sinuses/exams/complications Flashcards
What sinuses are present at birth radiographically?
Maxillary and ethmoid
When are the frontal sinuses radiographically visible?
develop over the first year of life but not visible on x-ray until between 3-7 years old
What age are the sphenoid sinuses radiographically visible?
anatomically present at age 4-5 but not visible on x-ray til age 9
Under the age of 7 kids usually have an infection of what instead of sinusitis?
Adenoiditis
sinus symptoms lasting more than 10 days, worsening of symptoms after initial improvement (double sickening), persistent purulent nasal discharge, fever, unilateral face or tooth pain….
This is more likely a bacterial or viral sinusitis?
Bacterial
T/F The vast majority of cases of rhinosinusitis are bacterial not viral?
False…most sinus infections are viral NOT bacterial
**It is the persistence of symptoms that suggests sinusitis.
What different organsmisms cause bacterial sinusitis?
Streptococcus species (most common) Haemophilus influenza (common in smokers) M. Catarrhalis
What are the causative viral organisms of sinusitis?
Adenovirus
rhinovirus
influenza A and B
RSV
What are the symptoms of sinus infection?
fever in children not adults thick, purulent nasal discharge (green, yellow) cough (nocturnal or early morning) sore throat from post nasal drip headache pressure over frontal or maxillary sinuses bad breath (halitosis) periorbital edema (usually in kids)
What are the 3 clinical presentation scenarios seen in bacterial sinusitis instead of viral sinusitis?
Based off the 2012 IDSA
1: persistent symptoms consistent with sinusitis not lessening or improving for > 10 days
2: Onset with severe symptoms or high fever >103 and purulent nasal discharge or facial pain lasting >3-4 days
3: onset with worsening symptoms or double sickening (relapse after initial improvement with fever, headache or increase in nasal discharge after a URI for 5-6 days) for >3-4 days
What conditions would warrant the use of a CT scan of the sinuses, sinus radiographs or ultrasonograms?
acute sinusitis and facial swelling not responsive for antibiotics over 48 hours
patient with toxic appearance
chronic or recurrent sinusitis
chronic unresponsive asthma
What is the first line antibiotic for acute sinusitis
Augmentin
500-875 mg bid in adults x 5-14 days
45-90 mg/kg/day in kids 10 days
Higher dosages if chance of resistance
What are some risk factors for resistance to antibiotic therapy?
age <2 years or >65 years recent antibiotic use hospitalization with in the last 5 days presence of co morbidities immunocompromised states geographic regions with endemic antibiotic resistance ABRS attendance at daycare These patients would get 875 mg po bid for adults and 90 mg/kg/day for kids higher doses associated with diarrhea
What is the supportive care for viral sinusitis
NSAIDs and acetaminophen
Flonase (intra nasal steroids)
saline irrigation (neti pot)
anti histamines/decongestants
What are complications of sinusitis?
orbital cellulitis secondary to ethmoid sinuses (life threatening, swelling of eyelids, decreased EOMs, altered vision)
cavernous sinus thrombosis
brain abscess
subdural empyema
