Understanding Rhinosinusitis

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Questions and Answers

Why is it rare for the nasal mucosa to be affected without involving the paranasal sinuses?

The ciliated respiratory mucosal lining of the nose and paranasal sinuses are contiguous.

What are the two main classifications of rhinosinusitis?

Infectious and non-infectious.

Identify one type of chronic specific rhinosinusitis.

Tuberculosis (TB).

What is the main cycle that complicates the pathogenesis of infectious rhinosinusitis?

Stagnation. Signup and view all the answers

List one type of non-allergic rhinitis.

Vasomotor rhinitis. Signup and view all the answers

What is a common treatment for allergic rhinitis that can lead to empty nose syndrome?

Surgical cutting of the inferior turbinate. Signup and view all the answers

Name one condition classified under chronic nonspecific rhinosinusitis.

Chronic rhinosinusitis without specific etiology. Signup and view all the answers

Identify a drug that can cause drug-induced rhinitis.

Aspirin. Signup and view all the answers

What characterizes acute rhinosinusitis?

It is a sudden onset of inflammation of the sinuses. Signup and view all the answers

What is rhinitis medicamentosa?

A form of non-allergic rhinitis caused by overuse of decongestant nasal sprays. Signup and view all the answers

List three commonly detected viruses associated with respiratory infections.

Rhinovirus, influenza virus, and respiratory syncytial virus. Signup and view all the answers

What are the major symptoms that indicate a sinus infection?

Facial pain/pressure, nasal obstruction, and purulence on nasal examination. Signup and view all the answers

What criterion is required for a diagnosis of a single sinus infection?

Two major factors or one major with two minor criteria. Signup and view all the answers

Identify a minor symptom associated with sinus infections.

Headache. Signup and view all the answers

What is the clinical significance of tenderness over the affected sinus during examination?

It indicates potential inflammation and is a common finding in sinus infections. Signup and view all the answers

What imaging study is noted as unnecessary for diagnosing acute rhinosinusitis?

CT scan. Signup and view all the answers

If symptoms of acute rhinosinusitis persist for more than one week, what treatment options are recommended?

Amoxicillin, amoxiclav, or a third-generation cephalosporin. Signup and view all the answers

Name two potential differential diagnoses for a single sinus infection.

Dental origin infection and foreign body. Signup and view all the answers

Describe one investigation approach if complications from acute rhinosinusitis are suspected.

A CT scan is needed to assess for complications. Signup and view all the answers

What is the significance of pus in the middle meatus during examination?

It signifies possible acute infection in the sinuses. Signup and view all the answers

What is the primary characteristic feature of Chronic Rhinosinusitis (CRS)?

CRS is characterized as an inflammatory condition lasting longer than 12 weeks. Signup and view all the answers

Identify the most common symptom of CRS.

Nasal obstruction is the most common symptom of CRS. Signup and view all the answers

What treatment option is recommended for acute exacerbation of CRS?

Antibiotics, such as Amoxiclav or levofloxacin, are recommended for acute exacerbation. Signup and view all the answers

What is a significant risk associated with prolonged use of topical decongestants like xylometazoline?

Prolonged use can cause rhinitis medicamentosa. Signup and view all the answers

Describe the investigation method of choice for assessing CRS.

A native CT scan of the nose and paranasal sinuses in coronal view is the investigation of choice. Signup and view all the answers

What classification exists concerning nasal polyps in CRS?

CRS can be classified as with nasal polyps or without nasal polyps. Signup and view all the answers

What role do steroids play in the management of CRS?

Steroid nasal sprays are used to reduce inflammation and alleviate osteal obstruction. Signup and view all the answers

What common factors can predispose an individual to CRS?

Local factors such as septal deviation can predispose individuals to CRS. Signup and view all the answers

What typically marks the difference between viral and bacterial rhinosinusitis in terms of symptom duration?

Viral rhinosinusitis typically resolves within a week to 10 days, while bacterial rhinosinusitis may persist for more than a week. Signup and view all the answers

Name at least two common viral agents responsible for acute rhinosinusitis.

Rhinovirus and influenza virus. Signup and view all the answers

What are the cardinal symptoms of acute bacterial rhinosinusitis?

Nasal obstruction and purulent rhinorrhea. Signup and view all the answers

Why are antibiotics generally unnecessary in treating acute viral rhinosinusitis?

Acute viral rhinosinusitis is self-limiting and typically resolves without the need for antibiotics. Signup and view all the answers

What is the incubation period for acute viral rhinosinusitis?

