Sinusitis

Question 1

What is Sinusitis?

Answer 1

Inflammation of the paranasal sinuses.

Question 2

What is Rhinosinusitis?

Answer 2

Sinusitis with inflammation of the nasal cavity.

Question 3

Types of Sinusitis (2).

Answer 3

1. Acute - Less than 12 Weeks.

2. Chronic - More than 12 Weeks.

Question 4

Anatomy of the Sinuses.

Answer 4

1. Hollow spaces within bones of the face arranged symmetrically around the nasal cavity.
2. Produce mucous which drain via Ostia.
3. Blockage of drainage - sinusitis.

Question 5

Paranasal Sinuses (4).

Answer 5

1. Frontal (Lower Forehead).
2. Maxillary (Either Side of Nose).
3. Ethmoid (Top of Nose).
4. Sphenoid (Back of Nasal Cavity).

Question 6

Aetiology of Sinusitis (5).

Answer 6

1. Infection e.g. Viral URTI.
2. Allergies e.g. Allergic Rhinitis.
3. Obstruction of Drainage - Foreign Body, Trauma, Polyps.
4. Smoking.
5. Swimming/Diving.
   * risk factor : asthma.

Question 7

Commonest Causative Organisms of Sinusitis.

Answer 7

1. S. pneumoniae.
2. H. influenza.
3. COMMONEST - Rhinovirus.

Question 8

Clinical Features of Acute Sinusitis (3).

Answer 8

1. Nasal Congestion & Discharge.
2. Facial Pain (worse on bending forward), Headache, Pressure, Swelling Over Affected Areas.
3. Anosmia.

Question 9

Examination Findings of Acute Sinusitis (5).

Answer 9

1. Tenderness of Affected Areas.
2. Inflammation and Oedema of Nasal Mucosa.
3. Discharge.
4. Fever.
5. Systemic Infection.

Question 10

Clinical Presentation of Chronic Sinusitis (3).

Answer 10

1. Similar presentation lasting more than 12 weeks - associated with nasal polyps.
2. Post-Nasal Drip and Chronic Cough.
3. Mouth-Breathing (Compensation).

Question 11

Red Flags of Sinusitis (3).

Answer 11

1. Unilateral.
2. Persistent Despite Treatment for 3 Months.
3. Epistaxis.

Question 12

Investigations of Sinusitis (2).

Answer 12

Not Necessary :

1. Nasal Endoscopy.
2. CT Scan.

Question 13

Management of Sinusitis (3).

Answer 13

1. Severe/Systemic/Septic - Emergency Admission.
2. No Antibiotics for 10 Days (usually Viral).
3. After 10 Days, Still No Improvement - (i) High Dose Steroid Nasal Spray for 2 Weeks; (ii) Delayed Antibiotic Prescription (Phenoxymethylpenicillin).

Question 14

Management of Chronic Sinusitis (3).

Answer 14

1. Saline Nasal Irrigation.
2. Steroid Nasal Sprays/Drops.
3. Functional Endoscopic Sinus Surgery.

Question 15

Nasal Spray Technique (5).

Answer 15

1. Tilt head slightly forward.
2. Contralateral hand to nostril (to direct spray away from septum).
3. Don’t sniff hard during spray.
4. Gently inhale through nose after spray.
5. Should not be able to taste spray (it has gone past the nasal mucosa).

Question 16

Functional Endoscopic Sinus Surgery (FESS) (3).

Answer 16

1. Small Endoscope through Nostrils and Sinuses.
2. Remove/Correct Obstructions e.g. Swollen Mucosa, Bone, Polyps, Deviated Septum.
3. CT Scan Prior to Confirm Diagnosis.

Question 17

Complication of Sinusitis.

Answer 17

Double-Sickening : Initial viral sinusitis worsens due to secondary bacterial infection.