Rhinosinusitis

Question 1

Most likely infections in children

Answer 1

• Throat
• Ear
• UTIs - culture and sensitivity always, DMSA - contrast check for refluc, US

Question 2

UTI antibiotic

Answer 2

Nitrofurantoin - 1st line

Question 3

What causes a swollen face in rhinosinusitis?

Answer 3

Infection causes swelling which closes off sinuses -> swollen face

Question 4

Treatment for rhinpsinusitis

Answer 4

Nasal steroids
Decongestants - short term
Antibiotics if acute
Surgery if severe or complicated - draingae/polyp excision

Question 5

Complications of rhinosinusitis

Answer 5

Peri/orbital cellulitis

Question 6

What is rhinosinisitis?

Answer 6

symptomatic inflammation of the paranasal sinuses.

Question 7

How is acute vs chronic rhinosinusitis defined?

Answer 7

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

Question 8

How many annual episodes recurrent acute rhinosinusitis

Answer 8

4+ without persistent symptoms in between

Question 9

Cause of acute rhinosinusitis

Answer 9

Triggerd by vural URTI - rhinovirus, respiratory syncytial virus, parainfluenza, or influenza
Can be followefd by bacterial infection

Question 10

Risk factors for acute sinusitis

Answer 10

Asthma
Allergic rhinitis
Smoking
Anatomical variation or mechanical obstruction - deviated spetum, polyps, trauma, foreign body
Seasonal variation
Impaired ciliary motility eg CF

Question 11

Chronic sinusitis risk factors

Answer 11

Also: asthma, ciliary impairment, smoking
Atopy - allergic rhinitis
Aspirin sensitivity - polyps
Immunocompromise
Genetics
Iatrogenic- surgery

Question 12

Complciations of rhinosinusitis

Answer 12

Orbital - cellulitis, abscess, cavernous sinus thrombosis
Intracranial - meningitis, encephalitis, abscess, venous throbosis
Bony - osteomyelitis
Progression to chronic
Chronic = sleep problems, fatigue

Question 13

Symptoms of acute rhinosinusitis

Answer 13

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

Question 13

Symptoms of acute rhinosinusitis

Answer 13

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

Question 14

Examination for rhinosinusitis

Answer 14

INspect and palpate maxofacial area - swell/tender
Anterior rhinoscopy

Question 15

When is bacteral cause of rhinosinusitis suspected?

Answer 15

Symptoms>10 days
Discoloured or ouruent nasal discharge
Severe local pain
Fever over 28
Marked deterioration after intially milder form
Elevated ESR/CRP

Question 16

Management of acute rhinosinusitis

Answer 16

Paracetemol adn ibuprofen
Nasal decongestants
Salt watere solution
Seek medical advise if doesnt improve in 3 weeks

Question 17

If symptoms of rhinosinusitis dont improve in 10 days what do

Answer 17

High dose nasal corticosteroid for 14 dyas for adults/12yrs + eg mometasone 200micrograms twice a day
back up antibiotic perscription

Question 18

What tell people about antibiotics in rhinosinusitis

Answer 18

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.

Question 19

First line antibiotic for rhinosinusitis

Answer 19

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

Question 20

hOW LONG CAN YOU GIVE INTRANASAL corticosteroids for in chronic rhinosinusitis?

Answer 20

3 months