Rhinonusitis Flashcards
What’s the most prevalent chronic disease in the US?
Chronic rhinosinusits.
Where to the frontal, maxillary, and anterior ethmoid sinuses drain?
The middle meatus.
Where do the sphenoid and posterior ethmoid sinuses drain?
The sphenoethmoidal recess.
How is acute vs. subacute vs. chronic sinusitis classified?
Duration -
Acute: < 4wks.
Subacute: 4-12 wks.
Chronic: > 12 wks
2 major components of sinusitis physiology?
Obstruction and infection.
What can cause inflammation of the sinuses?
Lots of things:
URI, allergy, irritants (smoking!), barotrauma, dental infections.
Anatomic causes of sinus obstruction? (3 things)
Septal deviation.
Pneumatized middle turbinate (concha bullosa.)
Nasal tubes.
3 causes functional sinus obstruction?
Ciliary dysfunction (PCD).
Thick mucus - CF, dehydration.
Excessive mucus - infection, irritants.
2 main things that could be confused with sinusitis?
Viral URI.
Allergic rhinitis.
Important, more specific symptoms in sinusitis?
Headache and/or facial pressure/pain.
Facial sweeling.
Hyposmia/anosmia.
How do you distinguish viral vs. bacterial sinusitis?
I.e., when do you give ABx?
When greater than 7 days, more likely to be bacteria.
Common, less specific, symptoms of acute sinusitis?
"Congestion." Thick, colored secretions. Sore throat from post-nasal drip. Cough. Fever. etc. etc.
3 most common bugs in acute sinusitis?
Gram positives:
S. pneumo.
S. aureus.
H. flu.
Is radiology useful in acute sinusitis?
No. It’s probably going to look really ugly, but that’s okay.
Treatment for acute sinusitis?
ABx if bacterial.
Oral decongestants
Topical nasal decongestants.
Mucolytics.
Nasal irrigation / steam.
(the last 4 don’t shorten course, but relieve symptoms)
(Antihistamines should not be used unless allergy is underlying factor.)
Chronic rhinosinusitis (CRS) is more about the inflammation than the infection per se. What pathogens are more common in rhinosinusitis?
S. aureus.
Pseudomonas.
Fungus.
Cycle of the pathophysiology of chronic sinusitis (CRS)? (4 things)
Obstruction -> hypoxia/mucociliary dyfunction/stasis of scretion -> bacterial proliferation -> inflammation -> mucosal edema -> (more obstruction)
What’s the goal of treatment of CRS?
Increase mucociliary clearance
What are nasal polyps from?
The result of lots of inflammation in CRS.
First thing to do for chronic rhinosinusitis?
Manage medically, allieviate predisposing factors:
Smoking cessation.
ABx (data unclear on for how long, maybe 2-3 weeks)
Steroids
Irrigation +/- ABx
Decongestants
When is surgery for CRS done?
Refractory cases, anatomic obstructions, complications
Goals of CRS surgery?
Restore mucocilliary clearance.
Open sinuses for application of topical therapies, esp. anti-inflammatories.
What complications do you worry about in ethmoid sinusitis?
Cellulitis.
Abscesses.
Cavernous sinus thrombosis - quite bad (recall from anatomy that CN VI can easily be affected here).
Complications of frontal sinusitis?
Cranial extensions - abscesses above/under dura, meningitis.
Orbital infections.
What’s Pott’s Puffy Tumor?
Infection spreads from frontal sinus via diploic vein -> pus in subgaleal space…
Circumscribed bump on forehead.
Why is the sphenoid sinus most concerning for complicastions?
Connections to the cavernous sinus can lead to cranial spread, vision loss, cranial neuropathies.
Most common finding in Invasive Fungal Sinusitis?
Pain.
