Sinusitis Lecture Powerpoint

Question 1

Rhinosinusitis

Answer 1

Proper term for sinusitis, inflammation of nasal cavity and paranasal sinuses either acute <4 weeks, subacute 4-12 weeks, recurrent acute, and chronic >12 weeks

Question 2

Complicated acute bacterial rhinosinusitis

Answer 2

Has clinical evidence of extension outsisde paranasal sinuses and nasal cavity

Question 3

Choanal atresia

Answer 3

Absence or impaired development of nasal passage

Question 4

Epithelium type in the paranasal sinuses

Answer 4

Ciliated columnar epithelium that can work against gravity to push debris out such as in the maxillary sinus

Question 5

The location of the vast majority of drainage from a sinusitis occurs from what?

Answer 5

Osteomeatal complex of the middle meatus

Question 6

The nasolacrimal duct empties into this part of the nose resulting in rhinorhea when crying

Answer 6

Inferior meatus

Question 7

Pathophysiology of sinusitis

Answer 7

Disturbance in the shape/function of sinus ostia from anything from viral URI to a nasal polyp leads to obstruction and stagnation of fluid acting as a space for bacteria and viruses to grow

Question 8

Vast majority of acute rhinosinusitis are due to a….

Answer 8

….virus

Question 9

Common bacterial pathogens that cause acute bacterial rhinosinusitis (4)

Answer 9

• strep pneumoniae
• haemophilus influenza
• moraxella catarrhalis
• pseudomonas (chronic obstruction)

Question 10

Translumination of the sinus

Answer 10

If seeing light shines thru the hard palate that implies air and that it is clear, however if it does not emit then that implies a fluid filled cavity

Question 11

Imaging for acute sinusitis

Answer 11

Not typically needed most of the time except in extreme circumstances when a CT is recommended or a MRI for a tumor or mass

Question 12

Acute sinusitis treatment (2)

Answer 12

• Supportive treatment (decongestants, nasal sprays, nasal steroids, antihistamines)
• antibiotic therapy only if indicated

Question 13

Differentiating between bacterial and viral sinusitis

Answer 13

Bacterial will have persistent symptoms >10 days, has a biphasic pattern with worsening in the morning while viral is similar to UTI and symptoms peak day between 3-6

Question 14

1st line antibiotic for acute bacterial sinusitis

Answer 14

1) augmentin 875/125mg twice daily 5-10 days

2) doxy 100mg twice daily or 200 mg daily

Question 15

Pott’s puffy tumor

Answer 15

Superiosteal Abscess and osteomyelitis of the frontal bone that is tender, pitting, requires I and D and IV antibiotics

Question 16

Chronic sinusitis etiology

Answer 16

Less likely to have bacterial or viral etiology, inflammation of the mucosa due to other ause such as allergies or mechanical obstruction, poorly understood what initial stimulus and perpetuation are, can co-occur with acute sinusitis with bacteria

Question 17

Signs and symptoms of chronic sinusitis (3)

Answer 17

• nasal congestion
• sometimes nasal discharge
• mild pain and headaches that flares with acute exacerbations

Question 18

If a patient has an upper respiratory infection first followed by a sinusitis, then it may be likely…

Answer 18

…bacterial in origin

Question 19

Severe facial pain in the sinuses is likely bacterial or viral?

Answer 19

Bacterial