Rhinosinusitis Flashcards
What is rhinosinusitis?
Inflammation in the nose and paranasal sinuses with 2+ symptoms, one of which must be nasal blockage, obstruction, congestion or nasal discharge
± facial pain or pressure, reduction or loss of smell and either endoscopic or CT signs
Describe acute rhinosinusitis
common cold
Many episodes are self limiting
If symptoms persist > 5 days, consider non-systemically bioavailable intransala corticosteroids (fluticasone)
What is acute post-viral sinusitis?
Increase in symptoms after 5 days or persistent symptoms > 10 days
What is chronic rhinosinusitis with nasal polyps?
Simple nasal polyps are swellings of the nasal or sinus mucosa prolapsing into the nasal cavity
More common in men
Where do nasal polys usually occur?
Usually bilateral
Middle meatus
Single, benign maxillary polyps may arise int the maxillary antrum and prolapse to fill the nasopharynx
What are symptoms of nasal polyps?
Watery anterior rhinorrhoea Sneezing Postnasal drip purulent Nasal obstruction Sinusitis Mouth-breathing Snoring Headaches
What investigations are done in nasal polyps?
Anterior rhinos copy or nasal endoscopy
Polyps are pale, mobile and insensitive to gentle palpation
Turbinates are pink, mobile and sensate
Single unilateral polyp requires urgent referral for biopsy was it may turn out to be nasopharyngeal cancer
What is management for nasal polyps?
Medical:
Topical steroid drops shrink polyps (betamethasone drops followed by fluticasone sprays)
Consider adding long term antibiotics
Advise on correct posture for drops - bent over
Surgery: Endoscopic sinus surgery
Simple polypectomy
Post op: don’t blow nose until better, watch for bleeding
What are nasal polyps associated with?
Allergic rhinitis Non-allergic rhinitis Chronic ethmoid sinusitis Cystic fibrosis Aspirin hypersenstivity Asthma (late-onset particularly)
How is chronic rhinosinusitis without nasal polyps treated?
Intranasal corticosteroids
Nasal saline irrigation
If there is no improvement after 4 weeks, consider micro cultures and add long-term abx.
CT
If poor response consider surgery
Describe allergic rhinosinusitis. What is the cause?
Inflammatory disorder of nose where nose becomes sensitised to allergens.
May be:
Seasonal: symptoms occur around the same time every year - hay fever - more common in children
Perennial: symptoms occur throughout the year - more common in adults
Occupational: symptoms follow exposure to particular allergens within work place
IgE mediated inflammation from allergen exposure to nasal mucosa causing inflammatory mediator relapse from mast cells
What are symptoms and signs of allergic rhinosinusitis?
Sneezing Pruritus Nasal discharge (bilateral and variable) Bilateral itchy red eyes Bilateral nasal obstruction Post-nasal drip
Turbinates may be swollen and mucosa pale
Nasal polyps
What is management for allergic rhinosinusitis?
Allergen avoidance
Oral or intranasal antihistamines first line - loratadine
Intranasal coricosteorids sprays - fluticasone
Short course of oral coricosteroids can help rapid resolution e.g. during exams
Immunotherapy - can induce long term tolerance to allergens
Topical nasal decongestants (e.g. oxymetazoline) - note: should not be used for prolonged periods as increasing doses are required to achieve same effect and rebound hypertrophy of nasal mucosa may occur.
What are other causes of nasal congestion in children?
Large adenoids
Coanal atresia (congenital blockage of one or both nasal passages by bone or tissues)
Post nasal space tumour
Foreign body
Refer same day if unilateral obstruction ± foul/bloody discharge
What are other causes of nasal congestion in adults?
Deflected nasal septum
GRanuloma (TB, syphilis, granulomatosis with polyangitis)
Topical vasoconstirctors
Tricyclics
