What is acute viral rhinosinusitis
common cold
what is acute bacterial rhinosinusitis
acute sinusitis
what causes acute bacterial rhinosinusitis
impaired mucocilliary clearance… obstruction of osteomeatal complex AKA sinus pore… accumulation of mucous in the sinus cavity… becomes secondarily infected by bacteria
acute bacterial rhinosinusitis bacteria
mostly S. pneumonia and then H influenza others: M catarrhalis Staph aureus anaerobes Streptococcus species and more
clinical manifestations of acute bacterial rhinosinusitis
purulent (pus) yellow-green nasal discharge facial pain or pressure over affected sinus or sinuses nasal obstruction acute onset of symptoms lasts 1-4 weeks (so after 10 days of what you think was common cold AKA acute viral rhinosinusitis start thinking this instead) cough malaise fever headache
treatment of acute bacterial sinusitis
NSAIDs: examples Ibuprofen oral (pseudoephedrine) or nasal (oxymetazoline) decongestants intranasal corticosteroids for the first 5 days after dx: (reduces swelling of mucosal surface of nose so allows other drugs to get in) systemic oral antibiotics: (majority will get better without these but immunodeficient will need) neti-pot
Weeks to be considered acute rhinosinusitis
0-4 weeks
Weeks to be considered chronic rhinosinusitis
12 or more weeks
chronic rhinosinusitis etiology
inflammatory disorder of paranasal sinuses and nasal passage lining
diagnosis of chronic rhinosinusitis
2 of 4 cardinal sign of symptoms objective evidence of sinus mucosal inflammation/disease seen on direct examination, transillumination, CT, fiberoptic
clinical manifestation: 4 cardinal sign and symptoms of chronic rhinosinusitis
anterior and/or posterior nasal mucopurulent drainage nasal obstruction/nasal blockage/congestion facial pain/pressure/and/or fullness reduction or loss of smell in kids the 4th sign is cough rather than loss of smell
treatment of chronic sinusitis
not curable goals of therapy are to control and improve quality of life intranasal
treatment of chronic sinusitis
not curable goals of therapy are to control and improve quality of life intranasal saline topical and systemic glucocorticoids antibiotics (systemic and topical) surgery refer to otolaryngology
order of sinuses most affected with acute or chronic sinusitis
maxillary>frontal>ethmoid>sphenoid pansinusitis is all infected
etiology of allergic rhinitis
exposure to airborne allergen in predisposed individual immune response
clinical manifestations of allergic rhinitis
clear rhinorrhea sneezing tearing eye irritation pruritus associated sx: cough bronchospasm eczematous dermatitis upon PE mucosa of turbinates is pale or violaceous
treatment of allergic rhinitis
avoidance of allergen intranasal corticosteroid sprays antihistamines antileukotrienes cromolyn sodium ad nedocromil intranasal anticholinergic agents referral to allergist for immunotherapy
define epistaxis
nose bleed lots of times the vascular Kiesselbach’s plexus
causes of epistaxis
dryness, vigorous nose rubbing, nose blowing, nose picking, rhinitis, foreign body, facial trauma, intranasal steroids
less common but more serious causes of epistaxis
bleeding disorders, anticoagulation/aspirin therapy, Osler-Weber-Rendu disease, aneurysm of the carotid artery (posterior bleed), nasal neoplasm, hypertension
less common but more serious causes of epistaxis
bleeding disorders, anticoagulation/aspirin therapy, Osler-Weber-Rendu disease, aneurysm of the carotid artery (posterior bleed), nasal neoplasm, hypertension
diagnostic testing for epistaxis
+/- CBC if uncertain about etiology or if bleed is massive/prolonged prothrombin time and international normalized ratio is NOT indicated as a routine test but should be done for anti-coagulated patients
epistaxis treatment
type and crossmatch for massive or prolonged hemorrhage nasal packing: (nasal gauze/tampons/balloon/catheters) fibrin glue cautery: (chemical-silver nitrate or electrically) gelatin or collagen sponge topical 4% cocain
is it better to have an anterior or posterior bleed
anterior b/c posterior are medical emergency
symptoms of foreign body in nose
lots asymptomatic kids nasal discharge usually unilateral halitosis epistaxis septal perforation
if foreign body in nose batteries or disc magnets
get out right away medical emergency
diagnosis of foreign body in nose
direct visualization fiber optic examination sinus x-ray CT
treatment of foreign body in nose
apply topical anesthetic/vasoconstrictor (reduce pain and swelling) to nose blow nose positive pressure alligator forceps ballon catheter derma bond on cotton applicator magnet?
features of nasal polyps
pale edematous fixed glistening gray or white mucoid masses in nasal cavity mucosally covered masses seen in patients with allergic rhinitis but don’t necessarily have to have allergic rhinitis to get decreased sense of smell
treatment of nasal polyps
intranasal corticosteroids 1-3 months oral corticosteroids: 6 day course surgery
define nasal polyps
Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They hang down like teardrops or grapes. They result from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders
what to do if patient comes in with nasal trauma
examine inside of nose for hematoma of nasal septum if hematoma refer to ENT immediately: medical emergency could have fractured nasal bone could have epistaxis creptis refer to ENT
criteria for diagnosis of acute sinusitis
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Oral antibiotics for acute sinusitis
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disorders that may exacerbate and/or contribure to chronic rhinosinusitis
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classification of allergic rhinitis
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