Sinusitis

Question 1

Define acute rhinosinusitis

Answer 1

1. Rapid onset inflammation of nose and paranasal sinuses +
   Nasal blockage or nasal discharge
   Facial pain or pressure
   Reduction/loss of smell

Question 2

Commonest cause of acute rhinosinusitis

Answer 2

1. Viral

Question 3

When can bacterial occur

Answer 3

Usually as result of viral
immunocompromised
Odontogenic infection
Deficient mucociliary clearance
Mechanical nasal obstruction

Usually S pneumoniae
Severe fungal in immunocompromised/diabetic

Question 4

Management of uncomplicated acute viral rhinosinusitis

Answer 4

1. Usually for 7-10 days
2. Adequate and regular simple analgesia
3. Saline nasal sprays
4. Topical nasal corticosteroids
5. Decongestants->do not use for longer than three days
6. Topical ipratropium bromide may lessen rhinorrhea

Question 5

When to consider antibiotics

Answer 5

1. Symptoms >7 days, purulent discharge, sinus tenderness, maxillary toothache
2. Severe symptoms and high fever >39 at onset and lasting>3 days
3. Worsening after initial improvement

Question 6

Antibiotics used

Answer 6

Amoxycillin 500mg, 15mg/kg PO 8 hourly for 5 days
If inadequate
Amoxycillin + clavulanate

Question 7

What is chronic sinusitis, contributing

Answer 7

Symptoms lasting >12 weeks
Bacterial infection
Allergy
CF
Physical obstruction
Swelling for another reason
Mucocillary impairment
Immune deficiency
Prolonged use of decongestants

Question 8

On inspection of nose, in chronic rhinosinusitis what may be found

Answer 8

Nasal polyps

Question 9

Treatment in chronic rhinosinusitis

Answer 9

Prednisilone: tapering dose over three weeks if polyps, for 5-10 days if without polyps

Question 10

Should NSAIDs be used in chronic with nasal polyps

Answer 10

Risk of sensitivity, also in asthma

Question 11

DDX of sore throat

Answer 11

1. Strep pharyngitis
2. Viral pharyngitis
3. Infectious mononucleosis
4. Tonsilitis
5. Peritonsillar abscess
6. Foreign body/trauma
7. Leukemia
8. Hodgkins disease