Rhinosinusitis

Question 1

Definition

Answer 1

Inflammation of the nasal cavities and paranasal sinuses

Question 2

Acute

Answer 2

< 4 weeks

Question 3

Subacute

Answer 3

Up to 12 weeks

Question 4

Chronic

Answer 4

> 12 weeks

Question 5

Acute recurrent

Answer 5

> 4 acute episodes within a year

Question 6

Uncomplicated rhinosinusitis

Answer 6

Inflammation that does not extend beyond the anatomical boundaries of the nasal cavities and paranasal sinuses

Question 7

Complicated rhinosinusitis

Answer 7

Evidence of clinical extension of inflammation outside the nasal cavity and paranasal sinuses (e.g orbital cellulitis, osteomyelitis, meningitis)

Question 8

Types of chronic rhinosinusitis

Answer 8

• Chronic rhinosinusitis without nasal polyposis (MC)
• Chronic rhinosinusitis withnasal polyposis
• Allergic fungal rhinosinusitis (<5%)

Question 9

Risk factors

Answer 9

• Allergic rhinitis
• Environmental irritants
• Recurrent URTI’s
• Subnormal anatomy leading to sinus obstruction (deviated septum)
• Defective mucociliary clearance
• Smoking
• Asthma

Question 10

Signs

Answer 10

• Fever
• Swelling of nasal mucosa
• Tenderness over the affected sinus
• Nasal discharge = mucopurulent and white/yellow

Question 11

Symptoms

Answer 11

• Nasal congestion
• Facial pain (exacerbated by leaning forward) = due to poor innervation of paranasal sinus
  Headache
  Reduced sense of smell

Question 12

Red flag symptoms

Answer 12

• Severe, persistent headaches
• Periorbital oedema
• Visual changes (reduced acuity, double vision)
• Abnormal extra-ocular eye movements
• Cranial nerve palsies
• Proptosis
• Pain on eye movement
• Altered mental status
• Meningism: headache, stiff neck, photophobia

Question 13

Diagnosis

Answer 13

Uncomplicated = clinical diagnosis
Nasal endoscopy = visualise nasal passage and presence of polyps/obstructions
Sinus culture and CT sinus

Question 14

Acute Treatment

Answer 14

Viral (symptoms < 10 days) = self limiting, supportive
- consider: analgesia/antipyretic, decongestants (PHENYLEPHRINE = Max 3 days), Intranasal corticosteroid (IPATROPIUM) or intranasal saline
Bacteria (>10 days but < 4 weeks) = 7 days delayed or immediate Abx (purulent discharge) = AMOXICILLIN or Doxycycline
Suspected invasive fungal = refer to ENT

Question 15

Chronic Treatment

Answer 15

Intranasal corticosteroids (budesonide)
LTRA (Montelukast)
Surgery
- fail to respond to therapy
- who have pulp
- restore sinus ventilation

Question 16

Complications

Answer 16

• Chronic sinusitis
• Orbital complications: orbital cellulitis, subperiosteal abscess
• Intracranial complications: meningitis, brain abscess
• Osteomyelitis of the frontal bone: causing an abscess, known as Pott puffy tumour