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?

<p>Stagnation.</p>
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List one type of non-allergic rhinitis.

<p>Vasomotor rhinitis.</p>
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What is a common treatment for allergic rhinitis that can lead to empty nose syndrome?

<p>Surgical cutting of the inferior turbinate.</p>
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Name one condition classified under chronic nonspecific rhinosinusitis.

<p>Chronic rhinosinusitis without specific etiology.</p>
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Identify a drug that can cause drug-induced rhinitis.

<p>Aspirin.</p>
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What characterizes acute rhinosinusitis?

<p>It is a sudden onset of inflammation of the sinuses.</p>
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What is rhinitis medicamentosa?

<p>A form of non-allergic rhinitis caused by overuse of decongestant nasal sprays.</p>
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List three commonly detected viruses associated with respiratory infections.

<p>Rhinovirus, influenza virus, and respiratory syncytial virus.</p>
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What are the major symptoms that indicate a sinus infection?

<p>Facial pain/pressure, nasal obstruction, and purulence on nasal examination.</p>
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What criterion is required for a diagnosis of a single sinus infection?

<p>Two major factors or one major with two minor criteria.</p>
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Identify a minor symptom associated with sinus infections.

<p>Headache.</p>
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What is the clinical significance of tenderness over the affected sinus during examination?

<p>It indicates potential inflammation and is a common finding in sinus infections.</p>
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What imaging study is noted as unnecessary for diagnosing acute rhinosinusitis?

<p>CT scan.</p>
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If symptoms of acute rhinosinusitis persist for more than one week, what treatment options are recommended?

<p>Amoxicillin, amoxiclav, or a third-generation cephalosporin.</p>
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Name two potential differential diagnoses for a single sinus infection.

<p>Dental origin infection and foreign body.</p>
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Describe one investigation approach if complications from acute rhinosinusitis are suspected.

<p>A CT scan is needed to assess for complications.</p>
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What is the significance of pus in the middle meatus during examination?

<p>It signifies possible acute infection in the sinuses.</p>
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What is the primary characteristic feature of Chronic Rhinosinusitis (CRS)?

<p>CRS is characterized as an inflammatory condition lasting longer than 12 weeks.</p>
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Identify the most common symptom of CRS.

<p>Nasal obstruction is the most common symptom of CRS.</p>
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What treatment option is recommended for acute exacerbation of CRS?

<p>Antibiotics, such as Amoxiclav or levofloxacin, are recommended for acute exacerbation.</p>
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What is a significant risk associated with prolonged use of topical decongestants like xylometazoline?

<p>Prolonged use can cause rhinitis medicamentosa.</p>
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Describe the investigation method of choice for assessing CRS.

<p>A native CT scan of the nose and paranasal sinuses in coronal view is the investigation of choice.</p>
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What classification exists concerning nasal polyps in CRS?

<p>CRS can be classified as with nasal polyps or without nasal polyps.</p>
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What role do steroids play in the management of CRS?

<p>Steroid nasal sprays are used to reduce inflammation and alleviate osteal obstruction.</p>
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What common factors can predispose an individual to CRS?

<p>Local factors such as septal deviation can predispose individuals to CRS.</p>
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What typically marks the difference between viral and bacterial rhinosinusitis in terms of symptom duration?

<p>Viral rhinosinusitis typically resolves within a week to 10 days, while bacterial rhinosinusitis may persist for more than a week.</p>
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Name at least two common viral agents responsible for acute rhinosinusitis.

<p>Rhinovirus and influenza virus.</p>
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What are the cardinal symptoms of acute bacterial rhinosinusitis?

<p>Nasal obstruction and purulent rhinorrhea.</p>
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Why are antibiotics generally unnecessary in treating acute viral rhinosinusitis?

<p>Acute viral rhinosinusitis is self-limiting and typically resolves without the need for antibiotics.</p>
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What is the incubation period for acute viral rhinosinusitis?

<p>The incubation period is 1 to 4 days.</p>
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What might complicate an acute viral infection in an immunocompromised patient?

<p>It can convert to bacterial rhinosinusitis or lead to other bacterial infections such as pharyngitis or pneumonia.</p>
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Identify two features of treatment for acute rhinosinusitis.

<p>Topical nasal decongestants and plenty of fluid intake.</p>
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What role does the ciliary epithelium play in the pathophysiology of acute bacterial rhinosinusitis?

