Rhinosinusitis

Question 1

Definition of rhinosinusitis

Answer 1

inflammation nose and paranasal sinuses w/ >2 symptoms one of which = nasal congestion and nasal discharge
Other symptoms – facial pain/heaviness and reduced olfaction

Question 2

Is it common? When and who is it most common in?

Answer 2

Very common, usually self-limiting
Winter>summer
Children>adolescents>adults>elderly

Considered chronic if last 12+ weeks – affects 1/10 people
Predisposed to chronic rhinosinusitis:
Atopy – hayfever, asthma
Nasal obstruction – septal deviation/polyps
Recent local infection – rhinitis or dental extraction
Swimming/diving
Smoking

Question 3

Causative organisms

Answer 3

Primarily viral – 2% develop bacterial infection
Bacterial more likely if >7 days or worsening, facial pain, purulent secretions

Viral – rhinoviruses&raquo_space; respiratory syncytial virus (RSV), coronaviruses, enteroviruses, adenoviruses etc.
Bacterial – S. pneumoniae, H. influenzae, M. catarrhalis

Question 4

Features

Answer 4

Facial pain – frontal pressure which is worse on bending forward
Nasal discharge – clear usually, if thick/purulent suggests secondary infection
Nasal obstruction
Post-nasal drip

Question 5

Complications

Answer 5

Persistent infection
Orbital cellulitis
Intracranial involvement – meningitis and encephalitis
Mucoceles
Osteomyelitis
Potts puffy tumour (subperiosteal abscess) - osteomyelitis of the frontal bone with associated subperiosteal abscess causing swelling and oedema over the forehead and scalp
Associated symptoms include fever, headache, tender on palpation, swelling

Question 6

Red flag symptoms:

Answer 6

Unilateral symptoms (may suggest anatomical cause e.g. malignancy)
Persistent symptoms despite compliance with 3 months treatment
Epistaxis (bleeding from nose)

Question 7

Management

Answer 7

Conservative management – avoid allergen, nasal irrigation with saline
Symptomatic relief – paracetamol for pain/fever; decongestants can be used but tachyphylaxis develops
Consider immunological and structural factors if persistent/recurrent
PO amoxicillin 500mg TDS OR PO clarithromycin 500mg BD 5-7d can be used
Symptoms >10 days – consider high dose nasal corticosteroid 14 days