Rhinonusitis

Question 1

What’s the most prevalent chronic disease in the US?

Answer 1

Chronic rhinosinusits.

Question 2

Where to the frontal, maxillary, and anterior ethmoid sinuses drain?

Answer 2

The middle meatus.

Question 3

Where do the sphenoid and posterior ethmoid sinuses drain?

Answer 3

The sphenoethmoidal recess.

Question 4

How is acute vs. subacute vs. chronic sinusitis classified?

Answer 4

Duration -
Acute: < 4wks.
Subacute: 4-12 wks.
Chronic: > 12 wks

Question 5

2 major components of sinusitis physiology?

Answer 5

Obstruction and infection.

Question 6

What can cause inflammation of the sinuses?

Answer 6

Lots of things:

URI, allergy, irritants (smoking!), barotrauma, dental infections.

Question 7

Anatomic causes of sinus obstruction? (3 things)

Answer 7

Septal deviation.
Pneumatized middle turbinate (concha bullosa.)
Nasal tubes.

Question 8

3 causes functional sinus obstruction?

Answer 8

Ciliary dysfunction (PCD).
Thick mucus - CF, dehydration.
Excessive mucus - infection, irritants.

Question 9

2 main things that could be confused with sinusitis?

Answer 9

Viral URI.

Allergic rhinitis.

Question 10

Important, more specific symptoms in sinusitis?

Answer 10

Headache and/or facial pressure/pain.
Facial sweeling.
Hyposmia/anosmia.

Question 11

How do you distinguish viral vs. bacterial sinusitis?

I.e., when do you give ABx?

Answer 11

When greater than 7 days, more likely to be bacteria.

Question 12

Common, less specific, symptoms of acute sinusitis?

Answer 12

"Congestion."
Thick, colored secretions.
Sore throat from post-nasal drip.
Cough.
Fever.
etc. etc.

Question 13

3 most common bugs in acute sinusitis?

Answer 13

Gram positives:
S. pneumo.
S. aureus.
H. flu.

Question 14

Is radiology useful in acute sinusitis?

Answer 14

No. It’s probably going to look really ugly, but that’s okay.

Question 15

Treatment for acute sinusitis?

Answer 15

ABx if bacterial.
Oral decongestants
Topical nasal decongestants.
Mucolytics.
Nasal irrigation / steam.
(the last 4 don’t shorten course, but relieve symptoms)
(Antihistamines should not be used unless allergy is underlying factor.)

Question 16

Chronic rhinosinusitis (CRS) is more about the inflammation than the infection per se. What pathogens are more common in rhinosinusitis?

Answer 16

S. aureus.
Pseudomonas.
Fungus.

Question 17

Cycle of the pathophysiology of chronic sinusitis (CRS)? (4 things)

Answer 17

Obstruction -> 
hypoxia/mucociliary dyfunction/stasis of scretion ->
bacterial proliferation -> 
inflammation ->
mucosal edema ->
(more obstruction)

Question 18

What’s the goal of treatment of CRS?

Answer 18

Increase mucociliary clearance

Question 19

What are nasal polyps from?

Answer 19

The result of lots of inflammation in CRS.

Question 20

First thing to do for chronic rhinosinusitis?

Answer 20

Manage medically, allieviate predisposing factors:
Smoking cessation.
ABx (data unclear on for how long, maybe 2-3 weeks)
Steroids
Irrigation +/- ABx
Decongestants

Question 21

When is surgery for CRS done?

Answer 21

Refractory cases, anatomic obstructions, complications

Question 22

Goals of CRS surgery?

Answer 22

Restore mucocilliary clearance.

Open sinuses for application of topical therapies, esp. anti-inflammatories.

Question 23

What complications do you worry about in ethmoid sinusitis?

Answer 23

Cellulitis.
Abscesses.
Cavernous sinus thrombosis - quite bad (recall from anatomy that CN VI can easily be affected here).

Question 24

Complications of frontal sinusitis?

Answer 24

Cranial extensions - abscesses above/under dura, meningitis.

Orbital infections.

Question 25

What’s Pott’s Puffy Tumor?

Answer 25

Infection spreads from frontal sinus via diploic vein -> pus in subgaleal space…
Circumscribed bump on forehead.

Question 26

Why is the sphenoid sinus most concerning for complicastions?

Answer 26

Connections to the cavernous sinus can lead to cranial spread, vision loss, cranial neuropathies.

Question 27

Most common finding in Invasive Fungal Sinusitis?

Answer 27

Pain.