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PHAR152 > Sinusitis > Flashcards

Sinusitis Flashcards

1
Q

Describe the anatomy of the sinuses.

A

4 symmetrical air-filled cavities called paransal sinuses
lined by ciliated, columnar epithelium
interconnected through small tubular openings (sinus ostia)
all drain into the osteomeatal complex which drains into the nasal cavity

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2
Q

What are the four sinuses?

A

frontal
ethmoidal
maxillary
sphenoidal

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3
Q

Describe what would be occurring during normal function of the sinuses.

A

mucus of appropriate viscosity, composition, and volume
normal mucociliary flow
open ostia to allow for adequate drainage and air flow

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4
Q

Which sinus drains against gravity, making functioning cilia very important?

A

maxillary sinus

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5
Q

What is sinusitis?

A

inflammation of the mucous membrane lining the paranasal sinuses

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6
Q

What is sinusitis best called?

A

rhinosinusitis
-nasal mucosa is always involved

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7
Q

True or false: sinusitis is only allergic and viral in nature

A

false
can be allergic, viral, bacterial, or fungal

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8
Q

What are the four types of sinusitis?

A

acute: new infection <4 weeks in duration
subacute: lasting 4-12 weeks
chronic: symptoms lasting >12 weeks
recurrent: 3 or more episodes in a year

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9
Q

What is responsible for the development of sinusitis?

A

blockage or inflammation of the osteomeatal complex
-the obstruction interferes with mucociliary clearance
-all the tubes are connected, URTI commonly results in sinus
inflammation

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10
Q

What happens once drainage and ventilation of the sinuses is compromised?

A

pH is decreased
oxygen content decreases
cilia is less functional
mucosal lining is damaged
MORE SUSCEPTIBLE TO INFECTION

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11
Q

What are the risk factors for sinusitis?

A

immune deficiencies
foreign bodies
fractured nose
polyps
allergies/asthma
dental infection

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12
Q

What is the most common cause of early phase sinusitis?

A

viral infection lasting up to 10 days
-may originate from a cold
-mostly rhinovirus, adenovirus, influenza, and parainfluenza

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13
Q

What percentage of viral sinusitis progress to bacterial infections?

A

0.5-2%
viral rhinosinusitis is 20-200x more common than bacterial sinusitis

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14
Q

What are the signs and symptoms of sinusitis?

A

mucopurulent discharge
nasal congestion/obstruction
tenderness over sinus/facial pain
sometimes fever, headache, and cough

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15
Q

How long does it take for acute viral sinusitis tend to improve?

A

1 week
most patients well within 10 days

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16
Q

Which group of patients would it be rare to see sinusitis in?

A

children <9yo
-undeveloped sinuses

17
Q

What is the presentation of bacterial sinusitis in children?

A

persistent symptoms of URTI without improvement after 10-14 days
WITH BOTH: purulent discharge AND continued unwell state
+/- fever, cough, irritability, lethargy, facial pain

18
Q

What is the severe presentation of bacterial sinusitis in children?

A

severely ill child
with both: purulent discharge AND fever >39 C (non-responsive to antipyretics)
usually associated with: cough, headache, facial swelling, sinus tenderness
LESS COMMON, SUSPECT COMPLICATIONS

19
Q

What is the presentation of bacterial sinusitis in adolescents/adults?

A

persistent symptoms of URTI without improvement after 10-14 days or worsening after 5 days
WITH BOTH: nasal congestion/purulent discharge AND facial pain
+/- fever, molar swelling, facial swelling

20
Q

What are other concurrent symptoms of bacterial sinusitis in adolescents/adults?

A

headache
bad breath
fatigue
cough
facial pain worse on bending forward
ear pain/pressure
loss of smell

21
Q

True or false: green nasal discharge is predictive of bacterial sinusitis

A

false
color and nature of nasal discharge does not predict bacterial infection

22
Q

How is sinusitis diagnosed?

A

mostly on signs and symptoms
-along with patient history and physical exam
-symptoms >10d=bacterial should be considered
nasal aspirates: not very helpful
transillumination of maxillary+frontal sinus: not helpful
X-ray, CT scan: used to see abnormalities or complications
-viruses produce same abnormalities as bacteria

23
Q

What is the microbiology of sinusitis?

A

frequently viral
in bacterial sinusitis:
-S. pneumoniae (30-60%)
-H. influenzae (21-23%)
-M. catarrhalis (2-19%; 20% in kids)
-may also be S. aureus, S. pyogenes

24
Q

Which organisms would be expected to cause sinusitis in immunocompromised or hospital acquired?

A

gram negative
fungus

25
Q

True or false: anaerobes are the cause of chronic sinusitis

A

false
unknown if they are cause of chronic sinusitis or just inhabiting the area
maybe chronic sinusitis is just an inflammatory disease without chronic infection

26
Q

What are the complications of sinusitis?

A

complications are rare but include:
-abscess
-cellulitis
-osteomyelitis
-spread of infection of nervous system

27
Q

What are some non-pharmacological symptomatic reliefs of sinusitis?

A

steam inhalation
fluids
apply warm face cloth or heat of some kind
avoid irritants such as smoke
saline drops or irrigation

28
Q

What is the pharmacological symptomatic relief for sinusitis?

A

ANALGESICS
oral or topical decongestants (no evidence of benefit)
intranasal steroids (not as beneficial in acute)
avoid 1st gen antihistamines
oral steroids: reduce edema and inflammation but little evidence of benefit

29
Q

Which approach should be used for sinusitis, in regards to antibiotic therapy?

A

wait and see
-if still bothersome at a week-10 days after onset and meet
clinical criteria then antibiotics may be warranted
-this strategy results in a 90% cure rate after 1 week of
treatment with antibiotics

30
Q

What are the goals of therapy with antibiotics when treating sinusitis?

A

restore/improve sinus function
prevent intracranial complications
eradicate pathogen

31
Q

What is first line treatment for sinusitis in adults? What is the dosing of this therapy?

A

amoxicillin 500mg-1000mg TID x 5-10d
-evidence that 5 days is sufficient

32
Q

What are the second line treatment options for sinusitis in adults? What are the dosings of these therapies?

A

AmoxiClav 500mg TID or 875mg BID
2nd gen cephalosporin
doxycycline 100mg BID day 1, then 100mg OD OR 200mg day 1, then 100mg BID
clarithromycin or azithromycin

33
Q

What are the third line treatment options for sinusitis in adults? What are the dosings of these therapies?

A

levofloxacin 500mg OD
moxifloxacin 400mg OD
5-10 days

34
Q

What is first line treatment of sinusitis in kids? What is the dosing of this therapy?

A

amoxicillin 40-90mg/kg/d BID or TID
10 days
max 3g/day

35
Q

What is second line treatment of sinusitis in kids? What is the dosing of these therapies?

A

AmoxiClav 40-90mg/kg/d BID
cefuroxime 30-40mg/kg/d BID30
cefprozil 30mg/kg/d BID
10 days

36
Q

What is third line treatment of sinusitis in kids? What is the dosing of these therapies?

A

clarithromycin 15mg/kg/d BID
azithromycin 10mg/kg/d on first day, 5mg/kg/d x 4 days
TMP/SMX 5-10mg/kg/d TMP divided BID

37
Q

Which organisms may you see more of in chronic sinusitis?

A

S. aureus and anaerobes

38
Q

What are the treatment options for chronic sinusitis? How long is therapy?

A

AmoxiClav or clindamycin
3 weeks

PHAR152 (21 decks)

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