pediatric sinusitis

Question 1

which meatuses drains what sinus

Answer 1

superior– posterior ethmoid
middle– ant & middle ethmoid, maxillary, frontal
inferior– nasolacrimal duct

Question 2

when does each sinus become detectable?

Answer 2

frontal @ 7 yo
ethmoid & maxillary @ birth
sphenoid @ 2 yo

Question 3

the mass motion of mucous layer in paranasal sinus of mucous blanket

Answer 3

mucociliary flow

Question 4

sx of sinusitis

Answer 4

nasal congestion
discharge
facial pain
post nasal drip

Question 5

duration of acute vs chronic sinusitis

Answer 5

acute <1 mo
chronic >3 mo

Question 6

when should you do imaging for acute sinusitis

Answer 6

if kid has suspected orbital or CNS complications

Question 7

if sx are worsening or not getting better after 3 days of therapy what should you do?

Answer 7

change therapy or start therapy if it was only being monitored

Question 8

other than duration, CRS is defined by 2+ sx of

Answer 8

purulent rhinorrhea
nasal obstruction
facial pressure/pain
cough
endoscopic evidence of mucosal edema, purulent drainage or nasal polyps
&/or CT scan findings

Question 9

findings on CT scan suggestive of chronic rhinosinusitis (CRS)

Answer 9

osteomeatal complex or sinus edema

Question 10

bacteria responsible for CRS

Answer 10

1 s. aureus

anaerobes, H.influ, fungal

Question 11

possible etiologies of CRS (6)

Answer 11

adenoiditis
allergic rhinitis
cystic fibrosis
primary ciliary dyskinesia
asthma
GERD

Question 12

3 environmental things that can contribute to CRS

Answer 12

smoke exposure, industrial pollution & day care

Question 13

if there is fungal balls in 1 sinus, what is the likely pathogen and how is it tx?

Answer 13

aspergillus
tx: surgical debridement

Question 14

tx principle for CRS

Answer 14

address the obstruction to control the dz

Question 15

how to thin secretions with CRS

Answer 15

stop all antihistamines (unless allergic dz is documented)
hydration & humidity
saline nasal wash

Question 16

to solve mucociliary transport issue

Answer 16

not much to do but stop smoking & diminish irritants

Question 17

4 orbital complications of sinusitis

Answer 17

preseptal celluliits
cavernous sinus thrombosis
orbital cellulitis
subperiosteal abscess
orbital abscess

Question 18

3 intracranial complications of sinusitis

Answer 18

epidural or subdural or brain abscess
meningitis
potts puffy tumor

Question 19

what is the most common intracranial complication? what sinus infection poses highest risk for it

Answer 19

meningitis
sphenoid sinusitis

Question 20

subperiosteal abscess of frontal bone that may have intracranial extension

Answer 20

potts puffy tumor

Question 21

association between nasal polyps and other medical conditions

Answer 21

nasal polyps are more associated w/ chronic sinusitis
10% of kids w/ CF have obstructive nasal polyps