HEENT 06: Sinusitis Flashcards
(37 cards)
What is acute sinusitis?
symptoms for < 4 weeks, ≤ 3 episodes per year
What is chronic sinusitis?
symptoms for ≥ 12 weeks
What is recurrent sinusitis?
≥ 4 symptomatic episodes per year, complete resolution of symptoms between episodes
What are the causative organisms of sinusitis?
viral – 90%
bacterial
- Streptococcus pneumoniae
- Hemophilus influenzae
- Moraxella catarrhalis – 25% in children, infrequent in adults
- less common pathogens: Staphylococcus aureus, Group A Streptococci, anaerobes (acute)
What are the risk factors for sinusitis?
- recent viral URTI
- asthma
- allergic rhinitis, rhinitis medicamentosa
- smoking or exposure to second-hand smoke
- anatomy – deviated septum, turbinate deformity
What are the signs and symptoms of sinusitis?
- facial pain, pressure or fullness
- referred pain to ears, teeth
- headache
- purulent nasal discharge
- fever
- altered smell, taste
- halitosis
- cough
- malaise
PODS: facial Pain, nasal Obstruction, purulent nasal Discharge, Smell disorder
What are the most common symptoms of sinusitis in children?
- cough
- rhinorrhea
How is viral vs. bacterial sinusitis differentiated?
based on symptom timeline
- individual signs/symptoms cannot be used to distinguish between bacterial and viral infection
What is the clinical presentation of viral sinusitis?
- symptoms peak rapidly, start to decline by 3rd day, end in 1 week
- symptoms may last longer in 25% of cases, but will be improving overall
What is the clinical presentation of bacterial sinusitis?
- 10 days or longer without improvement
- severe symptoms and high fever (> 39ºC) with purulent discharge or facial pain for 3-4 consecutive days at start of illness
- symptoms start to improve, then worsen by 5-7 days
How long do symptoms last?
- symptoms may last up to 1 month
- most symptoms resolve within 1 week
Are cultures used for sinusitis diagnosis?
no – not helpful in identifying pathogen (colonization)
Is diagnostic imaging used for sinusitis diagnosis?
- sinus x-rays do not differentiate between viral URTI and bacterial sinusitis
- CT scan considered if chronic sinusitis not responding to treatment
- colour of nasal discharge/sputum not used to diagnose sinusitis as bacterial – colour related to presence of neutrophils, NOT bacteria
What are the adjunctive treatments for sinusitis?
- intranasal corticosteroids
- analgesics
- nasal saline irrigation or steam inhalation
- decongestants (oral or nasal spray)
Intranasal Corticosteroids
- reduce inflammation to promote sinus drainage and improve sinus ventilation
- use in sinusitis is controversial
- consider for mild to moderate disease – reassess in 72 hours
When is a referral required?
- signs of periorbital or orbital cellulitis (eye pain, high fever, swelling around eye, decreased vision)
- blindness or impaired visual acuity or double vision
- altered mental status, confusion
- sign of intracranial complications (high fever, severe headache, stiff neck) – ie. brain abscess, meningitis
What is drug-induced rhinitis medicamentosa (rebound congestion)?
- non-allergic rhinitis due to prolonged topical vasoconstrictors presenting with reactive swelling of nasal turbinates, increased watery secretions
- caused primarily by topical decongestants: (phenylephrine/pseudoephedrine, naphazoline, oxymetazoline)
How should rebound congestion be managed?
discontinue oxymetazoline nasal spray gradually
- preferred over abrupt cessation to reduce discomfort
- tapering strategy: reduce usage to once daily for few days, then stop completely
- alternatively: switch to saline nasal spray to help with moisture and mild relief
initiate intranasal corticosteroid
- ie. fluticasone 50 mcg 2 sprays per nostril once daily
- helps reduce inflammation and congestion
- safe for long-term use and beneficial in managing rebound symptoms
supportive therapy:
- saline nasal irrigation (ie. neti pot or saline spray) to clear mucus and improve nasal breathing
- adequate hydration to thin mucus secretions
- avoid other nasal decongestants (ie. pseudoephedrine) – can worsen the rebound effect
What is the first-line treatment for sinusitis?
amoxicillin
- 500-1000 mg PO TID x 5-7 days
What is the first-line treatment if penicillin allergy?
doxycycline
- 200 mg PO once daily, then 100 mg PO twice daily x 5-7 days
What is the first-line treatment if beta-lactam allergy?
cefixime
- 400 mg PO once daily x 5-7 days
What is the treatment if severe symptoms or first-line is ineffective?
amoxicillin/clavulanate
- 875 mg PO twice daily x 5-7 days
What is the treatment if severe symptoms or first-line is ineffective and penicillin allergy?
doxycycline
- 200 mg PO once daily, then 100 mg PO twice daily x 5-7 days
What is the treatment if severe symptoms or first-line is ineffective and beta-lactam allergy?
levofloxacin
- 750 mg PO once daily x 5 days
