ENT

Question 1

ABRS (Acute Bacterial Rhinosinusitis)

1. Diagnosis requirements

Answer 1

1. >7-10 days + Nasal obstruction OR nasal purulent discharge AND At least one other symptom of PODS : nasal Pressure or pain, nasal obstruction, nasal discharge or anosmia.

Question 2

ABRS (Acute Bacterial Rhinosinusitis)

1. Top 3 bacterial causes

Answer 2

1. Streptococcus pneumonia
2. Haemophilus influenza
3. Moraxella catarrhalis

Question 3

ABRS (Acute Bacterial Rhinosinusitis)

Treatment

Answer 3

1. Mild to moderate : INCS + follow up in 72 hours
2. Severe : INCS + Antbiotics

Antibiotics: First line Amoxicillin. If beta lactam allergy : TMP/SMX

Second line: Amox- Clav; FQ. Can also use if high suspicion of bacterial resistance or high chance of therapy failure or failed first line

Symptomatic Tx : Oral analgesics, nasal decongestant, INCS, Saline

Question 4

ABRS (Acute Bacterial Rhinosinusitis)

-Red flag signs for urgent referral

Answer 4

1. Altered mental status
2. Changes in vision
3. Systemic Toxicity
4. Signs of meningitis
5. Severe headaches

Question 5

ABRS (Acute Bacterial Rhinosinusitis)

-When to consider a referral to ENT (No red flag signs)

Answer 5

1. Failed first and second line of therapy
2. >3 recurrences/year
3. Structural abnormalities of the nose
4. Immunocompromised

Question 6

ABRS (Acute Bacterial Rhinosinusitis)

Algorithm