Rhinosinusitis Flashcards
What is rhinosinusitis?
Rhinosinusitis (RS) is inflammation of the nasal cavity mucosal linings and paranasal sinuses.
What are the different types of rhinosinusitis a pt can present with?
- Viral rhinosinusitis: rhinoviruses and coronaviruses.
- Post-viral rhinosinusitis – residual mucosal inflammation following a viral infection that produces ongoing symptoms.
- Bacterial rhinosinusitis – usually preceded by a viral infection, which predisposes the mucosa to bacterial infection
What causes rhinosinusitis?
- Nasal polyps. These tissue growths can block the nasal passages or sinuses.
- Deviated nasal septum
- Other medical conditions. The complications of conditions such as cystic fibrosis, HIV and other immune system-related diseases can lead to nasal blockage.
- Respiratory tract infections.
- Allergies such as hay fever. Inflammation that occurs with allergies can block your sinuses
- Most common causative organisms are S. pneumoniae, H. Influenzae, M. catarrhalis, and S. aureus
What are the risk factors for rhinosinusitis?
- A deviated nasal septum
- Nasal polyps
- Asthma
- Aspirin sensitivity
- A dental infection
- A fungal infection
- Tumors
- An immune system disorder such as HIV/AIDS or cystic fibrosis
- Hay fever or another allergic condition
- Regular exposure to pollutants such as cigarette smoke
What are the presenting symptoms of rhinosinusitis?
- Nasal inflammation
- Thick, discoloured discharge from the nose (runny nose)
- Drainage down the back of the throat (postnasal drainage)
- Blocked or stuffy (congested) nose causing difficulty breathing through your nose
- Reduced olfaction
- Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
- Reduced sense of smell and taste
- Ear pain
- Headache
- Aching in your upper jaw and teeth
- Cough or throat clearing
- Sore throat
- Bad breath
- Fatigue
What signs of rhinosinusitis can be found on physical examinations?
- Face pain or pressure that’s worse when leaning forward.
- Postnasal drip.
- Nasal congestion.
- Pain in your upper jaw.
- Toothache in your upper jaw.
- Yellow or greenish discharge from your nose.
- Fever.
- Cough.
What investigations are used to diagnose/ monitor rhinosinusitis?
- The diagnosis of acute rhinosinusitis is typically made on clinical symptoms alone.
- Imaging, such as a CT scan may be required if complications are suspected.
- Skin prick testing for allergy might be appropriate in patients with recurrent episodes and symptoms suggested of allergic rhinitis.
How is rhinosinusitis managed?
- Initial Management :
- For patient with symptoms up to 5 days (or >5 days but improving), symptomatic treatment with analgesia and nasal decongestants will suffice.
- For cases of >10 days or worsening after 5 days, topical nasal steroids and oral antibiotics are indicated. (amoxicillin or doxycycline.)
- If there is no improvement after 7-14 days of treatment or the presence of red-flag symptoms, referral to ENT services should be considered. - Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages.
- Nasal corticosteroids.
- Decongestants.
- Allergy medications.
- OTC pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or aspirin.
What complications may arise following rhinosinusitis?
- Vision problems. If your sinus infection spreads to your eye socket, it can cause reduced vision or possibly blindness that can be permanent.
- Infections. Uncommonly, people with chronic sinusitis may develop inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis), an infection in the bones, or a serious skin infection.
- Orbital cellulitis
- Osteomyelitis
Describe the prognosis of rhinosinusitis?
Acute rhinosinusitis tends to follow a favourable course and have a good prognosis.
Describe the pathophysiology behind rhinosinusitis?
Most commonly a viral upper respiratory infection causes rhinosinusitis secondary to edema and inflammation of the nasal lining and production of thick mucus that obstructs the paranasal sinuses and allows a secondary bacterial overgrowth. There are frontal, maxillary, sphenoid, and ethmoid sinuses.
Describe the epidemiology of rhinosinusitis?
Chronic rhinosinusitis (CRS)affects 12.5% of the US population.
