Rhinosinusitis

Question 1

What is rhinosinusitis?

Answer 1

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)

Question 2

what are the four types of rhinosinusitis?

Answer 2

1. Acute rhinosinusitis
2. Subacute rhinosinusitis
3. Chronic rhinosinusitis
4. Recurrent rhinosinusitis

Question 3

What is defined as acute rhinosinusitis?

Answer 3

Symptoms last less than 4 weeks

Question 4

What is defined as subacute rhinosinusitis?

Answer 4

Symptoms that last from 4 - 12 weeks

Question 5

What is chronic rhinosinusitis defined as?

Answer 5

Symptoms that last longer than 12 weeks

Question 6

What is recurrent rhinosinusitis defined as?

Answer 6

Four or more episodes per year.

Question 7

What are the common symptoms of rhinosinusitis?

Answer 7

Runny nose
Postnasal drip
Nasal congestion
Sinus pain or pressure
Headache
Toothache
Loss of smell
Halitosis (bad breath)

Question 8

Unlike adults, what will children typically have alongside rhinosinusitis?

Answer 8

A cough

Question 9

If untreated, what can chronic rhinosinusitis lead to?

Answer 9

1. Sleep apnea
2. nasal polyps

Question 10

What is the most common organism causing rhinosinusitis?

Answer 10

Streptococcus pneumonia (most common)

Haemophilus influenzae

Question 11

What does rhinosinusitis typically follow?

Answer 11

Typically follows common cold.

Question 12

Symptoms of rhinosinusitis?

Answer 12

Pain

Nasa congestion/obstruction

Nasal discharge

Question 13

What should you always check in a patient presenting with rhinosinusitis?

Answer 13

The eyes!

Question 14

Ophthalmologic complications of rhinosinusitis?

Answer 14

Preseptal cellulitis
Orbital cellulitis
Subperiosteal abscess (Pott’s puffy tumour)
Orbital abscess
Cavernous sinus thrombosis

Question 15

What are the most common viral causes of rhinosinusitis?

Answer 15

Rhinovirus
Influenza virus
Parainfluenza virus

Question 16

What is the most common cause of bacterial acute rhinosinusitis?

Answer 16

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.

Question 17

Which bacterial pathogens most commonly cause ABRS?

Answer 17

Streptococcus pneumoniae
Haemophilus influenza
Staphylococcus aureus
Moraxella catarrhalis

Question 18

what factors may impair the physiological clearance mechanism?

Answer 18

Physical obstruction
Individual anatomy
Immunodeficiency
Illness which impair ciliary clearance (cystic fibrosis, Kartagener syndrome),
allergic/ non-allergic rhinitis

Question 19

What are the three main cardinal symptoms of ARS?

Answer 19

1. Purulent nasal discharge
2. Facial pressure
3. Nasal obstruction

Question 20

What are 4 other symptoms that are common in ARS?

Answer 20

Fever
Fatigue
Headache
Ear pressure

Question 21

Does viral or bacterial ARS have a shorter and milder course?

Answer 21

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.

Question 22

Does bacterial or viral ARS often present with a ‘biphasic’ pattern?

Answer 22

Bacterial - This pattern is characterised by a period of recovery, followed by a worsening of symptoms.

Question 23

What is more essential when diagnosing rhinosinusitis: History or examination?

Answer 23

History

Question 24

What are 4 main clinical presentations of Acute rhinosinusitis?

Answer 24

1. Purulent discharge
2. Facial swelling
3. Palpable cheek tenderness
4. Facial redness

Question 25

What are some differential diagnoses?

Answer 25

1. Common cold 2. 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

Question 26

What are some laboratory investigations for ARS?

Answer 26

For cases of complicated ABRS unresponsive to initial antibiotic therapy, nasal cultures can help to identify the causative agent

Question 27

Is imaging required for a diagnosis?

Answer 27

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.

Question 28

What is the main line of management?

Answer 28

Since the majority of cases of ARS are viral in origin and will improve within 10 days, symptomatic relief is the mainstay of treatment

Question 29

What type of symptomatic relief can be provided?

Answer 29

1. Oral analgesics 2. Saline nasal irrigation 3. 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.

Question 30

In immunocompetent patients with ARBS what is the best line of treatment?

Answer 30

1. Watchful waiting for 7 days may be more prudent than early antibiotic use. 2. However, if these patients do not improve within 7 days or experience worsening of symptoms at any time, prescribe appropriate antibiotics.

Question 31

What is the first-line treatment for ABRS?

Answer 31

amoxicillin

Question 32

What are some complications of ABRS?

Answer 32

Severe headache Visual changes Periorbital oedema Altered mental status Persistent infection Intracranial involvement: meningitis and encephalitis Mucoceles Osteomyelitis

Question 33

Pharmacological management of rhinosinusitis?

Answer 33

Nasal corticosteroids Saline nasal irrigation

Question 34

What is the main treatment option for chronic rhinosinusitis?

Answer 34

Nasal irrigation with saline solution is a treatment option for chronic rhinosinusitis