Upper Respiratory Tract Infection

Question 1

Give examples of URTIs

Answer 1

Common cold (most common, involves mucosa, nose, throat, sinuses, larynx)
Rhinitis
Sinusitis
Otitis media ± effusion
Otitis externa
Pharyngitis/tonsilitis
Croup

Question 2

What are the causes of the common cold

Answer 2

Rhinovirus (50%)
Coronavirus
Influenza and parainfluenza
RSV

Question 3

What are the symptoms of the common cold

Answer 3

Nasal block
Clear/mucopurulent discharge

Question 4

What is the management for the common cold

Answer 4

Health education → self-limiting (no ABx; virus) → may reduce anxiety and unnecessary visits to doctor
- Cough may last 4 weeks after cold
- Generally, recovery after 2 weeks
Pain → paracetamol or ibuprofen
Potentially decongestants or antihistamines

Question 5

Define sinusitis

Answer 5

Infection of the maxillary sinuses from viral URTIs → secondary bacterial infection

Question 6

What are the signs and symptoms of sinusitis

Answer 6

Uncommon <10yo as the frontal sinuses do not develop until late childhood

Pain, swelling and tenderness on front of face
Influenza-like illness

Question 7

What is the management for sinusitis

Answer 7

Consider admission (systemic infection, orbital issues, cranial complications)

<10 days: advice (2-3 weeks to resolve, simple analgesia, safety net (3 wks, very unwell, symptoms worsen), CONSIDER nasal decongestants/saline)

> 10 days:
12yo → intra-nasal corticosteroid for 14 days e.g. mometasone (symptomatic relief)
Back-up Abx if no resolvein 7 days/worsening
- Phenoxymethylpenicillin (clari if penAll)

Question 8

Define otitis externa and what are the types

Answer 8

inflammation of the outer ear – auricle, external auditory canal and outer surface of eardrum

Acute diffuse otitis externa
Chronic otitis externa
Necrotising otitis externa

Question 9

Describe acute diffuse otitis externa

Answer 9

AKA swimmer’s ear

Moderate temperature and lymphadenopathy
Diffuse swelling
Variable pain and pruritus
Moving ear/jaw is painful
Impaired hearing
± Bacterial infection

Question 10

Describe chronic otitis externa

Answer 10

Fungal and associated with underlying skin conditions, diabetes, immunosuppression

Discharge and itch are common
Less acute

Question 11

Describe necrotising otitis externa

Answer 11

Life-threatening extension into mastoid and temporal bones

Mainly due to P. aeruginosa or S. aureus
Mainly in elderly
Criteria – pain, oedema, exudate, micro abscess, granulation tissue, pseudomonas culture
If suspected requires urgent ENT referral

Question 12

What is the management for otitis externa

Answer 12

Topical drops of:
- Acetic acid (but is only effective for 1 week)
- Antibiotics – neomycin or clioquinol
Wicking and removal of debris
If this fails, reconsider diagnosis
If cellulitis or cervical lymphadenopathy → oral antibiotics