Rhinosinusitis

Question 1

What is it?

Answer 1

Inflammation of the nasal cavities and paranasal sinuses
Acute
- resolves within 12 weeks
- normally triggered by URTI
- rarely followed by bacterial infection

Chronic
- symptoms >12 weeks
- inflammatory rather than infective

Question 2

What are the clinical features?

Answer 2

Most commonly follows a cold
Nasal congestion- or nasal drip/nasal speech
Frontal headache- worse on leaning forward
Anosmia
Nasal obstruction
Post nasal drip
- may lead to chronic cough

Bacterial infection
- purulent nasal discharge
- fever
- elevated CRP

Question 3

What is the management?

Answer 3

Symptoms <10 days
- Conservative management for most people usually resolves within 2-3 weeks

Symptoms >10 days without improvement
- consider a high dose nasal corticosteroid (mometasone)

Bacterial rhinosinusitis
- if suspected
- no life threatening features- PenV
- systemically very unwell or no improvement with PenV- co-amoxiclav

Chronic >12 weeks
- intranasal corticosteroids for up to 3 months (mometasone or fluticasone)