Rhinosinusitis Flashcards
What is rhinosinusitis?
Sinusitis (also known as rhinosinusitis) is a symptomatic inflammation of the mucosal lining of the paranasal sinuses and nasal cavity.
Inflammation of the nose and paranasal sinuses with greater than 2 symptoms; one of which must be nasal congestion and nasal discharge. Other symptoms can be facial pain or heaviness and reduction of olfaction. Can be acute of chronic (>12 weeks)
what are the four types of rhinosinusitis?
- Acute rhinosinusitis
- Subacute rhinosinusitis
- Chronic rhinosinusitis
- Recurrent rhinosinusitis
What is defined as acute rhinosinusitis?
Symptoms last less than 4 weeks
What is defined as subacute rhinosinusitis?
Symptoms that last from 4 - 12 weeks
What is chronic rhinosinusitis defined as?
Symptoms that last longer than 12 weeks
What is recurrent rhinosinusitis defined as?
Four or more episodes per year.
What are the common symptoms of rhinosinusitis?
Runny nose
Postnasal drip
Nasal congestion
Sinus pain or pressure
Headache
Toothache
Loss of smell
Halitosis (bad breath)
Unlike adults, what will children typically have alongside rhinosinusitis?
A cough
If untreated, what can chronic rhinosinusitis lead to?
- Sleep apnea
- nasal polyps
What is the most common organism causing rhinosinusitis?
Streptococcus pneumonia (most common)
Haemophilus influenzae
What does rhinosinusitis typically follow?
Typically follows common cold.
Symptoms of rhinosinusitis?
Pain
Nasa congestion/obstruction
Nasal discharge
What should you always check in a patient presenting with rhinosinusitis?
The eyes!
Ophthalmologic complications of rhinosinusitis?
Preseptal cellulitis
Orbital cellulitis
Subperiosteal abscess (Pott’s puffy tumour)
Orbital abscess
Cavernous sinus thrombosis
What are the most common viral causes of rhinosinusitis?
Rhinovirus
Influenza virus
Parainfluenza virus
What is the most common cause of bacterial acute rhinosinusitis?
most commonly occurs as a secondary infection of inflamed paranasal sinuses, either following a viral illness or another method which impairs the physiological clearance mechanisms and promotes bacterial stasis.
Which bacterial pathogens most commonly cause ABRS?
Streptococcus pneumoniae
Haemophilus influenza
Staphylococcus aureus
Moraxella catarrhalis
what factors may impair the physiological clearance mechanism?
Physical obstruction
Individual anatomy
Immunodeficiency
Illness which impair ciliary clearance (cystic fibrosis, Kartagener syndrome),
allergic/ non-allergic rhinitis
What are the three main cardinal symptoms of ARS?
- Purulent nasal discharge
- Facial pressure
- Nasal obstruction
What are 4 other symptoms that are common in ARS?
Fever
Fatigue
Headache
Ear pressure
Does viral or bacterial ARS have a shorter and milder course?
viral typically has a shorter and milder course, with symptoms lasting between 7 and 10 days
ABRS is more likely to last beyond 10 days.
Does bacterial or viral ARS often present with a ‘biphasic’ pattern?
Bacterial - This pattern is characterised by a period of recovery, followed by a worsening of symptoms.
What is more essential when diagnosing rhinosinusitis: History or examination?
History
What are 4 main clinical presentations of Acute rhinosinusitis?
- Purulent discharge
- Facial swelling
- Palpable cheek tenderness
- Facial redness
What are some differential diagnoses?
- Common cold
- Allergic and non-allergic rhinitis
However, facial pain and purulent nasal discharge are unlikely to present in any of these illnesses
Aside from these differentials, another cause of facial pain that may mimic ARS is cluster headache or migraine. Although neither of these typically present with facial pain, the retro-orbital pain of a cluster headache may be confused
What are some laboratory investigations for ARS?
For cases of complicated ABRS unresponsive to initial antibiotic therapy, nasal cultures can help to identify the causative agent
Is imaging required for a diagnosis?
It is generally not recommended to request imaging in cases of suspected ARS unless the clinician suspects either a complicated infection or an alternate diagnosis.
In these cases, a CT scan with contrast can help to reveal intracranial or orbital involvement.
What is the main line of management?
Since the majority of cases of ARS are viral in origin and will improve within 10 days, symptomatic relief is the mainstay of treatment
What type of symptomatic relief can be provided?
- Oral analgesics
- Saline nasal irrigation
- intranasal corticosteroids
If patients do not feel any improvement after 10 days or feel worsening of symptoms at any time, treat them as a presumed case of ABRS.
In immunocompetent patients with ARBS what is the best line of treatment?
- Watchful waiting for 7 days may be more prudent than early antibiotic use.
- However, if these patients do not improve within 7 days or experience worsening of symptoms at any time, prescribe appropriate antibiotics.
What is the first-line treatment for ABRS?
amoxicillin
What are some complications of ABRS?
Severe headache
Visual changes
Periorbital oedema
Altered mental status
Persistent infection
Intracranial involvement: meningitis and encephalitis
Mucoceles
Osteomyelitis
Pharmacological management of rhinosinusitis?
Nasal corticosteroids
Saline nasal irrigation
What is the main treatment option for chronic rhinosinusitis?
Nasal irrigation with saline solution is a treatment option for chronic rhinosinusitis
