Rhinosinusitis Flashcards
the 4 sinuses and function
Maxillary
Ethmoid
Frontal
sphenoid
Lighten skulls
Resonate voice
layers of sinus
- Lines by ciliated stratified or pseudostratified columnar epithelium
- Mucous layer trapping particles
- Mucous layer is wafted into nose
rhino sinusitis definition, symptoms & signs
Inflammation of the nose and paranasal sinuses.
It is characterised by two or more symptoms, one of which should be
- nasal blockage/obstruction/congestion
or
- nasal discharge (anterior/posterior nasal drip)
+- facial pain/pressure (Rhinorrhoea)
+- reduction or loss of smell
and either endoscopic signs of:
- nasal polyps and/or
- mucopurulent discharge primarily from middle meatus and/or
- oedema/mucosal obstruction primarily in middle meatus
and/or CT changes:
- mucosal changes within the ostiomeatal complex and/or sinuses
RED FLAG - unilateral obstruction and bleeding
classification of rhino sinusitis: acute, chronic, recurrent acute
Acute:
- <12 weeks
- Complete resolution of Sx
- Increase in Sx after 5 days or persistent sx after 10 days with <12 weeks duration
Chronic:
- > 12 weeks
- Without complete - resolution of Sx
- May also be subject to exacerbations
Recurrent acute:
- >4 or more episodes ARS/year with interim symptom resolution
Acute Rhinosinusitis (ARS): aetiology
Commonest causes are nasal
Any condition that blocks the natural drainage of the sinuses may lead to secretion retention and poor ventilation
Usually viral URTI secondary bacterial infection
Viral: rhinovirus, influenza, RSV
Bacterial: pneumococcus, streptococcus,
H Influenza
Acute Rhinosinusitis (ARS): clinical diagnosis, examination, imaging
Clinical diagnosis – sx based, no need for imaging (plain x-ray not recommended)
Examination:
Anterior rhinoscopy: swelling, redness, pus
Imaging: CT-scan in very severe disease, immunocompromised patients & signs of complications
examples of nasal decongestants
pseudoephedrine, otrivine
examples of topical steroids
mometasone furoate, fluticasone
acute complications of ARS
Sepsis (toxic shock) Orbital - Orbital Cellulitis - Orbital Abscess - Vision loss (colour blindness=loss of vision)
Intracranial
- Meningitis
- Extradural abscess
- Subdural abscess
- Cavernous sinus thrombosis
chronic rhinosinusitis + aetiology
> 12 weeks
Often preceded by acute episode
Causes:
- Chronic infection: Streptococcus
- Allergic = sneezing, better in warm climate
- Non-Allergic
CRS – Clinically + examination
Similar to ARS Nasal obstruction/congestion Rhinorrhoea Post nasal drip hyposmia/anosmia ?facial discomfort
Examination: inflamed nasal mucosa, oedematous middle turbinate, pus, nasal polyps
CRS - Investigations
Nasoendoscopy
Allergy screen (skin prick/RAST blood test)
X rays of sinuses are USELESS.
CT Scanning excellent but do not help you make a diagnosis. Used to plan surgery.
CRS - Management
Management should be stepwise depending on how blocked the nose is:
- topical steroid spray
- topical steroid drops
- +oral steroids
- Surgery (FESS/Polypectomy)
- Some benefit for sinusitis without polyps
- Evidence of improvement in disease with polyps – improvement in symptoms and polyp size
- Drops more effective than sprays
- Minimal systemic effects due to small dose delivery
NB antihistamines & antibiotics
- low dose macrocodes to be used if topical steroids fail
anti-leukotrienes
aspirin desensitisation
- If associated with nasal polyps and aspirin intolerance showed benefit
chronic rhonosinusitis complication
Mucocoele/pyocoele
Intracranial Complications
Usually from frontal/ethmoid/sphenoid
- Meningitis
- Extradural abscess
- Subdural abscess
- Cavernous sinus thrombosis
