Rhinosinusitis Flashcards
Rhinosinusitis:
What proportion of acute rhinosinusitis: cases are bacterial?
<2%
Rhinosinusitis:
Diagnositic criteria?
2 or more symptoms
1) Nasal in origin
- congestion
- discharge
- obstruction (this type of patient generally has ‘nasal neglect’ and will often complain less of symptoms)
2) Sensory
- facial pain or pressure
- change in sense of smell
3) Eye irritation
- watery
- redness
- itch
Rhinosinusitis:
Bacterial symptoms?
at least 3 of:
- discoloured, purulent discharge
- severe localised pain
- fevers above 38 degrees
- elevated CRP
- double sickening (mild illness that deteriorates)
- symptoms often unilateral*
Rhinosinusitis:
Acute management?
- analgesia
- saline irrigation
- decongestant
- combination intranasal corticosteroid with antihistamine (work within 10 minutes)
Rhinosinusitis:
Red flag symptoms?
- bleeding
- unilateral
- perceived malodorous smell
- meningism
- focal neurology
- frontal swelling
- Any orbital involvement (vision changes [particularly green/red differentiation], painful EOM, proptosis)
Rhinosinusitis:
Important things to include in examination?
- nasal visualisation to look for polyps
- palpation of sinus
- observation of eye orbit changes
- EOM
- check colour vision
Rhinosinusitis:
Two types of chronic (> 3months) rhinosinusitis?
1) with polyps
2) without polyps
Rhinosinusitis:
In chronic forms, what particular symptom should be investigated?
- Facial pain (only 16% of chronic rhinosinusitis)
- consider other causes for the pain
- migraine, tension headache, cluster migraines
- paroxysmal hemicrania
- trigeminal neuralgia
- dental infection
- post herpetic neuralgia
Rhinosinusitis:
When to treat acute Rhinosinusitis?
- Red flag symptoms are present and hospital referral is required*
- acute-onset confusion or impaired consciousness
- diplopia or impaired vision
- meningism (eg neck stiffness, severe headache, photophobia)
- periorbital oedema or cellulitis
- proptosis
- signs of sepsis or septic shock
OR
1) severe symptoms of fever, purulence, facial pain persisting beyond 4 days or worsening
2) worsening symptoms after initial improvement
3) Persistent symptoms without improvement after 10
Red flag symptoms are present and hospital referral is required
Rhinosinusitis:
How to treat chronic Rhinosinusitis?
no Polyps
1) 8 weeks trial
- nasal irrigation BD
- intranasal steroids/antihistamine
with Polyps
- if in children test for cystic fibrosis
- if in asthmatics consider aspirin exacerbated respiratory disease
1) same approach as no polyps AND
2) oral steroid 25mg/d for 5 days then 12.5mg/d for 5 days
3) Consider 8-12 weeks of macrolide (reduce polyp size, inflammation and increase mucociliary function) (works best in those with normal IgE levels)
Allergic
-add in oral non sedating antihistamine
Rhinosinusitis:
Surgical options for chronic disease?
Functional Endoscopic Sinus Surgery (FESS)
-improves symptom control by increasing space for mucosal swelling (will need to continue treatments)
Rhinosinusitis:
Polyp recurrence rate?
60% will require polypectomy in 5 years
Rhinosinusitis:
What is Samter’s triad and how to manage it?
Combination of NSAID sensitivity, asthma and chronic Rhinosinusitis with polyps.
Managed by desensitising to aspirin which reduces polyp recurrence
Rhinosinusitis:
How common is allergic Rhinitis?
20% of australians
Rhinosinusitis:
Classification of allergic rhinitis?
1) Intermittent (<4 days)
2) Persistent (>4 days/week or < 4 days in consecutive weeks)
Mild (not troublesome or impacting sleep or function)
Moderate to severe (troublesome and impacting sleep and function)
