sinusitis (quiz 1, exam 1) Flashcards
inflammation of the sinuses leads to blackade of the normal sinus drainage pathways (__), which in turn leads to __(4)
- sinus ostia
- mucus retention
- hypoxia
- decreased mucocilliary clearance
- predisposition to bacteiral growth
acute sinusitis symtpom duration
<4 weeks
subacute sinusitis symtpom duration
4-8 weeks
chronic sinusitis symptom duration
>8 weeks
recurrent acute sinusitis: __ epidsodes per year, with each episode lasting __ weeks
- 3 or more
- <2 weeks
acute rhinosinusitis (aka sinusitis) is inflammation of the __ and __
paranasal sinuses
nasopharynx
mos people with non-speicif URI have some component of sinus inflammation, with __% of pts with URI having abnormalities in the __ sinus (regardless of whether symtpoms localize to the sinuses)
- 87%
- maxillary sinus
sphenoidal sinusitis is __, has a different presentation, and has a greater risk of complications including __ and __; symptoms are non specific and usually include __ and __, making diagnosis difficult
- rare
- meningitis
- cavernous sinus thrombosis
- headache
- retro-orbital pain
most cases are caused by __; 10-20% of pts seeing a clnician with complaints consistent with sinusitis have a __ infection
- viral
- bacterial
bacterial rhinosinusitis complicates only __% of all cases of URI
0.5-2% (but 85-95% receive a prescription for antibiotics)
pathophysiology of acute sinusitis
pathophysiology of acute sinusitis
T or F: antibiotics reduce symptoms in most cases of sinusitis and paly a role in preventing complications
false
the main serious complicatinos of bacterial sinusitis are these 3 things
- local extension (e.g. osteitis, infection of the intracranial cavity, orbital cellulitis)
- spread of bacteria to the central nervous system
- infection of the intracranial venous sinuses
(these complications are rare, estimated to occur in 1 per 10,000 cases of sinusitis)
classis cymptoms of acute rhinosinustits
- nasal congestion
- purulent nasal discharge
- headache
- maxillary tooth pain
- hyposmia or anosmia (decreased or absent sense of smell)
- facial pain that is worsened by bending forward
- malaise
T or F: no symptom or cluster of symptoms effectively diferentiates viral from bacterial rhinosinusitis
true
clinical features that are sugestive of bacterial sinusitis
- presence of symptoms greater than 7-20 days
- MAXILLARY TOOTH PAIN
- unilateral facial pain
- unilateral sinus tenderness
- FEVER (MOST CONSISTENTLY CORRELATED WITH BACTERIAL SINUSITIS)
- PURULENT NASAL DISCHARGE
- symptoms worsening after initial improvement
normal sinuses
acute maxillary sinusitis; note the fluid levels in the maxillary sinuses (arrows)
common viral causes of acute sinusitis
- rhinovirus
- coronavirus
- adenovivrus
- parainfluenza virus
common bacterial causes of acute sinusitis
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
- Staphylococcus aureus
fungal sinusitis occurs in populations with __
underlying immune disorders (poorly controlled diabetes, hematologic malignancies, and chronic renal failure)
pts with fungal sinusitis may present with symptoms similar to acute rhinosinusitis, but imaging may reveal
a mass in the sinus and erosion into contiguous bone
fungal sinusitis: rapid management including __ and __ is essential
- surgical debridement
- antifungal therapy
most common causes of fungal acute sinusitis
- Asppergillus
- Mucorales (e.g. mucormycosis): classically occur during episodes of diabetic ketoacidosis, and are uncommon in the normal host
symptomatic therapy: maximizing __ is the goal
isnus drainage
symptomatic therapy: __ can help decrease discomfort and inflammation
non-steroidal anti-inflammatory drugs (NSAIDs)
symptomatic therapy: __ may decrease mucus production
first generation antihistamines
symptomatic therapy: corticosteroid nasal spary had __ results in studies; studies of decongestants reveal __ evidence for clinical benefit
- conflicting
- little (but decongestants may relieve symptoms in some pts)
symptomatic therapy: saline, either as a spray or a lavage, is promoted as helping to __
- clear mucus
- maintain mucosal moisture
- clear viral antigens
there is a lack of evidence from clinical trials but some pts may perceive some relief
its appropriate to treat acute sinusitis with antibiotics when pts have
moderate to severe symptoms that localize to the sinuses, which significantly interfere with routine activiteis, and are consistent with bacterial infection
antibiotics against __ are appropriate; it is recommended that __, __ or __ be used
- S. pneumoniae
- amoxicillin
- doxycycline
- trimethoprim-sulfamethoxazole
pts who have received recent antibiotics (within the past __ weeks) are at higher risk for harboring drug resistant organisms; __ or __ or __ are reasonable choices for pts with recent antibiotic exposure
- 6 weeks
- amoxicillin/clavulanic acid (augmentin)
- moxifloxacin
- levofloxacin
failure to respond to antibiotics within __ hours suggests with incorrect diagnosis or inactive agents; switching antibiotics to either a __ or __ is appropriate in this situation
- 72 hours
- fluoroquinolone
- amoxicilin/clavulanate
standard treatment duration for acute bacterial sinusitis is __ days
10-14 days
sinus radiography __ recommended for the diagnosis of uncomoplicated sinusitis
is not
acute bacterial sinusitis __ requrie antibitoic treatment
does not (esp. if the symptoms are mild or moderate)
pts with __ should be treated with an antibiotic; __ antibiotics are reasonable first line agents
- severe or persistent moderate symptoms and specific findings of bacterial sinusitis
- narrow-spectrum
