Sinusitis Flashcards
Sinusitis
Refers to inflammation of the paranasal sinuses in the face
Rhinosinusitis
Inflammation of the nasal cavity
Acute sinusitis
Less than 3 months
Chronic sinusitis
More than 3 months
Purpose of paranasal sinuses
Lighter weight of skull
Produce mucous and drain into the nasal cavities via holes called ostia
Pathophysiology of sinusitis
Blockage of the ostia prevents drainage of the sinuses, resulting in sinusitis.
Names of paranasal sinuses
Frontal sinuses - above the eyebrows
Maxillary sinuses - either side of the nose below the eyes
Ethmoid sinuses - in the ethmoid bone in the middle of the nasal cavity
Sphenoid sinuses - in the sphenoid bone at the back of the nasal cavity
Causes of sinusitis
Infection- URTI
Allergies- hayfever (with allergic rhinitis), pets
Obstruction of drainage - foreign body, trauma or polyps
Smoking
Risk factor for sinusitis
Asthma
Presentation of sinusitis
Nasal congestion
Nasal discharge
Facial pain or headache worse when leaning forward
Facial pressure
Facial swelling over the affected areas
Loss of smell
Examination signs for sinusitis
Tenderness to palpation of the affected areas
Inflammation and oedema of the nasal mucosa
Discharge
Fever
Other signs of systemic infection (e.g., tachycardia)
Investigation for sinusitis
Most cases Ix are not necessary.
If persistent symptoms despite treatment, investigations include:
Nasal endoscopy
CT scan
Management of acute sinusitis
Do not offer abx to pts with symptoms for up to 10 days.
If not improving after 10 days:
- High dose steroid nasal spray for 14 days (e.g. mometasone twice daily)
- A delayed antibiotic prescription, used if worsening or not improving within 7 days (phenoxymethylpenicillin first-line)
Management of chronic sinusitis
- Saline nasal irrigation
- Steroid nasal sprays or drops (e.g. mometasone or fluticasone)
- Functional endoscopic sinus surgery (FESS)
How long does viral sinusitis take to reolve typically
2 - 3 weeks