<p>The cilia and epithelium are damaged by the initial viral infection, leading to obstruction and stasis of sinus secretions.</p>
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What is FESS and how does it minimize external scarring?

<p>FESS stands for Functional Endoscopic Sinus Surgery, which is minimally invasive and utilizes endoscopic techniques to avoid external scars by treating sinus issues internally.</p>
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Describe the main difference in treatment between preseptal cellulitis and orbital cellulitis.

<p>Preseptal cellulitis is treated with oral antibiotics, while orbital cellulitis requires intravenous antibiotics due to its severity and potential complications.</p>
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What complication does Chandler's classification associate with orbital cellulitis?

<p>Chandler's classification highlights that orbital cellulitis can lead to complications such as ophthalmoplegia and decreased visual acuity.</p>
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What is Pott Puffy Tumor and how does it relate to sinus infection?

<p>Pott Puffy Tumor is osteomyelitis of the frontal bone presenting with a subperiosteal abscess, commonly arising as a complication of frontal sinusitis.</p>
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What are common clinical features associated with preseptal cellulitis?

<p>Common clinical features include unilateral eyelid swelling, erythema, local pain, and sometimes fever, without proptosis or eye movement limitation.</p>
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What significant symptoms are indicative of a subperiosteal abscess in the context of sinus disease?

<p>Signs of a subperiosteal abscess include swelling on the forehead or scalp and may involve limitations of movement and vision changes.</p>
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How does cavernous sinus thrombosis present, and what is its treatment?

<p>Cavernous sinus thrombosis may present with symptoms like headache, ocular signs, and requires treatment with intravenous antibiotics along with possible sinus surgery.</p>
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In what age group is orbital complication due to sinus infection most common?

<p>Orbital complications from sinus infections are most commonly seen in children aged 7-10 years.</p>
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How long do symptoms last in acute rhinosinusitis?

<p>Less than or equal to 4 weeks.</p>
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List three common viruses that cause acute viral rhinosinusitis.

<p>Rhinovirus, influenza, and parainfluenza viruses.</p>
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What are the two most common bacteria responsible for acute bacterial rhinosinusitis?

<p>Streptococcus pneumoniae and Haemophilus influenzae.</p>
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What is the primary treatment approach for acute viral rhinosinusitis?

<p>Symptomatic treatment.</p>
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If a patient with acute rhinosinusitis has symptoms that do not improve within a week, what intervention should be considered?

<p>Antibiotics.</p>
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How long do symptoms last in chronic rhinosinusitis?

<p>More than 12 weeks.</p>
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List three major symptoms that are used to diagnose chronic rhinosinusitis.

<p>Facial pain/pressure, facial congestion/fullness, and nasal obstruction/blockage.</p>
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Identify a condition that can be a local predisposing factor for chronic rhinosinusitis.

<p>Septal deviation.</p>
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What is the first-line medical treatment for acute exacerbation of chronic rhinosinusitis

<p>Antibiotics, specifically amoxiclav or levofloxacin.</p>
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Besides antibiotics, name two other medical treatments for chronic rhinosinusitis.

<p>Steroid nasal spray and nasal douche by isotonic solution.</p>
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If medical treatment fails to control chronic rhinosinusitis, what surgical option is typically considered?

<p>Functional endoscopic sinus surgery (FESS).</p>
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Name two examination findings suggestive of allergic rhinitis.

<p>Pale or bluish mucosa covered with watery secretions and boggy hypertrophied inferior turbinate.</p>
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What is the duration for subacute rhinosinusitis?

<p>4-12 weeks.</p>
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Define recurrent rhinosinusitis.

<p>Four or more episodes of rhinosinusitis per year, each lasting 7-10 days or more, with complete resolution between episodes.</p>
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Why are rhinosinusitis and sinusitis usually combined?

<p>The mucosa of the nose and sinuses are continuous, it's rare for one to be affected without the other.</p>
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Name a major symptom from chronic rhinosinusitus.

<p>Facial pain/pressure.</p>
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For diagnosis, what are two major factors or one major with how many minor criteria?

<p>Two minor criteria.</p>
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Besides the major and minor symptoms, what else must a doctor consider when diagnosing sinusitis?

<p>Tenerness over the affeted sinus. Pus in the middle meatus. Swollen red turbinate.</p>
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What type of scan should a doctor consider when diagnosing sinusitis?

