Podcast
Questions and Answers
Why is it rare for the nasal mucosa to be affected without involving the paranasal sinuses?
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?
What are the two main classifications of rhinosinusitis?
Infectious and non-infectious.
Identify one type of chronic specific rhinosinusitis.
Identify one type of chronic specific rhinosinusitis.
Tuberculosis (TB).
What is the main cycle that complicates the pathogenesis of infectious rhinosinusitis?
What is the main cycle that complicates the pathogenesis of infectious rhinosinusitis?
Signup and view all the answers
List one type of non-allergic rhinitis.
List one type of non-allergic rhinitis.
Signup and view all the answers
What is a common treatment for allergic rhinitis that can lead to empty nose syndrome?
What is a common treatment for allergic rhinitis that can lead to empty nose syndrome?
Signup and view all the answers
Name one condition classified under chronic nonspecific rhinosinusitis.
Name one condition classified under chronic nonspecific rhinosinusitis.
Signup and view all the answers
Identify a drug that can cause drug-induced rhinitis.
Identify a drug that can cause drug-induced rhinitis.
Signup and view all the answers
What characterizes acute rhinosinusitis?
What characterizes acute rhinosinusitis?
Signup and view all the answers
What is rhinitis medicamentosa?
What is rhinitis medicamentosa?
Signup and view all the answers
List three commonly detected viruses associated with respiratory infections.
List three commonly detected viruses associated with respiratory infections.
Signup and view all the answers
What are the major symptoms that indicate a sinus infection?
What are the major symptoms that indicate a sinus infection?
Signup and view all the answers
What criterion is required for a diagnosis of a single sinus infection?
What criterion is required for a diagnosis of a single sinus infection?
Signup and view all the answers
Identify a minor symptom associated with sinus infections.
Identify a minor symptom associated with sinus infections.
Signup and view all the answers
What is the clinical significance of tenderness over the affected sinus during examination?
What is the clinical significance of tenderness over the affected sinus during examination?
Signup and view all the answers
What imaging study is noted as unnecessary for diagnosing acute rhinosinusitis?
What imaging study is noted as unnecessary for diagnosing acute rhinosinusitis?
Signup and view all the answers
If symptoms of acute rhinosinusitis persist for more than one week, what treatment options are recommended?
If symptoms of acute rhinosinusitis persist for more than one week, what treatment options are recommended?
Signup and view all the answers
Name two potential differential diagnoses for a single sinus infection.
Name two potential differential diagnoses for a single sinus infection.
Signup and view all the answers
Describe one investigation approach if complications from acute rhinosinusitis are suspected.
Describe one investigation approach if complications from acute rhinosinusitis are suspected.
Signup and view all the answers
What is the significance of pus in the middle meatus during examination?
What is the significance of pus in the middle meatus during examination?
Signup and view all the answers
What is the primary characteristic feature of Chronic Rhinosinusitis (CRS)?
What is the primary characteristic feature of Chronic Rhinosinusitis (CRS)?
Signup and view all the answers
Identify the most common symptom of CRS.
Identify the most common symptom of CRS.
Signup and view all the answers
What treatment option is recommended for acute exacerbation of CRS?
What treatment option is recommended for acute exacerbation of CRS?
Signup and view all the answers
What is a significant risk associated with prolonged use of topical decongestants like xylometazoline?
What is a significant risk associated with prolonged use of topical decongestants like xylometazoline?
Signup and view all the answers
Describe the investigation method of choice for assessing CRS.
Describe the investigation method of choice for assessing CRS.
Signup and view all the answers
What classification exists concerning nasal polyps in CRS?
What classification exists concerning nasal polyps in CRS?
Signup and view all the answers
What role do steroids play in the management of CRS?
What role do steroids play in the management of CRS?
Signup and view all the answers
What common factors can predispose an individual to CRS?
What common factors can predispose an individual to CRS?
Signup and view all the answers
What typically marks the difference between viral and bacterial rhinosinusitis in terms of symptom duration?
What typically marks the difference between viral and bacterial rhinosinusitis in terms of symptom duration?
Signup and view all the answers
Name at least two common viral agents responsible for acute rhinosinusitis.
Name at least two common viral agents responsible for acute rhinosinusitis.
Signup and view all the answers
What are the cardinal symptoms of acute bacterial rhinosinusitis?
What are the cardinal symptoms of acute bacterial rhinosinusitis?
Signup and view all the answers
Why are antibiotics generally unnecessary in treating acute viral rhinosinusitis?
Why are antibiotics generally unnecessary in treating acute viral rhinosinusitis?
Signup and view all the answers
What is the incubation period for acute viral rhinosinusitis?
What is the incubation period for acute viral rhinosinusitis?
Signup and view all the answers
What might complicate an acute viral infection in an immunocompromised patient?
What might complicate an acute viral infection in an immunocompromised patient?
Signup and view all the answers
Identify two features of treatment for acute rhinosinusitis.
Identify two features of treatment for acute rhinosinusitis.
Signup and view all the answers
What role does the ciliary epithelium play in the pathophysiology of acute bacterial rhinosinusitis?
What role does the ciliary epithelium play in the pathophysiology of acute bacterial rhinosinusitis?
Signup and view all the answers
What is FESS and how does it minimize external scarring?
What is FESS and how does it minimize external scarring?
Signup and view all the answers
Describe the main difference in treatment between preseptal cellulitis and orbital cellulitis.
Describe the main difference in treatment between preseptal cellulitis and orbital cellulitis.
Signup and view all the answers
What complication does Chandler's classification associate with orbital cellulitis?
What complication does Chandler's classification associate with orbital cellulitis?
Signup and view all the answers
What is Pott Puffy Tumor and how does it relate to sinus infection?
What is Pott Puffy Tumor and how does it relate to sinus infection?
Signup and view all the answers
What are common clinical features associated with preseptal cellulitis?
What are common clinical features associated with preseptal cellulitis?
Signup and view all the answers
What significant symptoms are indicative of a subperiosteal abscess in the context of sinus disease?
What significant symptoms are indicative of a subperiosteal abscess in the context of sinus disease?
Signup and view all the answers
How does cavernous sinus thrombosis present, and what is its treatment?
How does cavernous sinus thrombosis present, and what is its treatment?
Signup and view all the answers
In what age group is orbital complication due to sinus infection most common?
In what age group is orbital complication due to sinus infection most common?
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.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
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.