Rhinosinusities Flashcards
What is rhino sinusitis
Inflammation of the mucous membrane of the paranasal sinus
What is a sinus
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
What are the four paranasal sinus and location
Maxullary -below the eye
Frontal sinus -above the eye
Ethmoid -between the nose and eye
Sphenoid -within the body of the sphenoid bone
What’s lines the paranasal sinus
Lined by goblet cells that produce mucous (salty , sticky and contains lysozymes )
Briefly describe the drainage of the paranasal sinus
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
Functions of the paranasal sinuses
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
Pathophysiology
Obstruction to sinus drainage -congestion -inflammation -pain all over affected area
Types of RS
ARS
SARS
CRS
Causes of ARS
Viral -commonest eg rhinovirus and parainfluenza virus eg adenovirus
Bacterial -moraxella catarrhalis ,h influenza and strep pneumonia
Causes of CRS and SARs
Infections , allergens and fungi eg aspergillus in some immune compromised people
Classification and duration
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
Main Symptoms of ARS
Purulent nasal discharge and congestion
Facial pain and pressure
Symptoms of ABRS
thick nasal mucus
-plugged nose or nasal congestions(with or without purulent discharge)
-facial pain/headache
-fever
-hyposmia
-cough from postnasal discharge
How do you distinguish ABRS and ARS
ABRS is diagnosed When the symptoms of ARS persist without improvement for at least 10 days or worsen within 10 days after initial improvement
Gold standard for diagnosing ARS ,ARBS and CRS
Ars-clinical evaluation
ARBS-culture and sensitivity test
Chronic -CT scan because it’s provides an anatomical road map when surgery is needed
Is radiographing imaging done in ARS and why
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
treatment of ARS
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
Treatment of CRS
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
Types of fungal sinusitis
Invasive and non invasive
Types of non invasive
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
Types of invasive
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.
Treatment
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
