Rhinosinuisitis/Allergy Flashcards
1
Q
ESSENCE
A
Sinusitis refers to inflammation of paranasal sinuses in face, this is usually accompanied by inflammation of the nasal cavity and refered to as rhinosinusitis
2
Q
CLASSIFICATION
A
- Acute
- <12 weeks
- Chronic
- >12 weeks
3
Q
PATHOPHYSIOLOGY
A
Blockage of the ostia (which drains the sinuses) results in sinusitis
4
Q
ANATOMY
4 sets of paranasal sinuses
A
- Frontal
- Maxillary
- Ethmoid
- Sphenonid
5
Q
AETIOLOGY
A
- Infection - particularly viral URTI
- Allergies - such as hayfever
- Obstruction of drainage - foreign body or polyps
- Smoking
6
Q
CLINICAL FEATURES
Presentation
A
- Someone with recent upper resp tract infection with
- Nasal congestion
- Nasal discharge
- Facial pain or headache
- Facial pressure
- Facial swelling over affected areas
- Loss of smell
7
Q
CLINICAL FEATURES
Signs
A
- Tenderness to palpation
- Inflammation and oedema of nasal mucosa
- Discharge
- Fever
- Other signs of systemic infection such as tachycardia
8
Q
What is chronic case usually associated with
A
Nasal polyps
9
Q
INVESTIGATIONS
A
- Not usually done
- In patients with persistent symptoms
- Nasal endoscopy
- CT scan
10
Q
MANAGEMENT
General
A
- Hospital admission if systemic infection or sepsis
- No antibiotics until symptoms for 10 days - most cases viral
- If does not resolve after 10 days
- High dose nasal steroids for 14 days (mometasone)
- Delayed antibiotic prescription used if worsening or not improving within 7 days (phenoxymethylpenicillin first line)
11
Q
MANAGEMENT
First line antibiotic when used
A
Phenoxymethylpenicillin
12
Q
MANAGEMENT
First line if immunocompromised or severe infection
A
Amoxicillin/clavulanate
13
Q
MANAGEMENT
Chronic management
A
- Refer to ENT specialist
- Saline nasal irrigation
- Steroid nasal sprays or drops
- Functional endoscopic sinus surgery (FESS)
14
Q
COMPLICATIONS
A
- Risk of complications is low
- Chronic sinusitis
- Bacterial meningitis
- Subdural abscess
- Peri-orbital or orbital cellulitis
