Nasal Obstruction 2 Flashcards
(50 cards)
primaru causes of ars
rhinovirus, adenovirus, influenza
symptomatology of ars
sudden onset of two or more symptoms:
- nasal blockage, obstruction, congestion
- nasal discharge (ant/post)
- +/- facial pain or pressure
- +/- reduction or loss of smell
for <12 wks, with symptom free intervals if recurrent
what is the common cold or acute viral rs
duration of symptoms less than 10 days
what is acute post-viral rhinosinusitis
- increased or worsening of symptoms after 5 days
- persistent symptoms after 10 days
- with less than 12 wks duration
what is acute bacterial rs
at least 3:
- discolored discharge with unilateral predominance and purulent secretion
- severe local pain
- fever >38c
- elevated esr/crp
- double sickening
predisposing factors for abrs
- dental procedures
- iatrogenic causes
- immunodeficiency
- mechanical obstruction
- mucosal edema
respiratory viruses linking with receptors on nasal epithelium
icam1, tl3, rig-i, nlrp3, tlr7
if there are immune defense function defects you have __
prolonged course resulting to post-viral rhinosinusitis
secondary bacterial infection leads to acute bacterial rhinosinusitis
t/f some viruses like rsv can cause direct epithelial damage
true
epithelial dysfunction from inflammatory cascade
cilia loss
altered ciliary function
increased mucus production
barrier breakdown
t/f xray and ct is recommended on the first contact for ars
false
treatment for common cold
- analgesics, nasal saline irrigation, decongestants, selected herbal compounds
if failed after 10 days, add topical steroids
treatment for moderate (post viral) ars
- if symptoms persist after 10 d or increasing after 5 d
- tx: topical (intranasal) steroids for 7-14 d
- if no effect, refer
treatment for severe ars (+bacterial)
- if symptoms persist after 10 d or increasing after 5 d AND discolored discharge, fever, severe local pain, elevated crp/esr, double sickening
- tx: topical steroids and antibiotics
- no effect = refer
indications for immediate referral
- periorbital edema/ erythema
- displaced globe
- double vision
- ophthalmoplegia
- reduced vision acuity
- severe uni/bilateral frontal headache
- frontal swelling
- sx meningitis / neuro sx
empiric antibiotics for abrs
coamoxiclav 625 mg q8h or 1g q12h
amoxicillin 500 mg q8h or 1g q12h
allergic: doxycycline, levofloxacin, moxifloxacin
7-10 d
watchful waiting indicated for
temp less/= 38 C
no extra sinus complications
assurance of good follow up
indications for intranasal cs and topical nasal saline irrigation
cs: symptomatic relief
irrigation: to improve ciliary beat activity and mucociliary clearance
second line antibiotics
- for px with no response, or worsening symptoms after 5-7 d of first line
- sus amr
coamoxiclav 2g q12h, doxycyline, levofloxacin, moxifloxacin
definition of chronic rhinosinusitis
- > /= 12 wks for sinonasal symptoms
- endoscopic signs: nasal polyps, mucopurulent from middle, edema or obsturction in middle
- ct changes
predisposing factors to chronic rhinosinusitis
- allergy
- asthma
- nsaid exacerbated respiratory disease
- immune deficiencies
- microbiology
- fungal infection
- ciliary impairment
- smoking
- pollution
- osa, ms, obesity
how do nasid cause respiratory disease
- uninhibited 5 lipooxygenase resulting to increase leukotriene levels
- causes smooth muscle constriction resulting to airflow obstruction
- asthma + bronchiole constriction = bad
most common immunodeficiencies
common variable immunodeficiency
viruses that commonly cause exacerbations
coronavirus
parainfluenza
