Sinusitis - Med/High Priority

Question 1

What is sinusitis?

Answer 1

inflammation of the paranasal sinuses and is a subcategory of URTIs
-causes may be allergic, viral, bacterial, or fungal

Question 2

What is acute sinusitis?

Answer 2

lasting < or equal to 4 weeks

Question 3

What is the typical cause of acute sinusitis?

Answer 3

viral»>bacterial (S. pneumoniae, H. influenzae, M. catarrhalis)

Question 4

What is chronic sinusitis?

Answer 4

lasting > 12 weeks

Question 5

What are the typical causes of chronic sinusitis?

Answer 5

S. aureus
enteric gram-negative bacteria
Pseudomonas spp
fungal

Question 6

What is recurrent sinusitis?

Answer 6

4 or more episodes of acute sinusitis per year
-each episode lasting at least 10 days

Question 7

Describe the pathophysiology of sinusitis.

Answer 7

inoculation of conjunctiva or nasal mucosa –> spread to sinuses –> inflammation resulting in sino-nasal hypersecretion and increased vascular permeability

Question 8

What is the typical origin of sinusitis?

Answer 8

viral
-rarely complicated by bacterial infections

Question 9

How do the symptoms differ between bacterial and viral sinusitis?

Answer 9

symptoms are similar between bacterial and viral infections

Question 10

Differentiate viral and bacterial sinusitis.

Answer 10

viral infections peak at 3 days, improve in 7-10 days
bacterial infections last > 10-12 days and/or worsen after 3-4 days

Question 11

What are the risk factors for sinusitis?

Answer 11

preceding viral respiratory tract infection
prior recurrent rhinosinusitis

Question 12

What are the risk factors for penicillin-resistant S. pneumoniae?

Answer 12

daycare attendance
recent antibiotic use
age < 2 yrs
age > 65 yrs
immunocompromised

Question 13

What is the clinical presentation of sinusitis in adults?

Answer 13

pain, pressure or fulLness in the sinuses
obstruction (nasal)
discharge, purulent nasal/postnasal
smell, hyposmia, anosmia
other: HA, dental pain, fatigue, fever, ear pain

Question 14

What is the clinical presentation of sinusitis in children?

Answer 14

nasal discharge
fever
facial or sinus swelling and/or pain
irritability
lethargy
cough
vomiting

Question 15

What are the complications of sinusitis?

Answer 15

chronic sinusitis
spread of infection (meningitis, osteomyelitis, sepsis)

Question 16

How do the symptoms differ between chronic sinusitis and acute sinusitis?

Answer 16

chronic sinusitis presents with less specific symptoms

Question 17

What is the diagnosis of sinusitis based on?

Answer 17

clinical findings from patient history and physical examination

Question 18

What are the goals of therapy for sinusitis?

Answer 18

comforting pt and supportive care
encouraging hygiene for prevention of disease spread
providing symptomatic relief for congestion, pain, fever
providing antibiotic treatment for bacterial infections

Question 19

What are the components of PODS?

Answer 19

p: facial pain, pressure, or fullness
o: nasal obstruction
d: purulent/discoloured nasal or post-nasal discharge
s: hyposmia/anosmia (smell)

Question 20

Describe the treatment algorithm for sinusitis.

Answer 20

symptoms lasting < 7 days:
-symptomatic treatment

symptoms lasting > 7 days:
-PODS 2 or greater? 1/2 must be O or D
-mild-moderate sx: intranasal corticosteroid
-severe symptoms: antibiotics + INCS

Question 21

What are the non-pharmacological measures for sinusitis?

Answer 21

irrigation with nasal saline for congestion
rest and hydration
regular handwashing to limit infection spread
avoid allergen exposure and environmental toxins
sleep with head of bed elevated
apply warm facial compress

Question 22

How long should the use of oxymetazoline or xylometazoline be limited to?

Answer 22

3 days
-risk of rebound congestion

Question 23

Which pts should use oral decongestants cautiously?

Answer 23

cardiovascular disease
hypertension
diabetes
hyperthyroid

Question 24

In which age group should decongestants be avoided?

Answer 24

< 6 years of age due to side effect profile and lack of efficacy

Question 25

What is the role for antihistamines in sinusitis?

Answer 25

anticholinergic side effects may dry the mucosa and limit clearance of secretions -try to avoid 2nd gen antihistamines be useful for allergic sinusitis

Question 26

What is the role of intranasal corticosteroids in sinusitis?

Answer 26

some evidence for benefit if mild-moderate symptoms and as adjunct to antibiotics if severe symptoms

Question 27

What can be used for fever or pain in sinusitis?

Answer 27

analgesics and antipyretics

Question 28

What is 1st line therapy for uncomplicted acute sinusitis in adults?

Answer 28

amoxicillin

Question 29

What is 2nd line therapy for uncomplicated acute sinusitis in adults?

Answer 29

amoxicillin-clavulanic acid doxycycline respiratory FQ (levo/moxi) SMX/TMP macrolides ceftriaxone

Question 30

What is 1st line therapy for uncomplicated acute sinusitis in children?

Answer 30

amoxicillin 45-90 mg/kg/day

Question 31

What is 2nd line therapy for uncomplicated acute sinusitis in children?

Answer 31

amoxicillin-clavulanic acid macrolides SMX/TMP cefixime + clindamycin doxycycline (> 8 yrs of age)

Question 32

When is treatment failure suspected in sinusitis?

Answer 32

symptoms worsen after 72 hrs after treatment initiation

Question 33

What is 1st line therapy for sinusitis if risk of antibiotic resistance or failed initial therapy?

Answer 33

amoxicillin-clavulanic acid

Question 34

What is 2nd line therapy for sinusitis if risk of antibiotic resistance or failed initial therapy?

Answer 34

respiratory FQ (levo/moxi)

Question 35

What is the duration of therapy for sinusitis?

Answer 35

5-7 days in adults 10-14 days in children