Shevchuk- sinusitis Flashcards
what are your sinuses (include sinus ostia)
- 4 symmetrical air filled spaces called paranasal sinuses
- lined by ciliated, columnar epithelium
- interconnected through small tubular openings (sinus ostia)
- all drain into the osteomeatal complex which drains into nasal cavity
what are the 4 sinuses called
- ethmoid (above eye)
- sphenoid (beside eye)
- frontal (between eyes)
- maxillary (under eyes)
what do sinuses to
- make mucus appropriate viscosity, composition and volume
- normal mucociliary flow
- oen ostia to allow for adequate drainage and airflow
which sinus is functioning cilia of the utmost importance?
-maxillary sinus, because drainage is against gravity
how can you damage your cilia
- smoking and viruses mainly
- air concentrations that are too high or low
- certain diseases (cystic fibrosis, etc)
- fire smoke, etc
what is sinusitis (aka ____), and 4 things it can be from, who gets it
inflammation of the mucous membrane lining the paranasal sinuses
- aka rhinosinusitis (as nasal mucosa is always involved)
- viral, allergic, bacterial or fungal
- both adults and kids get
4 types of sinusitis
- acute- new infection less than 4 weeks in duration (divided into severe and non severe)
- subacute (4-12 weeks)
- chronic (sx over 12 weeks)
- recurrent (3 or more episodes in a year, but normal in between episodes. If not, its chronic)
what causes sinusitis
blockage or inflammation of osteomeatal complex
- it interferes with the mucociliary clearance
- early phase is often a viral infection (about 10 days), then about 0.5-2% progress to bacterial aerobes, then bacterial anaerobes (after 3 months) (not known if they are a cause of chronic form or just inhabiting the area, controversy that it might just be an inflammatory disease and no chronic infection)
sinusitis can commonly be caused by this infection
- URTI- all tubes are connected, and URTI commonly results in sinus infection
- 0.5% of all URTIs are complicated by sinusitis
once drainage and ventilation of the sinuses is compromised, what happens?
- ph decreases
- oxygen content decreases
- cilia is less functional
- mucosal lining is damaged
- ULTIMATELY THESE THINGS MAKE YOU MORE SUSCEPTIBLE TO INFECTION!
predisposing factors for sinusitis
- immune deficiencies
- foreign bodies
- fractured nose
- polyps
- allergies/asthma
- dental infection
what viruses typically cause sinusitis
mostly rhinovirus
-also adenovirus, influenza and parainfluenza
is viral or bacterial sinusitis more common?
viral is 20-200 times more common therefore ABs not needed
signs and sx of sinusitis
- mucopurulent nasal discharge
- nasal congestion
- tenderness over sinus/facial pain
- fever
- headache and cough
common bacterial sinusitis in children- presentation
- persistent sx of URTI w/o improvement after 10-14 days with both
- purulent nasal discharge and continued unwell state
- can include fever, cough, irritability, lethary, facial pain
severe bacterial sinusitis in children- presentation
- severely ill child with both
- purulant nasal discharge and a fever of over 39 (not responding to appropriately dosed antipyretics)
- ususally associated with cough, headache, facial swelling, sinus tenderness
- less common
- “severe sx for at least 3 days in febrile child who has purulant nasal discharge and seems ill”
common bacterial sinusitis in adolescents/adults- presentation
- persistant sx of URTI w/o improvement after 10-14 days or worsening after 5 days with both
- nasal congestion/purulant nasal discharge and facial pain
- with or without fever, molar toothache, facial swelling, headache, bad breath, fatigue, cough, facial pain worse on bending forward, ear pain/pressure, loss of smell
how to dx
-based on signs and sx, also patient history and physical exam
things that are not helpful to diagnose
- nasal aspirates
- transilllumination of maxillary and frontal sinuses
- xray, ct scan to see abnormalities- but bacteria and viruses produce the same ones
if sinusitis is bacterial, caused by these bacteria
- S pneumoniae (most common)
- haemophilus influenzae, maxilla catarrhalis
- *same list as AOM!
- in immunocompromised or hospital acquired, expect more gram negative bacteria or fungus
when does sinusitis clear up
-usually recover spontaneously w/o ABs within 10 days (some still after 2 weeks though)
complications
- rare, but include
- abscess, cellulitis and osteomyelitis
- spread of infection to the nervous system
non pharm tx
- steam inhalation
- fluids (never a bad thing, and can help with mucus viscosity)
- apply warm face cloth or heat of some kind
- avoid irritant like smoke (esp if have allergies)
- saline drops or irrigation
pharm tx
- analgesic
- oral/topical decongestants (have some benefit)
- intranasal steroid- not as beneficial in acute
- avoid 1st gen AHs for drying SE- we want sinuses to drain
- oral steroids- reduce edema and inflammation, but little evidence of benefit in acute
- ABs if bacterial
