Rhinosinusitis

Question 1

what is it

Answer 1

inflammation in the nose and paranasal sinuses with 2 or more sx
one of which must be nasal congestion or discharge

Question 2

what are sx of rhinosinusitis

Answer 2

1. facial pain or pressure - worse on bending forward
2. discharge from nose e.g. postnasal drip
3. nasal obstruction/congestion
4. anosmia
5. systemic sx e.g. fever

Question 3

how is rhinosinusitis classified?

Answer 3

acute or chronic

mild, mod or severe

Question 4

what is 1st line rx for acute R

Answer 4

topical CS + oral abx

Question 5

what is 1st line rx for chronic R

Answer 5

topical CS + nasal douching

Question 6

What are causes of nasal congestion in children.?

Answer 6

Rhinosinusitis 
big adenoids
rhinitis
choanal atresia 
postnasal space tumour e.g. angiofibroma 
foreign body

Question 7

what are causes of nasal congestion in adults

Answer 7

deflected nasal septum

granuloma (TB, syphilis, granulomatosis w polyangiitis)

Question 8

when does rhinosinusitis become chronic?

Answer 8

> 12 weeks

Question 9

what is the difference between rhinitis and sinusitis?

Answer 9

Sinusitis is that Rhinitis is irritation and inflammation of the mucous membrane inside the nose while Sinusitis is the inflammation of the sinuses, which are the air filled bony cavities located inside the facial bones.

Question 10

what is rx of allergic rhinosinusitis?

Answer 10

antihistamines: loratidine
systemic decongestants - nasal sprays 
nasal steroids - beclometasone
oral steroids 
immunotherapy (if + asthma)

Question 11

what are nasal polyps associated w?

Answer 11

asthma
aspirin sensitivity
infective sinusitis
CF

Question 12

What are the sx of nasal polyps?

Answer 12

nasal obstruction
rhinorrhoea
sneezing
poor sense of taste and smell

Question 13

What is the management of nasal polyps?

Answer 13

topical CS (betamethasone) shrink them well

Question 14

what features of a polyp is a red flag? what can it indicate? what is the management?

Answer 14

polyp causing unilateral nasal obstruction
nasopharyngeal cancer, glioma, lymphoma, neuroblastoma, sarcoma
do prompt CT and histology

Question 15

What are predisposing factors of bacterial sinusitis?

Answer 15

1. recent viral infection
2. direct spread - dental root infection, swimming in infected water
3. odd anatomy - septal deviation, large ethmoidal bulla, polyps
4. ITU causes
5. Systemic causes - kartageners, immunodeficiency, general debility
6. smoking

Question 16

What are frequent causative organisms of bacterial sinusitis?

Answer 16

staph aureus
pseudomonas
strep pneumoniae
h influenzae

Question 17

What is the management of acute /single episodes of sinusitis?

Answer 17

most self-limiting

After 5/10? days of sx - consider nasal douching + topical steroids/decongestants

Question 18

when are oral abx indicated in acute sinusitis? which abx?

Answer 18

severe presentations

phenoxymethylpenicillin or co-amox

Question 19

What is the treatment of chronic/recurrent episodes

Answer 19

abx

functional endoscopic sinus surgery

Question 20

what are complications of sinusitis?

Answer 20

mucocoeles
orbital cellulitis/abscess
osteomyelitis
intracranial infection