Sinusitis Flashcards
what is sinusitis?
symptomatic inflammation of the paranasal sinuses.
what is rhinosinusitis?
inflammation of the nasal cavities along with the paranasal sinuses
what is acute sinusitis?
sinusitis that completely resolves within 12 weeks
Recurrent acute sinusitis refers to four or more annual episodes of sinusitis without persistent symptoms in the intervening periods.
what is chronic sinusitis?
Chronic sinusitis refers to sinusitis that causes symptoms that last for more than 12 weeks.
what are the causes of sinusitis?
- viral URTI e.g influenza
- asthma
- allergic rhinitis
- smoking
- anatomical variation e.g deviated nasal septum, nasal polyps, trauma
what are the predisposing factors and associated conditions to sinusisits?
- atopy (allergic rhinitis)
- asthma
- ciliary impairment
- aspirin sensitivity
- immunocompromised
- genetics
- smoking
- iatrogenic e.g sinus surgery can result in a increases risk of persistent sinus infection
what are the complications of chronic sinusitis?
- extra sinus symptoms e.g sleep problems, fatigue, depression
- reduced productivity, can affect work
- reduction in social function
what are the complications of acute sinusitis?
rare
- orbital e.g orbital cellulitis, orbital abscess, cavernous sinus thrombosis
- intracranial complications e.g meningitis, encephalitis, abscess
- osteomyelitis
- progression to chronic sinusitis
what are the symptoms of acute sinusitis?
Acute sinusitis usually follows a common cold, and is defined as an increase in symptoms after 5 days, or persistence of symptoms beyond 10 days, but less than 12 weeks.
- nasal blockage (obstruction/congestion)
- nasal discharge
- nasal speech
- tenderness/swelling/redness over the cheekbone or
periorbital areas - cough
what can be seen on rhinoscopy for sinusitis?
- nasal inflammation
- mucosal oedema
- purulent nasal discharge
- nasal polyps
- anatomical abnormalities
when should acute bacterial sinusitis be suspected?
Symptoms for more than 10 days
Discoloured or purulent nasal discharge (with unilateral predominance).
Severe local pain (with unilateral predominance).
A fever greater than 38°C.
A marked deterioration after an initial milder form of the illness (so-called ‘double-sickening’).
Elevated ESR/CRP (although the practicality of this criterion is limited).
how is acute sinusitis managed?
- refer if signs of more serious illness/condition, or signs of complication
- symptoms for =10 days, suggest paracetamol/iboprofen. No antibiotics.
- > 10 days, high dose nasal corticosteroid
- back up antibiotic prescription if these dont help
- deterioration, complications or no improvement 3-5 days after treatment, come back for review
when should a patient with acute sinusitis be refered?
Frequent recurrent episodes (more than three episodes requiring antibiotics a year).
Treatment failure after extended courses of antibiotics.
Unusual or resistant bacteria.
Anatomic defect(s) causing obstruction.
Immunocompromise.
A suspected allergic or immunological cause.
Comorbidities complicating management such as nasal polyps
how should chronic sinusitis be managed?
- admit if associated with severe systemic infection or complications e.g orbital or intracranial involvement
- advise avoidance or triggers, smoking, practise good hygiene.
- consider nasal irrigation with saline to relieve congestion and nasal discharge
- seek specialist advice before giving antibiotics
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when should a patient with chronic sinusitis be refered?
Unilateral symptoms (consider urgent referral as this increases suspicion of neoplasia).
Persistent symptoms despite compliance with 3 months of treatment.
Nasal polyps complicating assessment or treatment, particularly if present in children.
Recurrent episodes of otitis media and pneumonia in a child.
Unusual opportunistic infections.
Symptoms that significantly interfere with functioning and quality of life.
Allergic or immunologic risk factors that need investigating.
