Rhinosinusitis

Question 1

What is the duration for acute rhinosinusitis and what are the symptoms experienced?

Answer 1

<4 weeks

• Systemic upset (pyrexia etc.)
• Rhinorrhoea w/ pus
• Nasal obstruction
• ± Facial pain & headache
• ± Anosmia/cachosmia
• ± Halitosis (bad breath)

Question 2

What is the duration for chronic rhinosinusitis and what are the symptoms experienced?

Answer 2

2 or more of the following for >12 weeks

• Nasal obstruction/ congestion
• Facial pain/pressure/fullness
• Hyposmia/anosmia
• Ant/post/both mucopurulent discharge (yellowish-green)

Question 3

What are the risk factors for acute rhinosinusitis?

Answer 3

Nasal polyps 🡪 blocks ostia of sinuses

Deviated septum 🡪 interferes w/ airflow through the nose

Dental infection 🡪 as roots of upper teeth may project into maxillary sinus

Question 4

When to suspect bacterial rhinosinusitis?

Answer 4

• Persistent symptoms w/o improvement (> 10 days)
• Severe symptoms, e.g. high fever >39 , purulent rhinorrhoea, facial pain > 3 days
• Worsening symptoms after 5- 7 days (new onset fever, headache increased nasal discharge)

Question 5

What is the treatent for bacterial rhinosinusitis?

Answer 5

Oral antibiotics

• Augmentin first line
• Doxycycline if allergic to penicillins (NOT IN CHILDREN)
• Fluoroquinolones (levoflox, moxiflox)

Intranasal steroids

Nasal decongestants

Oral antihistamines

Question 6

Complications of acute bacterial rhinosinusitis (ABRS)?

Answer 6

Intracranial (meningitis, abscess, cavernous sinus thrombosis)

Orbital (preseptal and orbital cellulitis, subperiosteal abscess, orbital abscess)

Others: chronic rhinosinusitis, facial cellulitis, osteomyelitis

Question 7

What are the clinical features of frontal sinusitis?

Answer 7

• Severe frontal headache, worse on bending

- Tenderness over the forehead, especially on percussion

Question 8

What are the complications of frontal sinusitis?

Answer 8

Spread to orbit 🡪 blindness

Spread to cranium 🡪 extradural or intracranial abscess

Question 9

What is the management of frontal sinusitis?

Answer 9

Treat aggressively, w/ broad-spectrum antibiotics and decongestants

If complications are present 🡪 surgical intervention w/ drainage of infected sinuses

Question 10

What are the red flags that suggest orbital movement in a patient with preseptal cellulitis?

Answer 10

loss of visual acuity & colour vision, RAPD, pain & limitation on eye movement, diplopia, proptosis

Question 11

How is chronic rhinosinusitis/ recurrent rhinosinusitis managed?

Answer 11

Medical: (for all sinusitis) intranasal steroids and abx

• Intranasal steroids - ↓ inflammation of sinus ostia
• PO Augmentin x10-14 days (if bacterial infection)

Surgical: to improve sinus drainage, depending on CT findings