The incubation period is 1 to 4 days. Signup and view all the answers

What might complicate an acute viral infection in an immunocompromised patient?

It can convert to bacterial rhinosinusitis or lead to other bacterial infections such as pharyngitis or pneumonia. Signup and view all the answers

Identify two features of treatment for acute rhinosinusitis.

Topical nasal decongestants and plenty of fluid intake. Signup and view all the answers

What role does the ciliary epithelium play in the pathophysiology of acute bacterial rhinosinusitis?

The cilia and epithelium are damaged by the initial viral infection, leading to obstruction and stasis of sinus secretions. Signup and view all the answers

What is FESS and how does it minimize external scarring?

FESS stands for Functional Endoscopic Sinus Surgery, which is minimally invasive and utilizes endoscopic techniques to avoid external scars by treating sinus issues internally. Signup and view all the answers

Describe the main difference in treatment between preseptal cellulitis and orbital cellulitis.

Preseptal cellulitis is treated with oral antibiotics, while orbital cellulitis requires intravenous antibiotics due to its severity and potential complications. Signup and view all the answers

What complication does Chandler's classification associate with orbital cellulitis?

Chandler's classification highlights that orbital cellulitis can lead to complications such as ophthalmoplegia and decreased visual acuity. Signup and view all the answers

What is Pott Puffy Tumor and how does it relate to sinus infection?

Pott Puffy Tumor is osteomyelitis of the frontal bone presenting with a subperiosteal abscess, commonly arising as a complication of frontal sinusitis. Signup and view all the answers

What are common clinical features associated with preseptal cellulitis?

Common clinical features include unilateral eyelid swelling, erythema, local pain, and sometimes fever, without proptosis or eye movement limitation. Signup and view all the answers

What significant symptoms are indicative of a subperiosteal abscess in the context of sinus disease?

Signs of a subperiosteal abscess include swelling on the forehead or scalp and may involve limitations of movement and vision changes. Signup and view all the answers

How does cavernous sinus thrombosis present, and what is its treatment?

Cavernous sinus thrombosis may present with symptoms like headache, ocular signs, and requires treatment with intravenous antibiotics along with possible sinus surgery. Signup and view all the answers

In what age group is orbital complication due to sinus infection most common?

Orbital complications from sinus infections are most commonly seen in children aged 7-10 years. Signup and view all the answers

Study Notes

Rhinosinusitis

Rhino and Sinusitis are often combined because the mucosa lining of both are continuous
The ciliated respiratory mucosal lining of the nose and paranasal sinuses are contiguous
Rhinosinusitis typically affects children
Stagnation leads to a vicious cycle and the need to break it

Pathogenesis of Infectios Rhinosinusitis

Infective rhinosinusitis is a common disorder
Infectious rhinosinusitis is part of the common cold
Spread through aerosolized droplets from coughing and sneezing
Incubation period is 1-4 days

Classification of Rhinosinusitis

Rhinosinusitis can be classified as infectious or non-infectious
Infectious Rhinosinusitis:
- Acute Rhinosinusitis
- Chronic Nonspecific Rhinosinusitis
- Chronic Specific Rhinosinusitis (TB, Syphilis, Atrophic rhinitis and Rhinoscleroma)
Non-Infectious Rhinosinusitis
- Allergic Rhinitis
- Non Allergic Rhinitis:
  - Idiopathic/Vasomotor
  - Occupational
  - Hormonal
  - Drug induced (aspirin, NSAIDs, methyldopa, ACEi, β ⊖, OCP)
  - Rhinitis medicamentosa
  - NARES
  - Trauma
  - Smoking
Acute Rhinosinusitis:
- Caused by respiratory viruses
- Includes Rhinoviruses, influenza, and parainfluenza viruses
- Clinical Features:
  - Nasal congestion
  - Rhinorrhoea
  - Sneezing
  - Low-grade fever
- Self-limiting disease, usually resolves within a week or 10 days
- Can convert to Bacterial Rhinosinusitis in immunocompromised individuals
Acute Bacterial Rhinosinusitis:
- Usually follows viral upper respiratory infection
- Virus damages the cilia and epithelium
- Causes edema of the mucosa membrane and obstruction of sinus ostia
- Leads to stasis of sinus secretion and subsequent bacterial infection
- Common bacteria responsible:
  - Streptococcus pneumoniae
  - Haemophilus influenzae
  - Moraxella catarrhalis
  - Staphylococcus aureus
- Clinical features:
  - Nasal obstruction
  - Purulent rhinorrhoea
  - Facial pain/pressure
  - Hyposmia/anosmia
  - Cough
  - Fever
  - Headache
  - Fullness of ear
  - Dental pain
  - Halitosis

