Rhinosinusities

Question 1

What is rhino sinusitis

Answer 1

Inflammation of the mucous membrane of the paranasal sinus

Question 2

What is a sinus

Answer 2

Sinus is a air filled hollow cavity in a bone or tissue -para nasal sinuses
Dilation of a blood vessel -eg dural venous sinuses
A fistula or a tract that that transforms into cavity

Question 3

What are the four paranasal sinus and location

Answer 3

Maxullary -below the eye
Frontal sinus -above the eye
Ethmoid -between the nose and eye
Sphenoid -within the body of the sphenoid bone

Question 4

What’s lines the paranasal sinus

Answer 4

Lined by goblet cells that produce mucous (salty , sticky and contains lysozymes )

Question 5

Briefly describe the drainage of the paranasal sinus

Answer 5

They produce mucous which drains to the nasal cavity through distinct passages of lateral nasal cavity (nasal meatus)
The meatus is divided into 3
Superior - spenoidal sinus drains speno-ethmoidal recess and posterior ethmoid sinus drains here
Middle -middle and anterior ethmoid
Inferior-maxillary and frontal sinus

Question 6

Functions of the paranasal sinuses

Answer 6

1.serves as an echo chamber for resonance
decreases the relative weight of the skull
Humidifies inhaled air
Protect (insulate ) sensitive structures from rapid temperature fluctuations in the nose
Provides buffer against facial trauma

Question 7

Pathophysiology

Answer 7

Obstruction to sinus drainage -congestion -inflammation -pain all over affected area

Question 8

Types of RS

Answer 8

ARS
SARS
CRS

Question 9

Causes of ARS

Answer 9

Viral -commonest eg rhinovirus and parainfluenza virus eg adenovirus
Bacterial -moraxella catarrhalis ,h influenza and strep pneumonia

Question 10

Causes of CRS and SARs

Answer 10

Infections , allergens and fungi eg aspergillus in some immune compromised people

Question 11

Classification and duration

Answer 11

Acute -lesss than for weeks
Class-acute bacterial
Acute viral
Recurrent (more than 3 episodes in a year for at least 7-10 days with asymptoma periods in between
Subacute (1-3 months )
Chronic (more than 3 months )
Chronic sinusitis with nasal polyp (they’re chronic hyperplasia of the the tissue )
CRS WITHOUT nasal polyp
Allergic sinusitis
Fungi sinusitis

Question 12

Main Symptoms of ARS

Answer 12

Purulent nasal discharge and congestion
Facial pain and pressure

Question 13

Symptoms of ABRS

Answer 13

thick nasal mucus
-plugged nose or nasal congestions(with or without purulent discharge)
-facial pain/headache
-fever
-hyposmia
-cough from postnasal discharge

Question 14

How do you distinguish ABRS and ARS

Answer 14

ABRS is diagnosed When the symptoms of ARS persist without improvement for at least 10 days or worsen within 10 days after initial improvement

Question 15

Gold standard for diagnosing ARS ,ARBS and CRS

Answer 15

Ars-clinical evaluation
ARBS-culture and sensitivity test
Chronic -CT scan because it’s provides an anatomical road map when surgery is needed

Question 16

Is radiographing imaging done in ARS and why

Answer 16

No

Clinical diagnosis is often sufficient: In most cases of uncomplicated ARS, a thorough clinical assessment, including a detailed medical history, physical examination, and evaluation of symptoms, is sufficient to make an accurate diagnosis. Radiographic imaging is not necessary for the initial diagnosis of uncomplicated ARS

Question 17

treatment of ARS

Answer 17

First line for infection
Amoxicillin -500 mg 3x daily
6-12 years -250 mg ….
1-5. Years -125mg
Less than 1 year -62.5
Resistance to amoxicillin
Amoxickav
1g 12 hourly 7 days
Greater 12….500/125 12 hrky
6-12 …….5ml of 400/57 12 hrly 10 days
1-5…….5ml of 200/28.5
1month -1year -2.5 ml …..
2weeks to 1months - 1.25 ml of
2nd line
Cefuroxume
500 mg 12 hourly 5-7 days
Penicillin allergy
Azithromycin
500mg daily for 5 days
Erythromycin 500 6 hourly for 10 days

Pain relieve -paracetamol
Nasal decongestant
Ephedrine adult 1% 1-2 drops in each ear
Children 0.5% -same dose
Or
neomycin hydrocortisone
Adult - 2drops 12 hourly
Children -1 drops 12 hourly

and nasal steroid

Question 18

Treatment of CRS

Answer 18

Same as ARS but treatment is extended to 6 weeks
CRS with polyp -prednisone 20-40mg daily tapered over 10 days plus internal steroid

Short term treatment with oral steroid help reduce poly size
Omalizumab(antie) -severe CR with polyp

Question 19

Types of fungal sinusitis

Answer 19

Invasive and non invasive

Question 20

Types of non invasive

Answer 20

Saprophytic - type of infection does not affect the nose tissue .its the growth of fungi on crusts of mucus
Allergic -this infection causes and allergic reaction
Fungal ball -Fungi build up in the sinuses and form a clump or ball

Question 21

Types of invasive

Answer 21

Acute fulminant invasive rhinosinusitis-Fungi destroy blood vessels inside the nose. Without a blood supply, the tissue begins to die. The infection can quickly spread to the eyes and brain, leading to blindness and deat

Chronic invasive rhinosinusitis: People with diabetes are more likely to have this type of sinusitis. It’s similar to acute fulminant invasive rhinosinusitis, but it doesn’t spread as quickly.

Granulomatous invasive fungal sinusitis (GIFS): This rare type of fungal sinusitis happens when the body launches an immune response to fungi. The person’s immune system attacks the lining of the nose and destroys the nasal tissue.

Question 22

Treatment

Answer 22

Surgery for fungal balls and saprophytic sinusitis often involves a procedure called functional endoscopic sinus surgery (FESS)
Nasal wash after like normal saline
Steroid and antifungal medication
Antihistamine -allergy
Antiffungal drugs (topical)

Aggressive debridement and systemic antifungal therapy is warranted for Fulminant invasive fungal RS
This often involves removing necrotic or damaged tissue to control the spread of the infection

Systemic antifungals like lipid formulation of intravenous (IV) amphotericin B or, if mucormycosis is ruled out by histopathology showing septate hyphae, voriconazole or Isavuconazole