PARANASAL SINUSES Flashcards
group of disorders characterized by inflammation of the mucosa of the paranasal sinuses
Rhinosinusitis
Major Symptoms of Rhinosinusitis
- facial pain/ pressure
- facial congestion/ fullness
- nasal obstruction/blockage
- nasal discharge/purulence, discolored posterior drainage
- hyposmia/anosmia
- purulence on nasal exam
- fever (acute rhinosinusitis only)
*dx of rhinosinusitis requires 2 MAJOR or 1 MAJOR and 2 MINOR symptoms
Minor Symptoms of Rhinosinusitis
- headache
- fever (nonacute)
- halitosis
- fatigue
- dental pain
- cough
- ear pain, pressure and/or fullness
- Lasts for up to 4 weeks and results from interactions between a predisposing condition and response from a viral infection
- Sudden in onset
- Diagnosed after at least 7-10 days of symptoms or in patients whose symptoms worsen after 5-7 days
- Self-limited disease in many cases
Acute Rhinosinusitis
Bacterias that can cause Acute Rhinosinusitis
- Streptococcus pneumonia (most common)
- Haemophilus influenza, (2nd mc)
- Moraxella catarrhalis,
- Staphyloccus aureus
- 4 or more episodes per year, with each lasting more than 7-10 days
- absence of intervening signs or symptoms that would suggest an ongoing or chronic sinusitis
Recurrent Acute Rhinosinusitis
DX of Acute Rhinosinusitis
- Gold Standard
- invasive, potentially painful
- more appropriately used in diagnosing patients whose symptoms of ARBS persist despite appropriate therapy
Sinus Aspirate and Culture
Treatment of Acute Rhinosinusitis
- If there is “onset with ‘persistent’ symptoms or signs compatible with acute rhinosinusitis lasting for 10 days or longer without any evidence of clinical improvement
- Onset with ‘severe’ symptoms or signs of high fever 39°C or higher and purulent nasal discharge or facial pain lasting for at least 3 to 4 days at the beginning of illness
- Onset with ‘worsening’ symptoms or signs such as new onset of fever, headache, or increase in nasal discharge following typical viral [upper respiratory infection] symptoms that lasted 5 to 6 days and were improving
Antibiotic treatment
Treatment of Acute Rhinosinusitis
- Given in “high-dose” for:
> Regions with high endemic rates of penicillin-nonsusceptible S. pneumonia
> Severe infection
> Recently hospitalized
> Antibiotic use for the past month
> Immunocompromised
Empiric Therapy:
Amoxicillin-Clavulanate
Treatment of Acute Rhinosinusitis
- Type I Hypersensitivity Allergy to Penicillin
- Non-Type I Hypersensitivity Allergy to Penicillin
- Doxycycline, Respiratory fluoroquinolone
- Third Generation Cephalosporin + Clindamycin
Treatment
- If symptoms worsen after 72 hours of initial empiric therapy or failure to improve despite 3-5 days of therapy
- If on high-dose Co-Amox or Fluoroquinolone with no improvement after 72 hours
- change medications
- consider other etiologies
Complications
Two mechanisms:
- Loss of anatomic barrier
> Dehiscence of the lamina (congenital vs osteitic bone destruction) - Hematologic spread
> Valveless ophthalmic venous system
> Thrombophlebitis of the vessel
- Younger than 7 years
- GROUP I: preseptal cellulitis or inflammatory edema superficial to the tarsal plates and orbital septum
- GROUP II: orbital or postseptal cellulitis with edema of the orbital contents without a discrete abscess
- GROUP III: subperiosteal abscess adjacent to the lamina papyracea and under the periosteum of the medial orbit
- GROUP IV: orbital abscess or a discrete collection within the orbital tissue
- GROUP V: cavernous sinus thrombosis
- Presentation:
> Periorbital edema or erythema
> Pain
> Visual changes
ORBITAL
- Adolescent and teenage
- No classification
- Presentation:
> History of upper respiratory infection
> Fever
> Headache
INTRACRANIAL
- When postseptal involvement is suspected or with intracranial complication
- Considered when preseptal complication progresses 24 to 48 hours despite antibiotic treatment
Contrast Enhanced CT
