Paranasal Sinus Flashcards
Pathophysiology
-Normal function depends on patent ostia, ciliary function, & quality of mucous
-Obstruction of natural ostia -> hypo-oxygenation -> ciliary dysfunction and poor mucous quality -> retention of secretions
-Local factors can impair ciliary function
-Cold air “stuns” the epithelium -> retained secretions
-Dry air desiccates the blanket
-Anatomical factors- polyps, tumors, foreign bodies and rhinitis, block the ostia
-Kartagener’s Syndrome (immotile cilia syndrome)
Kartagener’s Syndrome (immotile cilia syndrome)
-Situs inversus- rare disease when organs on the right side are on left (vice versa)
-chronic sinusitis
-bronchiectasis- destroyed architecture of bronchi - widened and tram like + mucus
-defect in the formation of cilia -> particles will get past and infect
-Autosomal recessive pattern
-result from defective cilia motility
-Immotile cilia and immotile spermatozoa
upper respiratory infection (URI)
-Common Cold, acute infective rhinitis,acute rhinopharyngitis/nasopharyngitis,acute coryza, andacute nasal catarrh
-Nasal congestion, clear rhinorrhea, and hyposmia
-malaise, headache, and cough
-Erythematous- engorged nasal mucosa without intranasal purulence (differs from allergic rhinitis)
-self-limited (goes away without treatment)
- < 4 weeks and typically < 10 days
-Numerous serologic types of rhinoviruses, adenoviruses, and other viruses -> this is why you catch it frequently
-can develop into viral sinus infection
3 types of rhinosinusitis
-1. acute rhinosinusitis (ARS)- acute viral rhinosinusitis & acute bacterial rhinosinusitis (ABRS)
-2. subacute rhinosinusitis- 4-12 weeks
-3. chronic rhinosinusitis (CRS)
-classified by length of time
classification of sinus infection
-symptomatic inflammation of paranasal sinuses and nasal cavity
-divided into Acute rhinosinusitis (ARS) & Chronic rhinosinusitis (CRS).
-ARS- < 4 weeks
-CRS- > 12 weeks, with or without acute exacerbations
-ARS -> acute bacterial rhinosinusitis (ABRS) or viral rhinosinusitis (VRS)
-Treatment depends on classification
-Recurrent-ARS - 4+ annual episodes of rhinosinusitis, without symptoms between.
-Uncomplicated rhinosinusitis- no extension of inflammation outside the paranasal sinuses and nasal cavity at time of dx -> no neurologic, ophthalmologic, or soft tissue involvement -> dont necessarily need antibiotics
VRS and ARBS diagnosis
-primarily clinical- use duration and pattern
-radiographs- used rarely- must be a complication
-transillumination- not reliable
acute viral rhinosinusitis (VRS)
-numerous serologic types of rhinoviruses, adenoviruses, and other
-recurrent
-3-4 weeks
-subacute- 4-12 weeks (not a separate entity)
-benign and self limited
-high loss of productivity, cost, overuse of antibiotics
-predisposing factors- URTI, allergic rhinitis, nasal polyps, immunodeficiency, environmental factors (smog, smoking)
-when acute viral rhinosinusitis is longer than 10 days or double worsening you suspect acute bacterial rhinosinusitis
VRS symptoms and signs
-nasal congestion
-initial watery discharge
-AVR- must have purulent discharge
-hyposmia
-associated symptoms- cough, postnasal drip, toothache, headache, facial pressure pain, sneezing, irritated throat, general malaise
-tenderness over sinus cavities
-increased posterior pharyngeal secretions
-purulent (Infected, colored, oozing) secretions (middle meatal region)
-reddened, edematous mucosa
-dark circles beneath eyes
-absence of transillumination
VRS differential diagnosis
-acute bacterial rhinosinusitis (ARBS)
-COVID-19
-URTI
-nasal polyposis
-orbital cellulitis
-headache differentials
-wegener’s granulomatosis
-immotile cilia syndrome
-neoplasms- rare
management of acute viral rhinosinusitis
-generally self-limited process
-Supportive; symptom relief
-NSAIDs; Acetaminophen
-Mechanical irrigation
-Intranasal corticosteroids; decongestants -> max 3 days
-? Antihistamines - efficacy
-? Mucolytics – thin secretions
-? high dose Zinc lozenges
COVID-19 and URI
-Predominantly lower respiratory
-Viral prodromal S&S
-Fever, nasal inflammation, rhinorrhea, cough, myalgias, fatigue
-*Hyposmia and anosmia - ? Pathognomonic
-If suspicious –> test immediately
-Can be transient or permanent
Complications of AVR
-Acute bacterial rhinosinusitis
-Chronic rhinosinusitis
-Eustachian tube dysfunction
-Middle ear effusion
-Precursor to more serious conditions:
-S pneumoniae, other streptococci, H influenzae, S aureus, and Moraxella catarrhalis
-Acute otitis media, asthma, and cystic fibrosis exacerbation, and bronchitis
complication of treatment AVR
-Rhinitis medicamentosa
-cannot use more than 3 days
-decongestants-> oxymetazoline or phenylephrine - rapidly effective BUT!!!
-> Chronic use of vasoconstrictor nasal sprays or intranasal cocaine abuse -> Beefy red nasal membranes
-Management:
-Stop offending drug
-Severe nasal congestion
-Topical intranasal corticosteroids
-Oral prednisone (5 days)
presentation of AVR in children vs adult
-children -> increased irritability and vomiting as result of gagging on mucus and prolonged cough
-Both adults & children- less frequent symptoms include fever, nausea, malaise, fatigue, halitosis, and sore throat (fever is more common in children than in adults)
acute bacterial rhinosinusitis (ABRS)
-DIAGNOSE WHEN:
-symptoms or signs of acute rhinosinusitis (AVR) are present 10 days or more beyond the onset of URS
OR
-symptoms or signs of acute rhinosinusitis (AVR) worsen within 10 days after initial improvement (double worsening)
-additional symptoms/signs: fever, cough, fatigue, malaise, reduced sense of smell (Hyposomnia), lack of smell (anosmia), maxillary dental pain, ear fullness or pressure
acute bacterial etiology
-streptococcus pneumoniae
-haemophilus influenzae
-moraxella catarrhalis
