Name the sinuses.
- frontal sinuses
- ethmoidal air cells
- sphenoidal sinuses
- maxillary sinuses
describe the common presentation of a pt with acute sinusitis
Symptoms:
- non-resolving cold
- facial pain/pressure over affected sinus, worse on bending forwards
- nasal obstruction or purulent nasal discharge
- +/- headache, fatigue, dental pain, cough…
Signs:
- pain on palpation of sinus
- pyrexia
- +/- erythema and oedema of nasal mucosa
how would you manage a pt with with acute sinusitis?
- Reassurance - generally self-resolving viral infection, improves in about 2.5 wks
- Symptom relief: paracetamol or ibuprofen for pain/fever, intranasal decongestant (max. 1 wk), nasal irrigation with warm saline solution…
If pt unwell for 10+ days with no improvement, consider:
3. High-dose nasal corticosteroid for 14 days or deferred antibiotic prescription, e.g. phenoxymethylpenicllin or co-amoxiclav
suggest possible complications of sinusitis
Rare but can include
- orbital cellulitis
- meningitis or brain abscess
- osteomyelitis
- cavernous sinus thrombosis
describe the common presentation of acute otitis media
Symptoms:
- ear pain
- fever
- malaise, vomiting
Signs:
- pyrexia
- red bulging tympanic membrane (+ air-fluid level behind it)
- +/- discharge in auditory canal secondary to TM perforation
how do infecting organisms reach middle ear?
From nasopharynx via Eustachian tube - children more at risk as ET shorter and more horizontal
what is the prognosis for acute otitis media?
- usually self-resolving within 3 days (80%).
- slowly resolving AOM may develop into otitis media with effusion (glue ear) - build up of fluid and negative pressure behind TM due to ET dysfunction. Most resolve spontaneously within 2-3 mths but some may require tympanostomy tube.
- possible complications inc. TM perforation, mastoiditis and cholesteatoma.
how would you manage a pt with acute otitis media?
- Usually conservative - paracetamol/ibuprofen - with no antibiotics.
- Delayed antibiotic prescription if lasting 4+ days or significant worsening.
- 5 day course of AMOXICILLIN if children systemically unwell, immunocompromise, perforation and/or discharge or bilateral AOM in children <2 yrs
what is mastoiditis? describe presentation
Spread of infection via mastoid antrum into mastoid bone.
- severe otalgia and pain behind ear
- swelling
- redness or tender mass behind ear
- external ear may protrude forwards
what is cholesteatoma? describe presentation
Abnormal skin growth into middle ear behind TM, expands and erodes into structures, e.g. ossicles, mastoid bone, cochlea.
- painless often smelly otorrhea
- +/- hearing loss
- crusting of superior TM and TM retraction (negative pressure due to blockage of ET)