<p>CT Scan.</p>
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Why topical use of Xylometazoline should be limited only for few days?

<p>Prolonged use of this can cause rhinitis medicamentosa.</p>
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Which nasal cavity and paranasal sinuses will have a inflammatory for longer than 12 weeks in chronic rhinosinusitis?

<p>Nasal.</p>
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Name one of the most common indications of CRS.

<p>Nasal obstruction.</p>
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What could be found during chronic rhinosinusitis examination?

<p>Mucosasl edema.</p>
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What type of scan is advised for investigation of chronic rhinosinusitis?

<p>CT Scan.</p>
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Which medication can be used to treat acute exacerebation of CRS

<p>Amoxiclav or levofloxacilin.</p>
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Name one surgical treatment of CRS

<p>Functional endoscopic sinus surgery or FESS</p>
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What system of complications can present with rhinosinusitis?

<p>Orbital complication.</p>
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What are the indications of Orbital complications?

<p>Meningitis, extradural, subdural and brain abscess.</p>
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How should preseptal cellulitis present?

<p>Present with Unilateral swelling.</p>
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How is color vision affected by Ethmoidal vein Thrombophelito?

<p>Color Vision is affected first.</p>
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What condition of orbital abscess can be an indication to proceed with an urgent CT scan?

<p>Painful eye movements.</p>
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What infection can progress from retrograde thrombophlebitis of the valveless ophthalmic veins?

<p>Cavernous sinus.</p>
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What should always be asked about a history when it relates to orbital complications?

<p>History of URTI</p>
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Flashcards

Rhinosinusitis

Inflammation of the nasal cavity and paranasal sinuses, often combined due to the continuous mucosal lining.

Infectious Rhinosinusitis

A common cause of rhinosinusitis spread by aerosolized droplets from coughing and sneezing.

Acute Viral Rhinosinusitis

Rhinosinusitis caused by respiratory viruses like rhinovirus, influenza, and parainfluenza viruses.

Acute Viral Rhinosinusitis Duration

Self-limiting, usually resolves within a week or 10 days

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Acute Bacterial Rhinosinusitis

Rhinosinusitis that follows a viral upper respiratory infection; common bacteria include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

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Symptoms of Acute Bacterial Rhinosinusitis

Nasal obstruction, purulent rhinorrhea, facial pain/pressure, hyposmia/anosmia, and cough.

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Treatment for Acute Rhinosinusitis

Oral antibiotics (Amoxicillin or Amoxiclav), decongestants, analgesia, and nasal irrigation.

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Major Symptoms of Rhinosinusitis

Facial pain/pressure, nasal obstruction/blockage, nasal discharge/purulence, hyposmia/anosmia.

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Minor Symptoms of Rhinosinusitis

Headache, fever, halitosis, fatigue, dental pain, cough, ear pain/pressure/fullness.

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Diagnosing Rhinosinusitis

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

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Physical Exam Findings in Rhinosinusitis

Tenderness over the affected sinus, pus in the middle meatus, and swollen red turbinate.

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Antibiotic Treatment Duration

Oral antibiotics for 3-4 weeks if symptoms persist for more than 1 week.

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Chronic Rhinosinusitis (CRS)

Inflammatory condition of the nasal cavity and paranasal sinuses lasting for longer than 12 weeks.

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Clinical Features of CRS

Nasal obstruction, facial congestion/pressure/fullness, discolored nasal discharge, and hyposmia.

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Investigating CRS

Investigation of Choice: CT scan of the nose and paranasal sinuses.

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Treatment of CRS

Antibiotics (Amoxiclav, levofloxacin), steroid nasal spray, oral steroids, and nasal douche.

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Surgical Treatment for CRS

Functional endoscopic sinus surgery (FESS).

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Orbital Complications of Rhinosinusitis

Preseptal cellulitis, orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis.

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Intracranial Complications of Rhinosinusitis

Meningitis, extradural/subdural/brain abscess, and Pott puffy tumor.

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Pott Puffy Tumor

Osteomyelitis of the frontal bone with subperiosteal abscess, manifesting as a puffy swelling on the forehead.

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Periorbital Edema

Unilateral swelling of the eyelids, erythema, local pain, and pyrexia.

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Orbital Cellulitis

Conjunctival oedema, limitation of eye movement, painful eye movements, and proptosis.

