Nose and Sinus Flashcards
(41 cards)
Most frequent acute illness in the U.S.?
URI
How often do children/adults get URIs?
Preschool children: 5-7 x per year
Adults: 2-3 x per year
Most common cause of common cold
Rhinovirus (30-50%)
Coronavirus (10-15%) Influenza virus (5-15%)
Who are risk factors for the common cold?
Who is at risk for more severe complications?
daycare
at home parents
psychological stress
poor sleep
more severe: chronic dz immunodeficiency malnutrition cigarette smoking
Explain the normal course of the common cold and duration. (incubation, what symptoms normally present when?)
incubation: 2-3 days
Day 1 of sx: sore throat
day 2-3: nasal congestion, rhinitis
day 4-5: cough
duration: 3-10 days
Common sx with common cold
rhinitis nasal congestion sore throat cough sneezing malaise \+/- fever \+/- conjunctivitis watery eyes HA- mild myalgias- mild
PE findings in common cold
- nasal mucosal edema
- nasal congestion
- pharyngeal erythema
- +/- adenopathy
- clear lungs
- +/- conjunctival injection
How do you dx common cold?
H&P!- aka clinical diagnosis
Tx of common cold
Supportive care
- zinc, >75 mg
- hypertonic nasal saline irrigation
- nasal decongestant sprays
- oral decongestants
- intranasal ipratropium bromide (atrovent)
- intranasal cromoly sodium
- antitussives: dextromethorphan; codeine
- expectorants: guaifenesin
- analgesics: NSAIDS, acetaminophen
Pt education
- expected duration
- discuss abx
when should you use abx in common cold?
Only when you think pt will have complications like secondary bacterial infection
Acute Rhinosinusitis:
how many get it yearly?
men vs women?
age?
1 in 7-8 yearly
women> men
45-74 yo
Common cause of acute rhinosinisitis
Viral: rhinovirus, influenza, parainfluenza
bacterial- 0.5-2%
risk factors for Acute Rhinosinisitis
- older age
- smoking
- air travel
- changes in atmospheric pressure
- swimming
- asthma
- allergies
- dental dz
- immunodeficiency
explain the process of acute rhinosinisitis
normal sterile environment
decreased drainage of thick secretions
mucosal edema and sinus inflammation
obstruction of sinus ostia
entrapment of bacteria- leading to infection
Most important sx of acute rhinosinisitis
- nasal congestion/obstruction
- purulent nasal discharge
- facial pain or pressure
others (not highlighted): tooth discomfort fever fatigue cough ear pressure HA
Clinical signs of acute rhinosinisitis
- erythema or edema of cheekbone or periorbital
- cheek tenderness
- percussion tenderness of upper teeth
- purulent dischage in nose or pharynx
- sinus pain w/ percussion
- opacity of sinuses w/ transillumination
- diffuse nasal mucosal edema, turbinate hypertrophy
What are some red flags to watch for in acute rhinosinusitis?
- Fever > 102 w/ severe HA
- Abnormal vision (diplopia, blindness)
- change in mental status
- periorbital edema
- cranial nerve palsies
How do you diagnose Acute rhinosinusitis?
If suspected complicated ABRS?
Recurrent resistent sinusitis?
clinically!
ABRS: CT w/ contrast
recurrent: Non contrast CT
Indications of bacterial rhinosinusitis
- lasting 10 or more days w/o improvement
- fever > 102, purulent nasal discharge, facial pain
- onset of worsening sx after initially improving (double-worsneing)
from days 1-9, how do you treat acute Rhinosinusitis?
Supportive care
- analgesics
- saline irrigation
- oral decongestants
- intranasal glucocorticoids
If bacterial acute Rhinosinusitis, how do you treat? How long?
w/ Penicillin allergy?
Amoxicillin-clavulanate (aka Augmentin) 500-875 mg BID; 5-7 days
-If penicillin allergy: doxycycline
What do you NOT treat bacterial acute Rhinosinusitis with?
probs don’t need to know
macrolides
trimethoprim-sulfamethoxazole
cephalosporins
Potential complications of acute Rhinosinusitis
periorbital/orbital cellulitis
meningitis
osteomyelitis of sinus bone
intracranial abscess
How long does a pt need to have sx before saying it is chronic rhinosinusitis?
more than 12 weeks
