Sinusitis

Question 1

What is sinusitis

Answer 1

Inflammation of the paranasal air sinuses in the face. Usually accompanied by inflammation of the nasal cavity - Rhinosinusitis

Question 2

What are the 2 types of sinusitis

Answer 2

Acute - <12 weeks

Chronic - >12 weeks

Question 3

Sinuses in the face

Answer 3

Frontal sinuses - above eyebrows
Maxillary sinuses - either side of nose below the eyes (most commonly affected)
Ethmoid sinuses - in ethmoid bone in middle of nasal cavity
Sphenoid sinuses - in sphenoid bone at back of nasal cavity

Question 4

What do the sinuses in the face do

Answer 4

Produce mucus and drain into the nasal cavity via holes called ostia

Question 5

What causes sinusitis

Answer 5

Blockage of ostia prevents drainage of the sinuses resulting in sinusitis
Infection - usually following viral upper resp. tract infection (Strep pneumonia , Haemophilius influenzae)
Allergies e.g. hayfever
Obstruction of drainage e.g. foreign body, trauma, polyps
Smoking

Question 6

Sinusitis presentation

Answer 6

Recent viral upper resp. tract infection - fever, tachycardia
Nasal congestion
Nasal discharge
Facial pain or headache
Facial pressure
Facial swelling and tenderness over affected areas
Loss of smell
Inflammation and oedema of the nasal mucosa

Question 7

Sinusitis investigations

Answer 7

Most cases not necessary
Nasal endoscopy
CT scan

Question 8

Sinusitis management

Answer 8

Self care - ibuprofen, paracetamol, nasal decongestants
If symptoms do not improve after 10 days:
-High does steroid nasal spray for 14 days (mometasone 200mcg twice daily)
-Delayed antibiotic prescription (phenoxymethylpenicillin)
Systemic infection or sepsis - hospital admission
Chronic sinusitis: saline nasal irrigation, steroid nasal spray, functional endoscopic sinus surgery (FESS)

Question 9

Nasal spray technique

Answer 9

Shouldn’t taste spray at back of throat
Tilt head slightly forward
Direct spray slightly away from septum
Don’t sniff hard during spray - gently inhale through nose after spray

Question 10

Functional endoscopic sinus surgery procedure

Answer 10

Small endoscope inserted through nostrils and sinuses
Any obstructions removed or corrected
Balloons may be inflated to dilate opening of sinuses
Need CT scan before procedure to confirm diagnosis