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Location of Subperiosteal Abscess

Adjacent to the lamina papyracea, or beneath the floor of the frontal sinus.

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Acute Rhinosinusitis (RS)

Lasts less than 4 weeks. Commonly caused by viral infections, may be complicated by bacterial infections.

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Subacute RS

Symptoms lasting between 4-12 weeks.

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Recurrent RS

Four or more episodes per year, each lasting 7-10 days or more, with complete resolution between episodes.

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Acute Exacerbation of Chronic RS

Sudden worsening of chronic RS with return to baseline after treatment.

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Pathogenesis of Infectios rhinosinusitis

Damage to cilia and epithelium, leading to mucosal edema and sinus ostial obstruction.

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Viruses Implicated in Rhinosinusitis

Common viral causes include rhinovirus, RCV, influenza, and parainfluenza viruses.

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Bacterial Causes of Rhinosinusitis

S. pneumoniae, H. influenzae, and M. catarrhalis

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Infection Type from Dental Origin

Anaerobic and mixed bacteria

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Single Sinus Infection Causes

Dental issues, fungal balls, or foreign bodies.

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Findings in Allergic Rhinitis

Nasal mucosa bilaterally swollen, edematous, pale or bluish, with watery secretions and boggy turbinates.

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Examination for Asthma Suspect

Includes PFTs and chest examination

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Chronic RS Characteristics

Nasal obstruction is most common; high fever usually absent.

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Antibiotics for Exacerbation of CRS

Amoxiclav or levofloxacin.

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Steroid Nasal Spray for CRS

Reduces inflammation and osteal obstruction over 8-12 weeks.

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Leukotriene Receptor Antagonist (LTRA)

Montelukast

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Acute RS Definition

Symptoms lasting for less than 4 weeks with complete resolution.

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Why Rhinosinusitis Together?

The mucosa of both the nose and sinuses are continuous.

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Causes of Mucosal Swelling

Allergy, infection, environment, superantigens, biofilms

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Vicious Cycle in RS

A vicious cycle triggered by mucosal swelling, mucus stasis, and sinus ostia obstruction.

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Examples of Infectious Rhinitis

Acute rhinosinusitis and chronic nonspecific RS

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Examples of Non-Infectious Rhinitis

Allergic rhinitis and vasomotor rhinitis

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Types of Non-allergic Rhinitis

Idiopathic/vasomotor, occupational, hormonal, drug-induced

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Common detected viruses

Rhinovirus, RSV, influenza virus, and parainfluenza virus.

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Viral Infection in Acute RS

The most common cause of acute rhinosinusitis.

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Symptomatic Treatments for Acute Viral RS

Topical nasal decongestants or antihistamines

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Features of Major symptoms

Nasal discharge/purulence/discoloured, Posterior drainage, Hyposmia/anosmia, Purulence on nasal examination

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Study Notes

  • Rhinosinusitis is defined as an inflammatory and/or infectious condition of nasal cavity and one or more of the paranasal sinus cavities
  • Usually rhinosinusitis is combined because the mucosa of both the nose and sinuses are continuous with each other
  • Acute Rhinosinusitis lasts for less than or equal to 4 weeks with complete resolution
  • Subacute Rhinosinusitis lasts for 4-12 weeks
  • Chronic Rhinosinusitis lasts for approximately 12 weeks
  • Recurrent Rhinosinusitis involves four or more episodes per year, each lasting 7-10 days or more with complete resolution in between episodes
  • Acute exacerbation of chronic Rhinosinusitis is the sudden worsening of chronic Rhinosinusitis with a return to baseline after treatment
  • With Acute viral Rhinosinusitis, symptoms improve within a week or 10 days
  • Treatment for Acute viral Rhinosinusitis is symptomatic and includes topical nasal decongestants, antihistamines and analgesics
  • Aspirin should be avoided in Acute viral Rhinosinusitis as it has been shown to increase shedding of the virus
  • Encourage plenty of fluid intake when treating Acute viral Rhinosinusitis
  • Nasal saline sprays are useful for treating Acute viral Rhinosinusitis
  • Antibiotics are not needed in Acute viral Rhinosinusitis
  • In immunocompromised patients, Acute viral Rhinosinusitis can convert to Bacterial Rhinosinusitis and may also cause pharyngitis, bronchitis, pneumonia, or otitis media
  • Two major symptoms or one major symptom and two minor symptoms are required in order to reach a diagnosis

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