Review Sinusitis

8/16/2019 Review Sinusitis

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Rhinosinusitis

Review for resident I

4 Aug 2015


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• Rhinosinusitis

– Symptomatic inammation of mucosal lining ofthe paranasal sinuses and nasal cavity

•

ncomplicated rhinosinusitis – Rhinosinusitis without clinically evident e!tension

of inammation outside the paranasal sinuses andnasal cavity at the time of diagnosis

•

"revalence of pathogen in acute rhinosinusitis – #irus $0%$&'

– (acteria 2%10'


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ARS de)nition *AA+%,-S.


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A(RS de)nition *I/SA.

• Any of – +nset with persistent symptoms or signs compatile

with acute rhinosinusitis lasting for 3 10 dayswithout any evidence of clinical improvement

– +nset with severe symptoms or signs of high fever*3 $67. and purulent nasal discharge or facial painlasting for at least %4 consecutive days at theeginning of illness

– +nset with worsening symptoms or signs characteri8ed

y the new onset of fever headache or increase nasaldischarge following a typical RI that lasted 5%9 daysand were initially improving *doule sic:ening.


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Rhinosinusitis de)nition*;"+S.

• – -asal polyps andor

– ?ucopurulent discharge from middle meatus andor

– ;demamucosal ostruction primarily in middle meatus

Andor


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• 7< changes> – ?ucosal changes within the osteomeatal

comple! andor sinuses

• Acute *@ 12 w:. #s chronic *3 12w:.


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7RS de)nition *AA+%,-S.


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Symptom prevalence y day for

rhinovirus illness

05%2' of #RS A(RS


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Batchful waiting *no A defering A


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7hoice and duration of A


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Eactor to consider plusclavulanate


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,igh dose amo!icillin

• 4 gday or $0 mg:gday *divide twice daily.

• 7over penicillin nonsusceptile *"-S.

S pneumoniae *"(" mutation.

– ,igh endemic area *310'. – Severe infection

– Age @2 3 95

– Attendance at daycare

– Recent hospitali8ation

– Recent antiiotic within the past months

– Immunocompromised


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Initial treatment failure

• Eailure to improved – ac: of reduction in presenting signssymptoms y D

days

• Borsening – "rogression of presenting signssymptoms or onset of

new signssymptoms

• Shorter period in I/SA guideline

• Re%evaluate

– ;ndoscopic guided 7S from middle meatus *drugresistant acteriaC.

– +ther diagnosisC

– 7omplicationC


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A


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A


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Imaging

• nnecessary for diagnoses A(RS

• +tain when complication *softtissue orital or intracranial. issuspected

• 7< is proper in most cases *?RI inselected cases.


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?odifying factors

• Asthma

• 7ystic )rosis *less common in


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Summary of evidence%asedstatements


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Summary of evidence%asedstatements


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AA+%,-S I/SA


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7RS

• 7RS with nasal polyps *7RSw-". – 7RS and ilateral endoscopically

visualised polyps in middle meatus

• 7RS without nasal polyps *7RSs-". – 7RS and no visile polyps in middle

meatus


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References

• 7linical practice guideline > adultsinusitis *AA+%,-S 2015.

• 7linical practice guideline for acuteacterial rhinosinusitis in childrenand adults *I/SA 2012.

• ;uropean positional paper on

rhinosinusitis and nasal polyps*;"+S 2012.

Review Sinusitis

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