Chapter 76 Sinusitis

Question 1

What is the recommended action when there is evidence of visual changes, periorbital cellulitis, mental status changes, high fever, significant headache, or acute focal pain?

Answer 1

Physician consultation

These symptoms indicate potential complications that require immediate medical attention.

Question 2

Define rhinosinusitis.

Answer 2

Symptomatic inflammation of the mucosal surface of the paranasal sinuses

It affects over 30 million Americans per year and results in significant healthcare costs.

Question 3

What are the subclassifications of rhinosinusitis based on symptom duration?

Answer 3

• Acute rhinosinusitis (ARS): resolves in < 4 weeks
• Subacute rhinosinusitis: resolves in 4 to 12 weeks
• Chronic rhinosinusitis (CRS): lasts > 12 weeks

This classification influences treatment guidelines.

Question 4

What is the most common cause of acute bacterial rhinosinusitis (ABRS)?

Answer 4

Streptococcus pneumoniae

Other common pathogens include Haemophilus influenzae and Moraxella catarrhalis.

Question 5

What are the common symptoms of acute rhinosinusitis (ARS)?

Answer 5

• Nasal congestion
• Purulent nasal discharge
• Headache
• Fever
• Fatigue

Symptoms often resemble those of an upper respiratory tract infection.

Question 6

True or false: Chronic sinusitis occurs with episodes of prolonged sinus infection lasting more than 12 weeks.

Answer 6

TRUE

It may also result from recurrent acute infections that are inadequately treated.

Question 7

What are the four cardinal symptoms of chronic rhinosinusitis (CRS)?

Answer 7

• Purulent nasal drainage
• Nasal obstruction
• Facial pain or pressure
• Decrease or loss of smell

Symptoms must last more than 12 weeks.

Question 8

What is the most commonly infected sinus?

Answer 8

Maxillary sinus

Its superior ostium placement fails to utilize gravity effectively.

Question 9

What are some predisposing factors for acute bacterial rhinosinusitis?

Answer 9

• Sinus surgery
• Immune compromise
• Mucosal edema from allergic rhinitis

These factors can lead to increased risk of infection.

Question 10

What is the gold standard for diagnostic certainty in complicated cases of rhinosinusitis?

Answer 10

Computed tomography (CT) without contrast

It is used for patients with prolonged or complicated courses.

Question 11

What is the initial management for uncomplicated acute bacterial rhinosinusitis (ABRS)?

Answer 11

Watchful waiting

Follow-up is planned in case symptoms worsen or last beyond 7 days.

Question 12

What are the first-line antibiotics for treating ABRS?

Answer 12

• Amoxicillin
• Amoxicillin-clavulanate

These are chosen to cover the most common pathogens.

Question 13

What is the number needed to treat (NNT) for clinical cure with antibiotic use in ABRS?

Answer 13

17

This indicates that treating ABRS with antibiotics may cause more harm than benefit.

Question 14

What are the priority differential diagnoses for unilateral nasal discharge?

Answer 14

• Foreign body or malignancy
• Dental abscess
• Trigeminal neuralgia
• Meningitis
• Orbital cellulitis
• Head injury
• Fungal rhinosinusitis

These conditions require careful evaluation to rule out serious complications.

Question 15

What is the number needed to treat (NNT) for antibiotic use in ABRS according to the text?

Answer 15

17

This indicates that for every 17 patients treated with antibiotics, one will achieve clinical cure.

Question 16

What is the number needed to harm (NNH) associated with antibiotic use in ABRS?

Answer 16

8

This suggests that for every 8 patients treated, one may experience harm.

Question 17

According to Lemiengre and colleagues’ Cochrane review, antibiotics should not be considered in treating ABRS due to what concerns?

Answer 17

• Risks of antibiotic resistance
• Risk of harm
• Low risk of serious complications

These factors led to the conclusion against antibiotic use in ABRS.

Question 18

What is the cornerstone treatment for CRS to combat inflammation?

Answer 18

Nasal steroids

They should be used for at least 8 to 12 weeks.

Question 19

What is the purpose of saline irrigation in CRS treatment?

Answer 19

• Improve quality of life
• Increase mucus clearance
• Remove allergens
• Improve ciliary action
• Protect nasal mucosa

Saline irrigation helps alleviate symptoms associated with CRS.

Question 20

True or false: Antibiotic treatment is supported for CRS patients with or without polyps.

Answer 20

FALSE

Evidence is lacking to support antibiotic treatment for CRS.

Question 21

What should be done if a patient with chronic recurrent sinusitis is not symptom-free after the second treatment with antibiotics?

Answer 21

Refer to an otolaryngologist

Worsening symptoms also warrant a referral.

Question 22

What percentage of patients with CRS, especially those with nasal polyps, have allergic rhinitis?

Answer 22

20% to 60%

This indicates a significant overlap between CRS and allergic conditions.

Question 23

What are the goals of endoscopic nasal surgery in sinusitis treatment?

Answer 23

• Remove nasal obstruction
• Improve sinus drainage
• Increase access for topical medications

Surgery aims to enhance the patient’s quality of life.

Question 24

What is a potential complication of sinusitis that can lead to Pott’s puffy tumor?

Answer 24

Osteomyelitis of the frontal bone

This condition is increasingly seen in the pediatric population.

Question 25

What is a serious complication of sinus infection that can lead to **visual loss**?

Answer 25

Orbital infection ## Footnote This occurs when the ethmoid sinuses are infected.

Question 26

What are the signs of **invasive fungal sinusitis** in immunocompromised patients?

Answer 26

* Fever * Facial pain * Epistaxis * Cognitive or visual changes ## Footnote Prompt recognition is essential to prevent infection proliferation.

Question 27

What is an important educational priority for patients with CRS regarding **nasal steroids**?

Answer 27

Correct use of nasal steroids ## Footnote Instructions include proper technique for administration.

Question 28

Patients should be reminded that antibiotic therapy is not beneficial in **viral rhinosinusitis**. True or false?

Answer 28

TRUE ## Footnote Antibiotics are ineffective against viral infections.

Question 29

What should patients with upper respiratory tract infections do if symptoms do not improve in **48 to 72 hours**?

Answer 29

Return for further evaluation ## Footnote This is crucial for assessing potential complications.

Question 30

What should patients with allergic rhinitis focus on to prevent **sinusitis**?

Answer 30

Environmental control ## Footnote This includes measures to manage allergens and irritants.

Question 31

What lifestyle changes are encouraged for patients to relieve nasal discomfort?

Answer 31

* Humidified air * Increased fluid intake * Smoking cessation * Frequent handwashing ## Footnote These changes can help alleviate symptoms and prevent infections.