sinusitis

Question 1

definition of sinusitis

Answer 1

symptomatic inflammation of the paranasal sinuses

• acute - follows cold - sx get worse after 5 days, or last more than 10 days; resolves within 12 wks
• recrrent - 4 or more annual episodes w/o persistent sx in intervening periods
• chronic - last for more than 12 wks
• uncomplicated - inflammation where sinusitis does not extend out of the paranasal sinuses and nasal cavity

Question 2

causes of sinusitis

Answer 2

acute
* triggored by viral URTI followed by bacterial
* Streptococcus pneumoniae and Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus

chronic
* more likely inflammatory than infectious
* multifactorial
* Staphylococcus aureus, Enterobacteriaceae spp, and Pseudomonas

Question 3

RFs for acute sinusitis

Answer 3

Asthma.
Allergic rhinitis.
Smoking.
Anatomical variation or mechanical obstruction (for example, deviated nasal septum, nasal polyps, trauma, foreign body).
Seasonal variation (more likely to occur in the early months of the year).
Impaired ciliary motility (for example, cystic fibrosis).

Question 4

predisposing factors for chronic sinusitis

Answer 4

atopy
asthma
ciliary impairment
aspirin sensitivity
immunocompromise
genetic factors
cigarette smoking
iatrogenic factors

Question 5

complications of sinusitis

Answer 5

orbital cellulitis, abscess
cavernous sinus thrombosis
meningitis
encephalitis
intracranial abscess / venous thrombosis

chronic
* sleep problems
* fatigue
* depression
* impact on employment
* reduction in socialisation

Question 6

diagnosing acute sinusitis

Answer 6

nasal blockage or discharge WITH facial pain/pressure/headache and/or reduction in smell
can have
* altered speech - from nasal obstruction
* tenderness, swelling or redness over cheekbone/periorbital areas
* cough

on exam
* nasal inflammation, mucosal oedema, purulent discharge
* polyps

Question 7

dx of chronic sinusitis

Answer 7

sx of acute - but lasting >12wks

Question 8

mx of acute sinusitis

Answer 8

if sx for less than 10days
* analgesia
* nasal saline

if more than 10 days
* high dose nasal steroid
* back up abx - pen V (phenoxymethylpenicillin) for 5 days
* if systemically unwell - co-amox for 5 days

Question 9

when to refer as an emergency for acute sinusitis

Answer 9

A severe systemic infection.
Intraorbital or periorbital complications, including:
* periorbital oedema or cellulitis,
* a displaced eyeball,
* double vision,
* ophthalmoplegia,
* newly reduced visual acuity.

Intracranial complications, including:
* swelling over the frontal bone,
* symptoms or signs of meningitis,
* severe frontal headache,
* focal neurological signs.

Question 10

when do you need admission for chronic sinusitis

Answer 10

Orbital involvement:
* peri-orbital oedema or cellulitis,
* a displaced globe,
* double vision,
* ophthalmoplegia,
* reduced visual acuity.

Intracranial involvement:
* severe frontal headache,
* swelling over the frontal bone,
* symptoms or signs of meningitis,
* focal neurological signs.

Question 11

mx of chronic sinusitis

Answer 11

advise can last months
avoid triggers
good dental hygiene
nasal irrigation
intranasal steroids for up to 3mo - esp if allergic cause