Rhinosinusitis

Question 1

Defintion

Answer 1

Inflammation of the mucous membrane lining the paranasal sinuses leafing to swelling, increase mucus production and impaired mucus drainage

Question 2

Classification

Answer 2

Acute: Up to 4 weeks
Subacute: 4 - 12 weeks
Chronic sinusitis: > 12 weeks

Question 3

Epidemiology and risk factor

Answer 3

Allergies
Smoking
Asthma
Nasal Polyps
Immunodeficiency

Question 4

Aetiology

Answer 4

Viral URTI:
- Rhinovirus
- Influenza virus
- Parainfluenza virus

Question 5

Signs

Answer 5

• Fever
• Swelling of nasal mucosa
• Tenderness over affected sinuses

Question 6

Symptoms

Answer 6

• Nasal congestion
• Facial pain (exacerbate by leaning forward)
• Headache
• Reduced sense of smell

Question 7

Investigations

Answer 7

Clinical diagnosis based on history and physical examination
Consider:
- CT scan: if symptoms persist or complications are suspected to asses extend of sinus
- Nasal endoscopy: visualise the nasal passages and assess for the presence of polyps or other obstructions

Question 8

Management

Answer 8

First line:
- Analgesia: paracetamol and ibuprofen
- Nasal decongestant: phenylephrine
- Intranasal corticosteroid: reduce inflammation with mometasone or fluticasone
- Saline nasal irrigation: to help clear mucus and improve sinus drainage
Second line:
- Antibiotics: if bacterial sinusitis suspected and symptoms persist for more than 10 days or worsen after initial improvement consider AMOXICILLIN or DOXYCYCLINE

Question 9

Complications

Answer 9

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