Rhinosinusitis Flashcards
What is rhinosinusitis?
Inflammation of the nasal cavity and paranasal sinuses, often due to viral or bacterial infection.
What is the most common cause of acute rhinosinusitis?
Viral upper respiratory infection (common cold).
What are the most common bacterial pathogens in acute bacterial rhinosinusitis?
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
What are common risk factors for bacterial rhinosinusitis?
Viral upper respiratory infections, allergic rhinitis, nasal polyps, deviated septum, foreign body, and immunosuppression.
What are the general symptoms of rhinosinusitis?
Facial pain/pressure, nasal congestion, purulent nasal discharge, maxillary tooth discomfort, fever, headache, ear pain/pressure.
What are the distinguishing features of bacterial rhinosinusitis?
Symptoms persisting >10 days without improvement, ‘double worsening’ (initial improvement followed by worsening), or severe symptoms (fever >102°F, purulent discharge >3 days).
What is the key symptom that differentiates chronic rhinosinusitis?
Symptoms lasting ≥12 weeks, often with decreased olfaction.
How is acute rhinosinusitis diagnosed?
Clinically based on symptom duration and severity; imaging is not routinely needed.
When is imaging indicated for rhinosinusitis?
If complications are suspected (e.g., orbital cellulitis, abscess, or CNS involvement).
What is the imaging modality of choice for complicated or chronic rhinosinusitis?
Head CT without contrast.
How is viral rhinosinusitis managed?
Supportive care including analgesia, saline irrigation, and intranasal steroids.
What are the first-line antibiotics for acute bacterial rhinosinusitis?
Amoxicillin-clavulanate (Augmentin); alternative is doxycycline.
When should antibiotics be given for rhinosinusitis?
- Symptoms that persist >10 days without improvement
- Double worsening occurs
- Severe symptoms (fever >102°F, purulent discharge >3 days) are present
How is chronic rhinosinusitis managed?
- Prolonged antibiotic therapy (Augmentin)
- Intranasal glucocorticoids, possible oral steroids
- Nasal cultures if refractory
When is surgical intervention considered for rhinosinusitis?
For refractory cases or complications like abscess formation.
What are potential complications of rhinosinusitis?
Orbital cellulitis, periorbital cellulitis, CNS abscess, meningitis, and cavernous sinus thrombosis.
Which complication of rhinosinusitis can lead to life-threatening intracranial infection?
Cavernous sinus thrombosis.
What is the most common bacterial pathogen causing secondary bacterial pneumonia after influenza?
Staphylococcus aureus.
What is the primary indication for imaging in rhinosinusitis?
Concern for complications such as orbital cellulitis or intracranial spread.
Why is intranasal glucocorticoid therapy useful in chronic rhinosinusitis?
Reduces mucosal inflammation and nasal polyps, improving symptoms.
What type of imaging is preferred to evaluate for chronic rhinosinusitis?
CT scan of the sinuses to assess for mucosal thickening and obstruction.
What is the role of oral steroids in chronic rhinosinusitis?
Used in refractory cases to reduce inflammation, especially if nasal polyps are present.
Why are fluoroquinolones not first-line therapy for bacterial rhinosinusitis?
High resistance rates and risk of tendon rupture.
