Sinusitis Flashcards
Anatomical facts about sinuses
4 symmetrical air filled spaces
Lined by ciliated, columnar epithelium
Interconnected through small tubular openings
All drain into the osteomeatal complex which drains into the nasal cavity
What is the function of the sinuses?
Mucus that is of appropriate viscosity, composition and volume
Normal mucocilliary flow
Open Ostia to allow for adequate drainage and air flow
What is sinusitis?
Inflammation of the muscles membrane lining the paranasal sinuses
Causes of sinusitis
Allergic
Viral
Bacterial
Fungal
Types of Sinusitis
Acute
Subacute
Chronic
Recurrent
What is acute sinusitis
New infection less than 4 weeks in duration
What is subacute sinusitis
Lasting 4 to 12 weeks
What is chronic sinusitis
Symptoms lasting over 12 weeks
What is recurrent sinusitis
3 or more episodes in a year
What is responsible for the development of sinusitis?
Blockage or inflammation of the osteomeatal complex
How gets sinusitis
Both adults and kids
What happens once drainage and ventilation of sinuses is compromised?
The pH decreases
Oxygen content decreases
Cilia is less functional
Mucosal lining is damage
Predisposing/risk factors for sinusitis
Immune deficiencies
Foreign bodies
Fractured nose
Polyps
Allergies/asthma
Dental infection
What is the epidemiology
0.5% of all URTICARIA are complicated by sinusitis
Is one of the 10 most common diagnosis in primary care
1 in 10 people visit their doctor with sinusitis every year
Causes of sinusitis
A viral infection usually lasting up to 10 days
Mostly rhinovirus, adenovirus, influenza, and parainfluenza viruses
What are signs and symptoms of sinusitis?
Mucopurulent nasal discharge
Nasal congestion/obstruction
Tenderness over sinus/facial pain
Sometimes fever,headache and cough
How long does acute viral sinusitis symptoms tend to improve?
Within 1 week
When is sinusitis rare?
In children less then 9 years old
They have undeveloped sinuses
What does bacterial sinusitis in children look like? Symptoms?
Persistent symptoms of URTI without improvement after 10-14 days
Purulent nasal discharge and continued unwell state
With fever, cough, irritability, lethargy
Severe presentation bacterial sinusitis in children
Purulent nasal discharge
Fever > 39
With
Cough
Headache
Facial swelling
Bacterial Sinusitis in Adults (common) presentation
Persistent symptoms of URTI without improvement after 10 to 14 days or worsening after 5 days
Symptoms for common presentation bacterial sinusitis
Nasal congestion
Purulent nasal discharge
Facial pain
Fever
Molar toothache
Facial swelling
Signs and symptoms of sinutis
With the common cold
Sore throat & sneezing (resolve 3-6 days)
Fever, malaise, myalgia (resolve 6-8 days)
Cough, nasal discharge and nasal obstruction
Diagnosis
Based mostly on signs and symptoms
Along with pt history and physical exam
Test that could be used for diagnosis for sinusitis
Nasal aspirates
Transillumination of maxillary and frontal sinuses
X-ray, CT scan
Microbiology of Sinusitis
S. pneumoniae
H. Influenzae
M. Catarrhalis
May also be s. aureus, s. pyogenes
Causes of Sinusitis
Maybe Anaerobes
Clinical Course of Action for SInusitis
Usually recovers spontaneously without antibiotics
Most pt will be better within 10 days
Non pharm Treatment for sinusitis
Steam inhalation
Fluids
Apply warm face cloth or heat of some kind
Avoid irritants such as smoke
Saline drops or irrigation
Pharm Treatment for Sinusitis
Analgesic
Oral/topical decongestants
Intranasal steroid
Oral steroids
How would oral steroids help with sinusitis?
Reduce edema and inflammation but little evidence of benefit in acute
Antibiotic Treatment strategies
Should use the wait and see approach
If still problem 7-10 days after meet with MD then might be warranted
Goals of Antibiotic treatments
Restore/improve sinus function
Prevent intracranial complications
Eradicate pathogen
What is the first line for sinusitis?
Amoxicillin
What is the dose of amoxicillin (adults) for sinutisis?
500-1000 mg TID for 5-10 d
What are the second line for sinusitis?
Amox/clav
2nd gen cephalosporin
Doxycycline
Clarithromycin or azithromycin
What is the dose for adults for amox/clav for sinusitis?
500 mg TID or 875 mg BID
What is the dose for doxycycline, adults, sinusitis?
100 mg BID day1
100 mg OD
Or
200 mg day 1
100 mg BID
What is the third line treatment for sinusitis?
Levofloxacin
Moxifloxacin
What is the dose for levofloxacin for sinusitis?
500 mg once daily for 5-10 days
What is the dose of moxifloxacin for sinusitis?
400 mg once daily for 5-10 days
What is the dose for amoxicillin (peds) for sinusitis?
40 to 90 mg/kg/day BID or TID
For 10 days
What is the second line for peds for sinusitis?
Amox/clav
Cefuroxime
Cefprozil
What is the peds dose for sinusitis for amox/clav?
40-90 mg/kg/day
BID
10 days
What is the dose for cefuroxime (peds) for sinusitis?
30-40 mg/kg/day
BID
For 10 days
What is the peds dose for cefprozil for sinusitis?
30 mg/kg/day
BID
For 10 days
What is the third line for peds sinusitis?
Clarithromycin
Azithromycin
TMP/SMX
What is the peds dose of clarithromycin for sinusitis?
15 mg/kg/day BID for 10 days
What is the peds dose for azithromycin for sinusitis?
10 mg/kg/day on 1 day
5 mg/kg/day for 4 days
What is the peds dose for TMP/SMX for sinusitis?
5-10 mg/kg/d TMP
Divided BID
What is the microbiology for chronic sinusitis?
S. aureus and anaerobes
What is used on chronic sinusitis? How long?
Amoxicillin/clavulanate or clindamycin
Treat for 3 weeks