Major Symptoms of Rhinosinusitis

Facial pain/pressure
Facial congestion/fullness
Nasal obstruction/blockage
Nasal discharge/purulence/discolored (Anterior)
Posterior drainage
Hyposmia/anosmia
Purulence on nasal examination
Fever (acute RS only)

Minor Symptoms of Rhinosinusitis

Headache
Fever (non-acute)
Halitosis
Fatigue
Dental pain
Cough
Ear pain/pressure/fullness

Diagnosing Rhinosinusitis

Diagnosis requires two major criteria or one major and two minor criteria

Examining Rhinosinusitis

Tenderness over the affected sinus
Pus in the middle meatus
Swollen red turbinate

Investigating Rhinosinusitis

Acute Rhinosinusitis is a clinical diagnosis and does not usually require investigation
CT scan is needed if complications are suspected or the condition does not improve with treatment
CT scan can reveal an air-fluid level or frothy secretions

Treatment of Acute Rhinosinusitis

Oral antibiotics for 3-4 weeks if symptoms persist for more than 1 week
- Amoxicillin or Amoxiclav
- 3rd gen cephalosporin
- Levofloxacin or macrolides if allergic to penicillin
Local decongestant (not more than 3 days)
- Xylometazoline
- Oxymetazoline
Analgesia
Nasal irrigation to liquefy nasal secretions (hypertonic saline)

Chronic Rhinosinusitis (CRS)

CRS is an inflammatory condition of the nasal cavity and paranasal sinuses lasting for longer than 12 weeks
CRS can be infectious (usually mixed) or non-infectious
Sub-acute: 4-12 weeks
Acute: < 3 months
Chronic: > 3 months

Clinical Features of CRS

Nasal obstruction is the most common symptom
Facial congestion, pressure, and fullness
Discolored nasal discharge
Hyposmia
High fevers are usually absent
Fatigue and myalgias are common

On Examination of CRS

Mucosal edema
Nasal polyp (CRS can be classified with or without polyps)
Purulent secretion in case of acute exacerbation
Local predisposing factors like septal deviation

Investigating CRS

CT scan of the nose and paranasal sinuses is the investigation of choice
Native CT, coronal view
Mucosal thickness

Treatment of CRS

Antibiotics:
- Amoxiclav, levofloxacin are preferred
- Route of administration:
  - Oral
  - Intravenous
  - Local by nebulizer (recently)
Steroid nasal spray: to reduce inflammation and osteal obstruction
Oral steroid: can be given with a tapered dose, and monitored for side effects (if polyps)
Nasal douche with isotonic solution
Leukotriene antagonists
Antihistamines: can thicken mucus

Surgical Treatment of CRS

Functional endoscopic sinus surgery (FESS)
- Minimally invasive
- Avoids external scarring
- Treats the pathology under direct vision

Complications of Rhinosinusitis

Orbital complications:
- More common in children (7-10 years)
- Preseptal cellulitis: Oral antibiotics
- Orbital cellulitis: IV antibiotics
- Subperiosteal & Orbital abscess: Drainage + sinus surgery
- Cavernous sinus thrombosis: IV Antibiotics, sinus surgery +/- AC
Intracranial Complications:
- Meningitis
- Extradural, subdural and brain abscess
- Pott Puffy Tumor: Osteomyelitis of the frontal bone with the development of a subperiosteal abscess manifesting as a puffy swelling on the forehead or scalp. Usually occurs as a complication of frontal sinusitis.

Periorbital Edema

Unilateral swelling of the eyelids
Erythema
Local pain
Pyrexia

Orbital Cellulitis

Conjunctival oedema (chemosis)
Limitation of eye movement (ophthalmoplegia)
Painful eye movements
Proptosis
Pupillary reaction
Visual acuity
Color vision

Subperiosteal Abscess

Abscesses typically arise adjacent to the lamina papyracea, although some extend or arise superiorly beneath the thin floor of the frontal sinus.

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Description

This quiz covers key aspects of rhinosinusitis, including its definitions, pathogenesis, and classifications. Students will learn about the differences between infectious and non-infectious types, as well as the impact on children's health. Test your knowledge on this common disorder and its various forms.