Sinusitus Flashcards
Frontal Sinuses
Eyebrow area
- Appear after 5th year and develop into adolescence
Maxillary Sinuses
Inside both cheekbones
- Present since birth
Ethmoid Sinuses
Between the eyes behind the bridge of the nose
- Present since birth
Sphenoid Sinuses
Behind the eyes and above the bridge of the nose
- Appear by 3rd year and develop until 12th year
Sinusitis
- Most Common Predisposing Factor
Viral Upper Respiratory Infection
- Ostia are obstructed from inflammation caused by viral infection / allergen
- Cilia are immobile due to viruses or smoke
–> Bacteria and fluid become trapped and thus, can proliferate
Sinusitis
- Predisposing Factors
Medical Conditions
- Respiratory infections
- Allergic rhinitis
- Cystic fibrosis
Irritants
- Pollution
- Tobacco smoke
Anatomic
- Deviated nasal septum
- Immotile cilia
Medications
- Overuse of nasal decongestants
- Cocaine abuse
Trauma
- Diving, Dental procedure
Sinusitis
- Symptoms
- Fever
- Nasal congestion
- Maxillary toothache
- Facial pain
- Cough (More so in children)
Acute Sinusitis
- Diagnosis: What not to use
Colour of sputum
- Is only related to neutrophil count, should not be used to diagnose sinusitis
X-Ray
CT Scans
Culture of nasal discharge
Illumination of sinuses
Acute Sinusitis
- Diagnosis: Gold Standard
Puncture aspirate of sinus fluid
- Invasive procedure, only really done in treatment failure
Acute Sinusitis
- Diagnosis
Requires at least 2 of the following
- P: Facial Pain, Pressure/Fullness
- O: Nasal Obstruction
- D: Nasal Purulence / Discoloured postnasal Discharge
- S: Hyposmia / Anosmia (Smell)
1 one of the must be Nasal Obstruction or Postnasal Discharge
What bacteria pathogens cause Sinusitis
50%:
- S. Pneumoniae
- H. Influenzae
20%:
M. Catarrhalis
10%:
Anaerobes
20% will have respiratory viruses alone or with bacterial pathogens
- Rhinovirus
- Influenza / Parainfluenza
What bacteria pathogens rarely cause Sinusitis
S. Aureus
S. Pyogenes
Aerobic Gram-Negative Organisms
Bacterial Sinusitis vs Viral Sinusitis
Bacterial Sinusitis
1. Persistent symptoms
2. Severe symptoms
3. Double Sickening
What is Persistient Symptoms
Symptoms that last longer than 10 days with no sign of getting better
What are Severe Symptoms of Bacterial Sinusitis
Fever greater than 39°C and Purulent Nasal Discharge or Facial Pains for longer than 3-4 days
What is Double Sickening
A sign of Bacterial Sinusitis
After a Viral Sinusitis Infection that lasted 5-6 days and was initially improving the patient develops new symptoms of:
- New onset of fever
- Increase in nasal discharge
- Headache
Sinusitis
- Management Treatment
Works for both Viral and Bacterial Sinusitis
- Analgesics (Pain)
- Normal Saline (Nasal Irrigation)
- Steam Inhalation
- Intranasal Decongestant (Short Duration)
Works if there is an allergic component
- Second Generation Antihistamines
- Nasal Corticosteroid
* First Generation Antihistamine not recommended
If patient meets criteria for Bacterial Sinusitis
- Selective Antibacterial Therapy
Acute Sinusitis - No Beta-Lactam Allergy
- Treatment
Amoxicillin 500 mg - 1g tid
- Use 1g if patient has had recent antibacterial use in last 3 months
- Shorter therapy demonstrates better efficacy
Acute Sinusitis - No Beta-Lactam Allergy
- Treatment (Severe/Immunocompromised)
If Fever greater than 39°C and Purulent Nasal Discharge or Facial Pain
- Amoxicillin 1g bid + Amox/Clav 875 mg bid
Acute Sinusitis - Beta-Lactam Allergy
- Treatment
Doxycycline
Acute Sinusitis - Beta-Lactam Allergy
- Treatment (Severe/Immunocompromised)
Non-Severe Allergy
- Ceftriaxone
Severe Allergy
- Levofloxacin
Acute Sinusitis - No Beta-Lactam Allergy
- Treatment (Treatment Failure)
If patient was initially on Amox 500 mg tid
- Amox 1g po bid + Amox/Clav 875 mg po bid
If patient was initially on Amox 1g tid
- Amox/Clav 875 mg po bid
Acute Sinusitis - Beta-Lactam Allergy
- Treatment (Treatment Failure)
Levofloxacin
Sinusitis
-Re-currence within 3 months even after using treatment failure options
- Consider allergy testing
- Topical intranasal corticosteroid can provide benefit, should be used before ostea closure
- Refer to ENT if 4 or more episodes per year
