?
Impaired mucociliary clearance
Inflammation of the nasal mucosa
Obstruction of the ostiomeatal complex (aka sinus pore)
This results in accumulation of mucus in the sinus cavity that gets secondarily infected by bacteria
What sinus cavity? Unilateral facial fullness, pressure, tenderness over cheek,
Referred pain to upper incisor and or canine teeth
maxillary
What sinus cavity? Pain or pressure on high lateral wall of nose, often referred to orbits. aka pain between the eyes
ethmoid
What sinus cavity? Points to pain on vertex of head. aka top of the head
sphenoid sinus
What sinus cavity? Pain and tenderness on forehead: pain elicited by palpation of orbital roof just below medial end of eyebrow aka forehead, above the eyebrows
frontal
Point on your face to where the following sinus cavities are located. Frontal, ethmoid, maxillary, sphenoid.
Nasal congestion and obstruction
Purulent nasal discharge
Tooth pain
Facial pain or pressure, worse with bending over
Fever
Fatigue
Cough
Hyposmia or anosmia: decreased/absent smell/taste
Ear pressure or fullness
Headache
Halitosis: bad breath
**What am I?
**What is the criteria?
acute bacterial rhinosinusitis
s/s of acute rhinitis lasting more than 10 DAYS!
or
severe s/s with FEVER/purulent nasal discharge/facial pain for 3-4 days
or
viral URI s/s that improve but then worsen to severe s/s after 5-6 days
How do you dx acute bacterial rhinosinusitis? What is the imaging of choice? What is the tx?
CT scan is TOC but not routinely used
can transilluminate sinuses!!
careful observation!!
can give tx based on s/s:
NSAIDS, nasal saline sprays and intranasal decongestants have shown to help with symptom reduction
Oxymetazoline 1-2 sprays q6-8h for 3 days (Afrin)
What 3 pathogens are common in nosocomial sinusitits?
S. aureus
P. aeruginosa
Anaerobes
What is considered a complicated case of acute bacterial rhinosinusitis? What is the tx? What is they have an allergy?
symptoms last more than 7-10 days
or
symptoms including fever, facial pain, or swelling are severe
or
Immunodeficiency, complicated (spreading to other places/tissues)
no risk factors: Augmentin
risk factors: high dose: Augmentin 2 grams BID
mild PCN allergy: clindamycin plus cefixime
severe PCN: doxy, levo, moxi, Zithromaz
What are some risk factors for resistance with acute sinusitis
What is the complete management for complicated acute bacterial rhinosinusitis
Antibiotics for 7 - 10 days: based on allergy
Intranasal corticosteroids
NSAIDS for pain
Nasal saline lavage
What are some common complications from bacterial rhinosinusitis
orbital cellulitis
Pott’s Puffy Tumor
intracranial complications
What is a Pott’s Puffy tumor? How does it present? What is the tx?
frontal bone osteomyelitis
Tender, doughy swelling over forehead
Drainage of abscess and frontal sinus
IV antibiotics for 6 weeks - culture sensitive
Immunocompromised patients
opportunistic infection of sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi
spreads rapidly through vascular channels
Severe facial pain
Nasal drainage clear / straw colored
Black eschar on middle turbinate
Orbital swelling and cellulitis
Proptosis, ptosis, decreased EOM
Retro orbital or periorbital pain
Nasopharyngeal ulcerations
CN V and VII involvement - more advanced
Bony erosions
What am I?
What are some common organisms?
How do you dx?
What is the tx?
invasive fungal sinusitis
Rhinocerebral mucormycosis (molds)
Aspergillus
nasal endoscopy with bx
sx and IV Amphotericin B, can switch to oral Itraconazole 3-6 months after improvement
What is chronic sinusitis define as? What is the dx TOC? What is the tx?
Symptoms > 12 weeks
Impaired mucociliary clearance due to repeated infections
Constant sinus pressure, nasal congestion
dx: CT scan
tx: Refer to ENT!!
abx
intranasal steroids
saline irrigation
if everything else fails: sinus sx
Non-invasive
Older patients, only mildly immunocompromised (DM II and low dose steroid therapy)
Molds, Aspergillus species
Patients often endure symptoms for months before development of a complication
White escar
What am I?
How do you dx?
What is the tx?
chronic fungal sinusitis
nasal endoscopy with bx, CT to determine the extent of the dz
tx: difficult to cure
IV Amphotericin B then Switch to Itraconazole for at least 3-6 months, some possibly lifelong
History of nasal polyposis and asthma
Multiple sinus surgeries
Thick, eosinophilic mucous and fungal debris
High levels of IgE found in blood
IgE-mediated allergy to fungus by skin testing or immunoassay
What am I?
What is the tx?
Allergic Fungal Sinusitis
tx: Endoscopic sinus surgery to remove mucin and debris, created drainage
Post-op systemic steroids mainstay