Rhinosinusitis Flashcards
Most likely infections in children
- Throat
- Ear
- UTIs - culture and sensitivity always, DMSA - contrast check for refluc, US
UTI antibiotic
Nitrofurantoin - 1st line
What causes a swollen face in rhinosinusitis?
Infection causes swelling which closes off sinuses -> swollen face
Treatment for rhinpsinusitis
Nasal steroids
Decongestants - short term
Antibiotics if acute
Surgery if severe or complicated - draingae/polyp excision
Complications of rhinosinusitis
Peri/orbital cellulitis
What is rhinosinisitis?
symptomatic inflammation of the paranasal sinuses.
How is acute vs chronic rhinosinusitis defined?
Acute - follows cold, increase in symptoms after 5 days or persistence beyond 10 dyas but Resolves in 12 weeks
can resolve in 4
Chronic is over 12 weeks
How many annual episodes recurrent acute rhinosinusitis
4+ without persistent symptoms in between
Cause of acute rhinosinusitis
Triggerd by vural URTI - rhinovirus, respiratory syncytial virus, parainfluenza, or influenza
Can be followefd by bacterial infection
Risk factors for acute sinusitis
Asthma
Allergic rhinitis
Smoking
Anatomical variation or mechanical obstruction - deviated spetum, polyps, trauma, foreign body
Seasonal variation
Impaired ciliary motility eg CF
Chronic sinusitis risk factors
Also: asthma, ciliary impairment, smoking
Atopy - allergic rhinitis
Aspirin sensitivity - polyps
Immunocompromise
Genetics
Iatrogenic- surgery
Complciations of rhinosinusitis
Orbital - cellulitis, abscess, cavernous sinus thrombosis
Intracranial - meningitis, encephalitis, abscess, venous throbosis
Bony - osteomyelitis
Progression to chronic
Chronic = sleep problems, fatigue
Symptoms of acute rhinosinusitis
Presence of nasal blockage or discharge
WITH facial pain/pressure
and/or reduction or loss of sense of smell
Altered speech -> obstruction
Tenderness, swelling, redness over cheekbone or periorbital areas
Cough
Symptoms of acute rhinosinusitis
Presence of nasal blockage or discharge
WITH facial pain/pressure
and/or reduction or loss of sense of smell
Altered speech -> obstruction
Tenderness, swelling, redness over cheekbone or periorbital areas
Cough
Examination for rhinosinusitis
INspect and palpate maxofacial area - swell/tender
Anterior rhinoscopy
When is bacteral cause of rhinosinusitis suspected?
Symptoms>10 days
Discoloured or ouruent nasal discharge
Severe local pain
Fever over 28
Marked deterioration after intially milder form
Elevated ESR/CRP
Management of acute rhinosinusitis
Paracetemol adn ibuprofen
Nasal decongestants
Salt watere solution
Seek medical advise if doesnt improve in 3 weeks
If symptoms of rhinosinusitis dont improve in 10 days what do
High dose nasal corticosteroid for 14 dyas for adults/12yrs + eg mometasone 200micrograms twice a day
back up antibiotic perscription
What tell people about antibiotics in rhinosinusitis
Evidence that antibiotics make little difference to how long symptoms last, or the proportion of people with improved symptoms.
Withholding antibiotics is unlikely to lead to complications.
Possible adverse effects, particularly diarrhoea and nausea.
Factors that might make a bacterial cause more likely.
First line antibiotic for rhinosinusitis
Phenoxymethylpenicillin 500mg 4 x a day for 5 days
Systemically unwell - co amoxiclaV (also second line if first anitbiotic doesnt work ater 2-3 days0
500/125mg 3 x a dya for 5 days
Allergic to penicillin - doxycycline or clarithromycin
Pregnant - erithromycin
hOW LONG CAN YOU GIVE INTRANASAL corticosteroids for in chronic rhinosinusitis?
3 months
