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A - MSRA ENT > Acute Rhinosinusitis > Flashcards

Acute Rhinosinusitis Flashcards

1
Q

What is acute rhinosinusitis also known as?

A

Acute sinusitis

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2
Q

What is acute rhinosinusitis?

A

A symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal sinuses?

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3
Q

What is the time span of acute rhinosinusitis?

A

4 weeks or less

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4
Q

How many pairs of paranasal sinuses are there?

A

4

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5
Q

What are the names of the paranasal sinuses?

A
  • Frontal
  • Ethmoidal
  • Maxillary
  • Sphenoidal
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6
Q

Where does acute rhinosinusitis of the frontal sinuses cause pain?

A

The forehead

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7
Q

Where can acute rhinosinusitis of the ethmoidal sinuses cause pain?

A
  • Between/behind the eyes

- Sides of the upper nose

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8
Q

What can ethmoidal acute rhinosinusitis be subdivided into?

A

Anterior and posterior

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9
Q

What separates anterior and posterior acute rhinosinusitis of the ethmoid sinus?

A

The basal lamella of the middle nasal concha

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10
Q

Where can acute rhinosinusitis of the maxillary sinuses cause pain?

A

Cheeks

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11
Q

Where can acute rhinosinusitis of the sphenoidal sinuses cause pain?

A
  • Behind the eyes
  • On top of head
  • Over mastoid
  • Back of head
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12
Q

What is acute rhinosinusitis typically precipitated by?

A

A recent URTI

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13
Q

What type of URTI typically preceeds acute rhinosinusitis?

A

Viral

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14
Q

What viruses can lead to acute rhinosinusitis?

A
  • Rhinovirus
  • Coronavirus
  • Influenza
  • Adenovirus
  • RSV
  • Metapneumovirus
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15
Q

What are the most common bacterial causes of acute rhinosinusitis?

A
  • Strep pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
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16
Q

What are some less common causes of acute rhinosinusitis?

A
  • Fungal invasion
  • Chemical irritation
  • Tooth infection
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17
Q

Who is more prone to fungal acute rhinosinusitis?

A

Immunocompromised patients

18
Q

What can cause immunocompromisation?

A
  • Diabetes
  • AIDS
  • Transplant patients
19
Q

What chemicals can cause acute rhinosinusitis?

A
  • Cigarette smoke

- Chlorine fumes

20
Q

What are the risk factors for acute rhinosinusitis?

A
  • Asthma
  • CF
  • Poor immune function
  • GORD
21
Q

How do most patients present with acute rhinosinusitis?

A

Non-resolving cold which may have a biphasic character

22
Q

What is meant by the biphasic character of acute rhinosinusitis presentation?

A

The initial URTI settles and is then followed by further malaise due to sinusitis

23
Q

What is meant by a non-resolving cold?

A

> 1 week of persistent symptoms or worsening symptoms over 4-5 days

24
Q

What are the most common symptoms of acute rhinosinusitis?

A
  • Pain over affected sinuses
  • Pyrexia
  • Purulent nasal discharge
25
Q

How is acute rhinosinusitis pain described?

A
  • Constant dull headache/facial pain
26
Q

What can make the pain of acute rhinosinusitis worse?

A

Bending over or lying down

27
Q

What are some other symptoms of acute rhinosinusitis?

A
  • Ear pressure
  • Aching in jaw and teeth
  • Reduced sense of smell/taste
  • Cough
  • Halitosis
  • Fatigue
  • Fever
28
Q

What can often indicate a bacterial cause of acute rhinosinusitis?

A

Symptoms beyond 10 days

29
Q

What is the most common sign on examination?

A

Painful sinuses

30
Q

How is acute rhinosinusitis typically diagnosed?

A

Clinically

31
Q

What further investigations may sometimes be indicated in acute rhinosinusitis?

A
  • ESR
  • CRP
  • X-ray
  • USS
  • Nasendoscopy
  • CT
  • MRI
  • Sinus puncture
32
Q

What are the differentials for acute rhinosinusitis?

A
  • Allergic rhinitis
  • Non-allergic rhinitis
  • Common cold
  • Migraine
  • Adenoiditis
33
Q

What is the typical treatment for acute rhinosinusitis?

A

Nothing - it’s typically self-limiting

34
Q

What type of therapy is offered to patients with acute rhinosinusitis?

A

Symptomatic relief

35
Q

Where are most cases of acute rhinosinusitis managed?

A

Primary care

36
Q

What measures can be used to reduce symptoms?

A
  • Analgesics e.g. paracetamol/ibuprofen
  • Intranasal decongestants
  • Nasal douching with warm saline
  • Warm face packs
  • Adequate fluids and rest
37
Q

What are antibiotics preserved for in acute rhinosinusitis?

A

Severe or prolonged infections

38
Q

When is hospital referral indicated for acute rhinosinusitis?

A
  • Severe systemic infections
  • Complications of sinusitis
  • High risk patients e.g. immunocompromised
39
Q

What are the potential complications of acute rhinosinusitis?

A
  • Intracranial spread
  • Orbital spread
  • Osteomyelitis
  • Cavernous sinus thrombosis
  • Conversion to chronic sinusitis
40
Q

What are the symptoms of intracranial spread?

A
  • Severe frontal headache
  • Frontal swelling
  • Symptoms or signs of meningitis
  • Focal neurological signs
41
Q

What can orbital spread lead to?

A

Orbital cellulitis

A - MSRA ENT (22 decks)

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