pediatric sinusitis Flashcards
which meatuses drains what sinus
superior– posterior ethmoid
middle– ant & middle ethmoid, maxillary, frontal
inferior– nasolacrimal duct
when does each sinus become detectable?
frontal @ 7 yo
ethmoid & maxillary @ birth
sphenoid @ 2 yo
the mass motion of mucous layer in paranasal sinus of mucous blanket
mucociliary flow
sx of sinusitis
nasal congestion
discharge
facial pain
post nasal drip
duration of acute vs chronic sinusitis
acute <1 mo
chronic >3 mo
when should you do imaging for acute sinusitis
if kid has suspected orbital or CNS complications
if sx are worsening or not getting better after 3 days of therapy what should you do?
change therapy or start therapy if it was only being monitored
other than duration, CRS is defined by 2+ sx of
purulent rhinorrhea
nasal obstruction
facial pressure/pain
cough
endoscopic evidence of mucosal edema, purulent drainage or nasal polyps
&/or CT scan findings
findings on CT scan suggestive of chronic rhinosinusitis (CRS)
osteomeatal complex or sinus edema
bacteria responsible for CRS
1 s. aureus
anaerobes, H.influ, fungal
possible etiologies of CRS (6)
adenoiditis
allergic rhinitis
cystic fibrosis
primary ciliary dyskinesia
asthma
GERD
3 environmental things that can contribute to CRS
smoke exposure, industrial pollution & day care
if there is fungal balls in 1 sinus, what is the likely pathogen and how is it tx?
aspergillus
tx: surgical debridement
tx principle for CRS
address the obstruction to control the dz
how to thin secretions with CRS
stop all antihistamines (unless allergic dz is documented)
hydration & humidity
saline nasal wash
to solve mucociliary transport issue
not much to do but stop smoking & diminish irritants
4 orbital complications of sinusitis
preseptal celluliits
cavernous sinus thrombosis
orbital cellulitis
subperiosteal abscess
orbital abscess
3 intracranial complications of sinusitis
epidural or subdural or brain abscess
meningitis
potts puffy tumor
what is the most common intracranial complication? what sinus infection poses highest risk for it
meningitis
sphenoid sinusitis
subperiosteal abscess of frontal bone that may have intracranial extension
potts puffy tumor
association between nasal polyps and other medical conditions
nasal polyps are more associated w/ chronic sinusitis
10% of kids w/ CF have obstructive nasal polyps
