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
Suspected intracranial complications based on PE or CT Scan findings
Contrast Enhanced MRI
Surgical Intervention
Indicated in:
- Decrease visual acuity
- Afferent pupillary defect
- Failure to improve on medical treatment after 48 hours of antimicrobial treatment
- benign, slow-growing osteoblastic lesion
- the most common benign tumor of the sinonasal tract
- 1% of patients undergoing plain sinus radiographs
- 3% of those undergoing CT for sinus symptoms
- 2ND – 5TH Decade
- slight male preponderance
OSTEOMA
frontal sinus – ethmoid sinus – maxillary sinus – sphenoid sinus
OSTEOMA involvement
OSTEOMA appear macroscopically
most osteomas appear as hard, white, multilobulated masses
CT examination after surgery is done
1 year after surgery and presence of a symptomatic stenotic frontal or maxillary sinusotomy
