Rhinosinusitis + other random Flashcards
What is rhinosinusitis
Inflammatory and infective process affecting nasal mucous membranes and sinuses
What are RF
Nasal obstruction Polyps Septal deviation Recent local infection Swimming Smoking
What are the major symptoms of rhino sinusitis
Facial pain and pressure - frontal, worse bending forward
Nasal discharge / rhionorrea - thick and purulent
Nasal congestion / obstruction
Anosmia
Post nasal drip
Cough due to post nasal drip
What are minor features
Headache - worse leaning forward Fever Fatigue Halitosis Dental pain as can be a cause of spread
How do you Dx
Need +1 of nasal discharge or blockage then +_ Facial pain Headache Reduction or loss of smell Endoscopic or CT signs
What is acute rhinosinusitis and how do you treat
Acute onset
Bacterial cause
<12 weeks
Symptoms resolve completely
Rx
Simple analgesia
Nasal irrigation
Intranasal decongestant for 1 week only
If symptoms >5 days
Intranasal corticosteroid
Avoid Ax unless severe or worsening symptoms as most likely viral
What is recurrent acute
> 1 but <4 episodes per year
8 weeks symptom free between attacks
Refer to ENT
May do CT of paranasal sinus and nasal endoscopy to conifirm Dx
What is chronic rhinosinusitis
> 12 weeks
Persistent inflammatory changes >4 weeks after therapy
Can be subdivided into
+- nasal polyps
allergic vs non allergic
Get acute exacerbations
Must refer ENT for specialist management/ surgery
What are most common infectious agents
S.pneumonia = most common
H.influenza
M.catarrhalis
S>aureus
If viral
Rhinovirus
RSV
Parainfluenza
How do you Dx and Rx chronic sinusitis
CT sinus to assess extent of disease and plan for surgery
Analgesia
Intranasal decongestant = short term only
Nasal saline + intranasal steroid = central
Anti-histamine if underlying allergy
Oral steroid if polyp followed by topical
Topical steroid if no polyps followed by intra-nasal maintenance
Ax only if conservative doesn’t work / systemically unwell / at risk of complications e.g. severe COPD
Endoscopic sinus surgery if max medical and ongoing severe symptoms
When do you give intra-nasal steroid
If symptoms >10 days but never long term
Give 2 week dose of steroid spray
What Ax
B-lactam - penicillin / cephalosporin 5 days
Macrolide - clarithromycin
What do you do if nothing helps
Sinus surgery
Remove disease tissue and obstruction
What are important relations and what do they relate too
Frontal and ethmoid sinus - anterior cranial fossa
Maxillary sinus - orbit of eye
Sphenoid bone - optic nerve / ICA / cavernous sinus
What is NOT offered for sinusitis
Oral steroid
Anti-histmiane - except if associated allergic rhinitis
Anti-histamine
How do you investigate sinusitis
Bloods + culture if systemically unwell
If complicated / not responding
- Swab for MC+S
- High definition CT with contrast for complications
What are surgical emergency
Intra-orbital complication as sight threatening
Why is this important / complications
Spread of infection Meningitis Encephalitis Cavernous sinus thrombosis Intracranial abscess - can press on optic nerve Orbital cellulitis / sepsis OM Pott's Puffy Risk of CSF leak / orbital complications
What is a post nasal drip
Body usually produces mucous which mixes with silva and drips down back of throat
Occurs when body produces more e.g. after an infection
What are the Sx
Constant need to clear throat
Cough, worse at night
Sore scratchy throat
Can get painful ear infection if blocks Eustachian tube
How do you Rx
Anti-histamine
Decongestant / saline nasal spray
Steroid nasal spray
Ax to clear bacterial infection
What are DDX facial pain
Trigeminal neuralgia
Cluster headache
Temporal arteritis
What is Pott’s Puffy tumour
Life threatening complications of infectious sinusitis or trauma
OM of frontal bone leading to abscess formation
How do you Dx
CT
What are the features
Nasal discharge
Headache
Acute onset fever
Frontal swelling
How do you Rx
Ax
Frontal sinus surgery - drains abscess
What is an ethmoidal mucocele
No drainage and blockage of air cells
Expands forming a cyst
Can press on orbit causing diplopia
How do you Dx
CT
Not X-ray as poor visualisation of sinus + high false +ve due to air fluid level / mucous thickening and sinus opacification
How do you Rx
Endonasal sinus surgery
What is black hairy tongue
Defective desquamation of filiform papillae of tongue
May go brown / green or pink
What are predisposing features
Poor oral hygiene Ax Head and neck radiation HIV IVDU
How do you Dx
Swab to exclude Candida
How do you Rx
Tongue scraping
Anti-fungal if Candida
What is gingival hyperplasia
Overgrowth of gum tissue around teeth
What causes
Poor oral Phenytoin Ciclosporin CCB AML
What is gingiivtis
Infections of gums usually due to poor hygiene
If systemic upset what do you give
Paracetamol
Oral metronidazole
Chlorhexiidine mouthwash
Refer to dentist
How does simple present
Red, painless swelling of gums which bleed
What is severe
Painful bleeding gums
Halitosis
Ulcers
What are other causes of nasal congestion in children
Large adenoids
Choanal atresia
Foreign body - refer same day if unilateral + foul discharge
What are causes of nasal congestion in adults
Deflected nasal septum Polyp Fracture Olfactory tumour = rare Granuloma
What symptoms would make you refer urgently
Bleeding
Unilateral obstructing mass
Numbness
Tooth loss
When are nasal polyps rare and what should you rule out
<10 years
Menigocele / encephalocele if unilateral and <2
Neoplasm
When do you suspect cancer of the paranasal sinus
If chronic sinusitis for the first time in later life
Blood stained nasal discharge
