Stuffy Nose/ Rhinosinusitis

Question 1

What is rhino sinusitis?

Answer 1

inflammation in the nose and paranasal sinuses

Question 2

What are the symptoms of rhino sinusitis?

Answer 2

Patient must have 2 or more of:

Nasal blockage/obstruction/congestion/discharge
Decrease or loss of smell
Facial pain or pressure

Question 3

What is acute rhino sinusitis

Answer 3

The common cold

Question 4

What is the treatment of acute rhino sinusitis?

Answer 4

It is mainly self limiting and caused by viruses so treatment is supportive - paracetamol, rest, fluids
Avoid antibiotics unless severe or worsening symptoms

Question 5

What is acute post viral sinusitis?

Answer 5

An increase in acute rhino sinusitis symptoms after 5 days
OR
Persistent symptoms for more than 10 days

Question 6

What is the clinical presentation of acute bacterial sinusitis?

Answer 6

Severe unilateral local pain
Fever
Discoloured discharge - predominantly unilateral 
'double sickening' 
increased CRP and ESR

Question 7

What viruses cause acute rhino sinusitis?

Answer 7

rhinovirus mainly

also coronavirus, influenza A and B, parainfluenza, respiratory syncytial virus, adenovirus, and enterovirus

Question 8

What are nasal polyps?

Answer 8

Swellings of the nasal and sinus mucosa that prolapse into the nasal cavity

Question 9

What are the symptoms of chronic rhino sinusitis with nasal polyps?

Answer 9

Sneeze
Watery anterior rhinorrhoea 
Nasal obstruction 
Headaches 
Sinusitis 
Snoring

Question 10

How long do you have to have symptoms of rhino sinusitis for for it to be chronic?

Answer 10

at least 12 weeks

Question 11

What is the treatment of chronic rhino sinusitis with nasal polyps?

Answer 11

Topical steroids (to shrink the polyps)
If maximum medical treatment fails: endoscopic sinus surgery

Question 12

What are the investigations for nasal polyps?

Answer 12

Nasal endoscopy

Anterior rhinoscopy

Question 13

What should polyps look like endoscopically?

Answer 13

Pale
Mobile
Insensitive to gentle palpation

Question 14

What should you look out for in children under 10 with nasal polyps?

Answer 14

Cystic Fibrosis

Neoplasms

Question 15

What is the treatment for chronic rhino sinusitis without nasal polyps?

Answer 15

Intranasal steroid and nasal saline irrigation

If no improvement after 4 weeks and moderate to severe mucosal disease on endoscopy –> microbiology cultures and long term antibiotics
Poor response to this - surgery

Question 16

What is the cause of allergic rhino sinusitis?

Answer 16

IgE-mediated inflammation from allergen exposure to nasal mucosa, causing inflammatory mediator release from mast cells

Question 17

What should you check for in children with allergic rhino sinusitis?

Answer 17

Asthma

Question 18

Who gets seasonal allergic rhino sinusitis and who gets perennial?

Answer 18

Children - seasonal

Perennial - Adults

Question 19

What is seasonal allergic rhino sinusitis?

Answer 19

Hayfever

Question 20

What are the symptoms of allergic rhino sinusitis?

Answer 20

sneezing
pruritus
nasal discharge - bilateral and variable
bilateral red itchy eyes

Question 21

What are the signs of allergic rhino sinusitis?

Answer 21

Pale mucosa
Swollen turbinates
?nasal polyps?

Question 22

What is the treatment of allergic rhino sinusitis?

Answer 22

Allergen avoidance
Nasal saline irrigation
Can do immunotherapy in selected patients with IgE mediated disease

Stepwise:
1 - antihistamines
2 - intranasal corticosteroids
3 - both