Sinusitis Flashcards

1
Q

Anatomical facts about sinuses

A

4 symmetrical air filled spaces
Lined by ciliated, columnar epithelium
Interconnected through small tubular openings
All drain into the osteomeatal complex which drains into the nasal cavity

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2
Q

What is the function of the sinuses?

A

Mucus that is of appropriate viscosity, composition and volume
Normal mucocilliary flow
Open Ostia to allow for adequate drainage and air flow

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3
Q

What is sinusitis?

A

Inflammation of the muscles membrane lining the paranasal sinuses

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4
Q

Causes of sinusitis

A

Allergic
Viral
Bacterial
Fungal

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5
Q

Types of Sinusitis

A

Acute
Subacute
Chronic
Recurrent

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6
Q

What is acute sinusitis

A

New infection less than 4 weeks in duration

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7
Q

What is subacute sinusitis

A

Lasting 4 to 12 weeks

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8
Q

What is chronic sinusitis

A

Symptoms lasting over 12 weeks

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9
Q

What is recurrent sinusitis

A

3 or more episodes in a year

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10
Q

What is responsible for the development of sinusitis?

A

Blockage or inflammation of the osteomeatal complex

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11
Q

How gets sinusitis

A

Both adults and kids

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12
Q

What happens once drainage and ventilation of sinuses is compromised?

A

The pH decreases
Oxygen content decreases
Cilia is less functional
Mucosal lining is damage

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13
Q

Predisposing/risk factors for sinusitis

A

Immune deficiencies
Foreign bodies
Fractured nose
Polyps
Allergies/asthma
Dental infection

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14
Q

What is the epidemiology

A

0.5% of all URTICARIA are complicated by sinusitis
Is one of the 10 most common diagnosis in primary care
1 in 10 people visit their doctor with sinusitis every year

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15
Q

Causes of sinusitis

A

A viral infection usually lasting up to 10 days
Mostly rhinovirus, adenovirus, influenza, and parainfluenza viruses

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16
Q

What are signs and symptoms of sinusitis?

A

Mucopurulent nasal discharge
Nasal congestion/obstruction
Tenderness over sinus/facial pain
Sometimes fever,headache and cough

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17
Q

How long does acute viral sinusitis symptoms tend to improve?

A

Within 1 week

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18
Q

When is sinusitis rare?

A

In children less then 9 years old
They have undeveloped sinuses

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19
Q

What does bacterial sinusitis in children look like? Symptoms?

A

Persistent symptoms of URTI without improvement after 10-14 days
Purulent nasal discharge and continued unwell state
With fever, cough, irritability, lethargy

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20
Q

Severe presentation bacterial sinusitis in children

A

Purulent nasal discharge
Fever > 39
With
Cough
Headache
Facial swelling

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21
Q

Bacterial Sinusitis in Adults (common) presentation

A

Persistent symptoms of URTI without improvement after 10 to 14 days or worsening after 5 days

22
Q

Symptoms for common presentation bacterial sinusitis

A

Nasal congestion
Purulent nasal discharge
Facial pain

Fever
Molar toothache
Facial swelling

23
Q

Signs and symptoms of sinutis

A

With the common cold
Sore throat & sneezing (resolve 3-6 days)
Fever, malaise, myalgia (resolve 6-8 days)
Cough, nasal discharge and nasal obstruction

24
Q

Diagnosis

A

Based mostly on signs and symptoms
Along with pt history and physical exam

25
Test that could be used for diagnosis for sinusitis
Nasal aspirates Transillumination of maxillary and frontal sinuses X-ray, CT scan
26
Microbiology of Sinusitis
S. pneumoniae H. Influenzae M. Catarrhalis May also be s. aureus, s. pyogenes
27
Causes of Sinusitis
Maybe Anaerobes
28
Clinical Course of Action for SInusitis
Usually recovers spontaneously without antibiotics Most pt will be better within 10 days
29
Non pharm Treatment for sinusitis
Steam inhalation Fluids Apply warm face cloth or heat of some kind Avoid irritants such as smoke Saline drops or irrigation
30
Pharm Treatment for Sinusitis
Analgesic Oral/topical decongestants Intranasal steroid Oral steroids
31
How would oral steroids help with sinusitis?
Reduce edema and inflammation but little evidence of benefit in acute
32
Antibiotic Treatment strategies
Should use the wait and see approach If still problem 7-10 days after meet with MD then might be warranted
33
Goals of Antibiotic treatments
Restore/improve sinus function Prevent intracranial complications Eradicate pathogen
34
What is the first line for sinusitis?
Amoxicillin
35
What is the dose of amoxicillin (adults) for sinutisis?
500-1000 mg TID for 5-10 d
36
What are the second line for sinusitis?
Amox/clav 2nd gen cephalosporin Doxycycline Clarithromycin or azithromycin
37
What is the dose for adults for amox/clav for sinusitis?
500 mg TID or 875 mg BID
38
What is the dose for doxycycline, adults, sinusitis?
100 mg BID day1 100 mg OD Or 200 mg day 1 100 mg BID
39
What is the third line treatment for sinusitis?
Levofloxacin Moxifloxacin
40
What is the dose for levofloxacin for sinusitis?
500 mg once daily for 5-10 days
41
What is the dose of moxifloxacin for sinusitis?
400 mg once daily for 5-10 days
42
What is the dose for amoxicillin (peds) for sinusitis?
40 to 90 mg/kg/day BID or TID For 10 days
43
What is the second line for peds for sinusitis?
Amox/clav Cefuroxime Cefprozil
44
What is the peds dose for sinusitis for amox/clav?
40-90 mg/kg/day BID 10 days
45
What is the dose for cefuroxime (peds) for sinusitis?
30-40 mg/kg/day BID For 10 days
46
What is the peds dose for cefprozil for sinusitis?
30 mg/kg/day BID For 10 days
47
What is the third line for peds sinusitis?
Clarithromycin Azithromycin TMP/SMX
48
What is the peds dose of clarithromycin for sinusitis?
15 mg/kg/day BID for 10 days
49
What is the peds dose for azithromycin for sinusitis?
10 mg/kg/day on 1 day 5 mg/kg/day for 4 days
50
What is the peds dose for TMP/SMX for sinusitis?
5-10 mg/kg/d TMP Divided BID
51
What is the microbiology for chronic sinusitis?
S. aureus and anaerobes
52
What is used on chronic sinusitis? How long?
Amoxicillin/clavulanate or clindamycin Treat for 3 weeks