Sinusitis

Question 1

Symptomatic inflammation of the sinuses and nasal mucosa, typically from an infection. Inflammation leads to constriction of nasal passages, poor mucus drainage, poor oxygenation

this is known as ________

Answer 1

this is called sinusitis or rhinosinusitis

Question 2

What is the duration of acute sinusitis?

Answer 2

symptomatic for less than 4 weeks

Question 3

What is the duration of chronic sinusitis?

Answer 3

symptomatic for 12 weeks or longer

Question 4

What is considered recurrent sinusitis?

Answer 4

4 or more symptomatic episodes per year with complete resolution of symptoms in between episodes

Question 5

List the 5 risk factors for sinusitis

Answer 5

1. recent viral upper respiratory tract infection
2. asthma
3. allergic rhinitis, rhinitis medicamentosa
4. smoking
5. anatomy (deviated septum, turbinate, deformity)

Question 6

List the causative organisms of sinusitis

Answer 6

viruses
strep pneumonie
Haemophilus influenzae 
Moraxella catarrhalis 
S. aureus 
anaerobes

Question 7

Describe the signs and symptoms of sinusitis

Answer 7

facial pain, pressure or fullness
pain in ears and teeth 
headache 
purulent nasal discharge 
fever
altered smell, taste 
halitosis 
cough
cough and rhinorrhea

Question 8

Differences in clinical presentation for bacterial vs viral sinusitis.

Answer 8

viral: symptoms peak rapidly, decline by 3rd day and end in 1 week

bacterial: 10 days or longer without improvement, severe symptoms,
symptoms improve but then worsen by 10 days

symptoms my last up to 1 month but most resolve in 1 week

Question 9

Symptoms for urgent referral

Answer 9

periorbital or orbital cellulitis (eye pain, high fever, swelling around eye, decreased vision) 
black necrotic tissue or discharge 
Blindness
altered mental status 
signs of intracranial complications

Question 10

Outline the diagnostic process for sinusitis.

Answer 10

differentiate between viral and bacterial symptom timeline
cultures are NOT helpful in identifying the pathogen

Imaging is NOT used in most cases

Question 11

List types of adjunctive treatment to reduce inflammation and promote sinus drainage

Answer 11

intranasal corticosteroids (nasal sprays)
analgesics
nasal saline irrigation or steam inhalation
decongestants (limit to 3 days)
avoid risk factors: allergen exposure, environmental toxins, tobacco smoke

Question 12

What is drug-induced rhinitis medicamentosa, including causative agents

Answer 12

it is rebound congestion

that happens when you use a topical vasoconstrictor for too long.
causes reactive swelling of nasal turbinates
increased watery secretions

caused by topical decongestants like
phenylephrine, pseudoephedrine
naphazoline
oxymetazoline

Question 13

First-line therapy for adults?
Alternative for severe infection or immunocompromised?
Allergy?

Answer 13

1. amoxicillin 500-1000mg po TID x 5-7 days
2. amoxi-clav 825mg po BID x 5-7 days
   3, doxycycline 200mg po 1 x dose, then 100mg po BID x 5-7 days

Question 14

First-line therapy for children?

alternative?

Answer 14

Amoxicillin 40mg/kg/day tid x 10 days
Amox 90mg/kg/day tid x 10 days –> use for < 2 years old

Alternative
amoxi/clav (7:1) ratio 45mg/kg/day bid-tid x 10 days
doxy 4mg/kg/day

Question 15

What is failure of first-line therapy considered?

Answer 15

symptoms worsen after 72 hours
no improvement
recurrence within 3 months

Question 16

Which class of antibiotics is not recommended due to resistance? select more than 1

a) penicillin
b) fluoroquinolone
c) macrolides
d) septra
e) beta lactam

Answer 16

c and d