Nose/Sinus Disorders

Question 1

What causes acute sinusitis?

Answer 1

Same organisms a/w otitis media: S. pneumo, H. flu, GABHS, M. catarrhalis

Often occurs w/ rhinitis or follows URI

Question 2

What are s/s of acute sinusitis?

Answer 2

Sinus pain/pressure (worse w/ bending down & leaning forward)

Maxillary MC

HA, malaise, purulent sputum or nasal discharge, fever, nasal congestion

Question 3

What does acute sinusitis look like on PE?

Answer 3

sinus TTP

Opacification w/ transillumination

Question 4

How do you diagnose acute sinusitis?

Answer 4

Clinical. Sx > 1 week duration

CT = test of choice! Water’s view

Question 5

How do you treat acute sinusitis?

Answer 5

Sx: decongesants, antihistamines, mucolytics, corticosteroids, analgesics, nasal lavage

Sx should be present > 10-14 days before starting abx. Amox = DOC x 10-14 days
2nd line = Doxy, TMP-SMX
If refractory –> FQ, augmentin

Question 6

What are the s/s of allergic rhinitis?

Answer 6

Sneezing, nasal congestion/itching, clear rhinorrhea

A/w nasal polyps

Worse in the AM

Question 7

What does allergic rhinitis look like on PE?

Answer 7

Pale/violaceous, boggy turbinates, nasal polyps w/ cobblestone mucosa of conjunctiva

Question 8

How do you treat allergic rhinitis?

Answer 8

Intranasal corticosteroids (most effective)

Oral antihistamines

Decongestants

Mast cell stabilizers

Question 9

What causes nasal polyps?

Answer 9

Allergic rhinitis MC

Cystic fibrosis

Samter’s triad: asthma, nasal polyps, ASA/NSAID sensitivity/allergy

Question 10

How do you treat nasal polyps?

Answer 10

Intranasal corticosteroids = TOC !

Surgical removal if medical therapy unsuccessful