Therapeutics - Sinusitis

Question 1

Name the 4 paranasal sinuses and where they’re located

Answer 1

1. frontal:
over the eyes in brow area
2. maxillary:
inside each cheekbone
3. ethmoid:
behind bridge of nose, between eyes
4. sphenoid:
upper region of nose, behind eyes

Question 2

What is an ostea and what happens to it with sinusitis?

Answer 2

Narrow passage, which allows drainage from sinus to nasopharynx

Inflammation of ostea blocks the drainage of sinuses: get overflow

Question 3

What is the purpose of paranasal sinuses?

What is produced in sinuses?

Answer 3

Turbinates air to warm and humidify

Thin mucous that washes over the sinuses via cilia

Question 4

What is the most common cause of acute rhinosinusitis?

How does acute bacterial sinusitis occur?

Answer 4

Uncomplicated viral upper respiratory tract infections

When ostea becomes obstructed and cilia immotile due to virus or allergens, the fluid and bacteria are trapped and proliferate

Question 5

Most common bacteria causing acute bacterial sinusitis

Answer 5

S.pneumo*
H.influ*
*Make up 50% of cases
M.catarrhalis
Mixed anaerobes

Question 6

ADULT

1. First line agent
2. Alternative First line
3. What constitutes severe acute sinusitis?

Answer 6

1. Amoxicillin 500mg-1g po tid x 5-7days (1g used if abx use in past 3 months)
2. If true penicillin allergy:
   Doxycycline
3. Fever >39; purulent nasal discharge; facial pain x3-4 days

Question 7

How is acute sinusitis diagnosed?

What is not helpful in diagnosing acute sinusitis?

Answer 7

Primarily hx and physical done

Not helpful: XRay scans, CT scans, nasal discharge culture

Question 8

Symptomatic management of acute sinusitis

What is not indicated?

Answer 8

Analgesics
NS irrigation
Steam inhalation
Topic decongestants (<5days)
Nasal corticosteroids: recurrent +/- allergic rhinosinusitis
2nd gen antihistamine if allergic component

Not indicated: First gen antihistamine

Question 9

PEDIATRIC

1. First line agent
2. Alternative

Answer 9

1. Amoxicillin 40mg/kg/day divided tid x10 days

IF <2 years; abx in past 3 mon; +/- daycare:

Amoxicillin 90mg/kg/day bid-tid x10days

2. If Nonsevere beta-lactam allergy:
   clindamycin + cefixime
   or
   Cefuroxime