Rhinosinusitis (acute and chronic) Flashcards
What are the diagnostic features of rhinosinusitis?
- Block
- 1 of: Facial pressure or Hyposmia
- Examination findings
For 12 weeks = chronic
What defines chronic RS?
12 weeks
What may be found in CRS?
Nasal polyps
How can you tell between a polyp and turbinate on examination of nose?
Polyps - insensate
Turbinate - pain if poked
What is the difference?
Right there is nasal polyposis filling all sinuses –> poor sense of smell, poor sleep, mouth breathing
What type of imaging may be used in CRS?
CT
What is the management of CRS?
- Long term topical steroids
- Surgical - if polyposis present, then use steroids to prevent recurrence
mAbs - being trialled e.g. Mepolizumab (anti-IL-5) helps with polyposis
What are the main features of acute sinusitis?
- Painful
- Purulent discharge
- Can follow viral URTI
Bacterial cause
Is purulent discharge unilateral or bilateral in acute sinusitis?
Unilateral
How do you manage acute sinusitis?
Antibiotics (co-amoxiclav)
Patient comes in saying their nasal decongestant no longer helps. Exam as below. What is the diagnosis?
Rhinitis Medicamentosa
Tx: few weeks weaned off. Seroids may be added but will not help much
What are the types of rhinosinusitis?
Allergic - seasonal or perennial or occupational
Non-allergic - infective or non-infective
How common is allergic rhinitis?
20 to 30% of adults and up to
40% of children
What are the clinical features of allergic rhinitis?
- rhinorrhoea
- nasal blockage
- sneezing attacks for longer than 1 hour per day lasting longer than 2 weeks
- itching—eyes, nose
- watery eyes
- interference with sleep leading to daytime sleepiness
- malaise
- headache
- wheezing
- shortness of breath
- clear nasal discharge
Other: reduced hearing from ET dysfunction, headaches, epiphora, reddening of conjunctivae, swollen eyelids, nasal crease or nasal salute (in children), oedematous nasal mucosa
What diagnostic tests can be done for allergic rhinitis?
History most important
Skin prick testing
RAST - radioallergosorbent testing; highly specific but not as sensitive as skin prick testing
High serum IgE
Nasolaryngoscopy