Sinusitis/ rhino sinusitis Flashcards
What is it?
Inflammation of the mucosa and paranasal sinuses caused by bacterial/ viral infection
Classification
Acute:
- Symptoms less than 12 weeks
- Symptoms resolve completely
Acute recurrent :
- > 1 and less than 4 episodes of acute sinusitis each ear
- Complete recovery between attacks
- Periods of well being of at least 8 weeks between attacks
Chronic:
- Over 12 weeks
- Inflammatory changes are continuous for >4weeks
Acute exarcebbations of chronic :
-Complete resolution of acute between attacks but not chronic
Aetiology
For acute
S.pneumoniae
H.Influenze
Gram negatives
For chronic:
- Head trauma
- Foreign body
Symptoms
Major:
- Facial pain / pressure
- Hyposmia/anosmia
- Nasal congestion/ obstruction
- Purulent postnasal drain
- Olfactory disturbance
- Cough (not related to asthma)
Minor
- Headache
- Fever
- Fatigue
- Halitosis: bad breath
- Dental pain
Treatment
Beta- lactams
Macrolides
Sinus surgery
Investigation
Nasal endoscopy
Sinus culture
CT/Xray
How do you manage a case of sinusitis with orbital swelling
- Emergency ENT referral
- Ophthalmology Opinion to assess colour vision, its the first to go when the optic nerve is damaged
- Urgent CT to show up abscess
- IV antibiotics and Steroids
- Emergency Surgery
What is Pott’s Puff tumour?
Its a complication of sinusitis, basically a subperiosteal abscess.
So the patient appears with sinusitis symptoms + fever, frontal headache and central forehead swelling.
How do you manage Pott’s Puff tumour?
Frontal Sinus Surgery or Endoscopic Sinus Surgery (ESS) followed by Abx
How do you manage a case of Ethmoidal mucocele
A benign cyst lesion of a minor salivary gland containing mucous. Needs to be removed with endocopic sinus surgery
What would you see on a CT of sinusitis?
- Sinus opacification
- Or a visible air/fluid level
- and/or mucosal thickening
