Rhinosinusitis Flashcards
Define rhinosinusitis
Inflammation of the nose and paranasal sinuses
What is it characterised by?
2 or more symptoms, one of which should be:
Either nasal blockage/obstruction/congestion or nasal discharge (anterior or posterior nasal drip)
+/- Facial pain/pressure
+/- Reduction or loss of smell
And either:
Endoscopic signs of polyps, mucopurulent discharge or oedema in middle meatus
And/or
CT changes - mucosal changes within the osteomeatal complex or sinuses
How is it classified?
Acute (ARS)
Chronic (CRS)
How long does ARS last?
Less than 12 weeks, complete resolution of symptoms
What can ARS be divided into?
Viral and non viral
How long does CRS last?
More than 12 weeks without complete resolution of symptoms
What can CRS be divided into?
With nasal polyps
Without nasal polyps
What is another term for viral ARS?
Common cold
What is viral ARS caused mainly by?
Rhinovirus
Influenza virus
Viral ARS normally has resolution of symptoms with how many days?
5 days
How long does non viral ARS last and what causes it?
Persistence of symptoms after 5 days
Streptococcus pneumoniae
Haemophilius influenzae
Moraxella catarrhalis
What can predispose ARS?
Allergy
Ciliary impairment
How is ARS managed?
Analgaesia if required
Nasal decongestants
If persists longer than 5 days consider - topical nasal steroids and oral antibiotics
What can predispose chronic rhinosinusitis with or without nasal polyps?
Allergy Infections Ciliary impairment - CF Anatomical abnormalities- septal deviation, abnormal uncinate process Immunocompromised Aspirin hypersensitivity Atmosphere irritants - smoking, dust, fumes Hormonal - pregnancy, hypothyroidism Trauma Foreign body Swimming and diving
Why is nasal congestion common during pregnancy?
Due to oestrogen and progesterone effect on nasal mucosal vascularity
What do nasal polyps represent?
The extreme end of the spectrum of inflammation seen in chronic rhinosinusitis
Are polyps normally bilateral ?
Yes - as long as no worrying signs from history and examination, they do not require biopsy for histiological diagnosis
Do all unilateral polyps require biopsy?
Yes
What investigations can be done for CRS?
Skin prick rest if allergy suspected
Radiology: CT sinuses - if surgery planned, atypical features to history or examination
How is CRS managed?
For majority there is no cure, treatment aimed at improving symptoms
Conservative- nasal douching, avoid allergens
Medical:
Antihistamines
Topical nasal steroids
Oral steroids - 1 week course in severe cases
Oral antibiotics
Surgical:
Nasal polypectomy
Functional endoscopic sinus surgery - improve ventilation /drainage
Septoplasty
Does nasal polypectomy have high reoccurrence rates?
Yes
What type of hypersensitivity reaction is allergic rhinitis?
Type 1 IgE mediated reaction in the mucous membranes of the nasal airways
What does allergic rhinitis have a strong association with?
Asthma
Allergic rhinitis can be seasonal ie summer hay fever or ..
Perennial
What are the commonest allergens I’m allergic rhinitis?
Pollens
Moulds
House mites
Animal epithelia
What are the duration of symptoms classified as in allergic rhinitis?
Intermittent : symptoms < 4 days per week and less than 4 weeks
Persistent: symptoms > 4 days per week and more than 4 weeks
Define mild allergic rhinitis
Normal daily activities and sleep
What investigations can be done (allergic rhinitis)?
Skin prick tests for specific allergens
Or RAST blood tests if SPT not possible
How is allergic rhinitis managed?
Allergen avoidance Nasal douching Antihistamines Topical nasal steroids Immunotherapy
