inflam of nasal cavity and paranasal sinuses causing nasal congestion, purulent drainage, and facial pain
rhinosinusitis
rhinosinusitis resolves in
acute
rhinosinusitis resolves 30-90d
subacute
rhinosinusitits w 3 episodes
recurrent acute
rhinosinusitis >90d w persistent symp
chronic sinusitis
path of viral rhinosinusitis
- direct inoculation via direct contact
- virus spreads paranasal sinuses by blowing nose and inc intranasal pressure that can impair nasal cilia
pt presents w mucosal edema, copious thickened secretions, and ciliary dyskinesia
viral rhinosinusitis
path of bacterial rhinosinusitis
complication viral sinusitis which bacteria take advantage of compromised cavities
risk factors of bacterial rhinosinusitis
allergic rhinitis, cocaine use, mechanical obstruction, swimming, dental infx, cystic fibrosis, immunocomp
organisms that can cause bacterial rhinosinusitis
strep pneumo
h infl
m cat
risk factors of rhinosinusitis
URI, allergic rhinitis, anatomical obstruction, mucosal irritants, sudden change atmospheric pressure
pt presents with nasal congestion, purulent drainage made worse when bends over
rhinosinusitis
pt presents nasal congestion, maxillary tooth pain, cough, ear pressure
rhinosinusits
guidelines for bacterial rhinosinusitis
persistent symp 10d w no improvement
severe symp or fever 102 w purulent discharge/facial pain for at least 3/4 consecutive days beginning
worsening symp following typical viral URI that lasted 5/6day and were initially improving
when should get ct with sinusitis
diminished visual acuity diplopia periorbital edema severe HA altered mental status
supportive tx viral rhinosinusitis
- nasal irrigation
- analgesics: tylenol/motrin
- top ster: flonase (fluticasone), nasacort (triamcinolone)
- top dec: afrin (oxymetazoline)
- oral dec: sudafed (pseudoephedrine), phenylephrine
- mucolytics: mucinex (guiafenesin)
tx for bacterial rhino sinusitis if >7d
amoxicillin-clavulanate (augmentin)
500 TID 875 BID 5-7d
peds- 90/kg 10-14 d
what should give person who is allergic to augmentin when tx bacterial rhinosinusitis
doxy or levofloxacin
what tx do you want to avoid for bacterial sinusitis
macrolides, bactrim, 2/3 gen cef due to inc resistance s pneumo
what should give kid with allergy to augmentin in tx bacterial sinusitis
anaphy- levofloxacin
mild- cefdodoxime, cefdinir, levofloxacin
3 types of chronic sinusitis
chronic w polyps
without polyps
allergic fungal
translucent, yellowish grey glistening masses filled w inflammatory material
nasal polyps
what will be shown on ct of chronic sinusitis
muscosal thickening, obstruction, sinus opacification, mucus retention cysts, nasal polyps
tx chronic sinusitis by ent
abx w oral steroids for several weeks, long term macrolide therapy, surgical debridement, antileukotrienes, antihistamines
