Rhinosinusitis

Question 1

What is chronic rhinosinusitis?

Answer 1

A persistent inflammatory condition affecting the paranasal sinuses and nasal passages, typically lasting longer than 12 weeks

Chronic rhinosinusitis can significantly impact quality of life and may require medical or surgical intervention.

Question 2

What are the two types of chronic rhinosinusitis?

Answer 2

• CRS with nasal polyps
• CRS without nasal polyps

Understanding the type of chronic rhinosinusitis is crucial for effective management.

Question 3

List predisposing factors for chronic rhinosinusitis.

Answer 3

• atopy (hay fever, asthma)
• nasal obstruction (e.g. septal deviation, nasal polyps)
• recent local infections (e.g. rhinitis, dental extraction)
• swimming/diving
• smoking

These factors can contribute to the development or exacerbation of chronic rhinosinusitis.

Question 4

What is the typical triad of clinical features for chronic rhinosinusitis?

Answer 4

• nasal obstruction
• facial pain/pressure
• purulent nasal discharge

Recognizing these symptoms is essential for diagnosis and management.

Question 5

What does nasal obstruction in chronic rhinosinusitis indicate?

Answer 5

A sensation of blocked nose resulting from inflammation and swelling of nasal mucosa or polyp formation

This symptom can significantly affect breathing and quality of life.

Question 6

Describe facial pain or pressure associated with chronic rhinosinusitis.

Answer 6

Intermittent or constant dull ache or pressure sensation over affected sinuses, can worsen with bending forward or lying down

This pain may be localized to forehead, cheeks, between eyes, or behind eyes.

Question 7

What is purulent nasal discharge in chronic rhinosinusitis?

Answer 7

Thick and colored nasal discharge, indicating infection, which can be anterior (out of nostrils) or posterior (down back of throat)

The nature of the discharge can help differentiate chronic rhinosinusitis from other conditions.

Question 8

What are other symptoms of chronic rhinosinusitis?

Answer 8

• fatigue
• headache
• dental pain
• cough
• hearing changes

These symptoms can vary in severity and may overlap with other conditions.

Question 9

What investigations are used for diagnosing chronic rhinosinusitis?

Answer 9

• nasal endoscopy
• imaging (CT scan is gold standard)

These methods help visualize the condition of the sinuses and nasal passages.

Question 10

Name a differential diagnosis for chronic rhinosinusitis.

Answer 10

Allergic rhinitis

Allergic rhinitis is characterized by sneezing, itching, nasal congestion, and discharge, often with seasonal variation.

Question 11

What are the clinical features of allergic rhinitis?

Answer 11

• sneezing
• itching
• nasal congestion
• discharge

These symptoms can often be alleviated with antihistamines.

Question 12

What are nasal polyps?

Answer 12

Non-neoplastic masses of edematous nasal or sinus mucosa

They are often associated with chronic rhinosinusitis and can cause significant nasal obstruction.

Question 13

List symptoms of nasal polyps.

Answer 13

• nasal obstruction
• hyposmia or anosmia (loss of sense of smell)
• rhinorrhoea (running nose)
• facial pain or pressure
• snoring
• epistaxis
• postnasal drip

These symptoms can vary in severity and might require surgical intervention.

Question 14

What is the management for nasal polyps?

Answer 14

• topical corticosteroids
• oral corticosteroids
• intranasal saline irrigation
• endoscopic sinus surgery

Medical management is often the first step, followed by surgical options if necessary.