Term
|
Definition
• Resonating chamber for voice
• Provide protection to brain from trauma
• Moisturize and humidify airflow
• Lightening the weight of facial skeleton
• Unknown |
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Term
| Some Problems With the Definition and Diagnosis of Sinusitis |
|
Definition
• Public misperception of sinusitis
• Symptomatic distinction from rhinitis or viral URI
• ‘Objective’ tests not helpful in diagnosis of acute disease
• Current classification systems are imperfect |
|
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Term
| Make the Diagnosis (of sinusitis) |
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Definition
| “Before deciding whether to treat or tolerate sinus disease, a physician must define the disease process and be sure of the diagnosis. Unfortunately, the general public and many physicians assume that the paranasal sinuses are diseased much more often than is actually the case. |
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Term
| Chronologic Classification of sinusitis |
|
Definition
• Acute: “The symptom complex accompanying inflammation of the sinuses present for less than 4 weeks in adults.”
• Subacute: “The manifestation of persistent minimal to moderate signs and symptom of sinus inflammation, sometimes lasting for long periods of time.”
• Chronic: “Signs and symptoms of inflammation of the sinuses persisting more than 12 weeks.”
• Recurrent acute: “Greater than four episodes of acute sinusitis per year, with resolution between episodes.”
• Acute exacerbations of chronic sinusitis: “Persistent symptoms between episodes.” |
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Term
|
Definition
Major
• Facial pain/pressure
• Nasal obstruction/blockage
• Nasal discharge/postnasal drainage
• Changes in smell
• Purulence on exam
• Fever (acute only)
Minor
• Headache
• Fever (all nonacute) • Halitosis
• Fatigue
• Dental pain
• Cough
• Ear pain/pressure/fullness |
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Term
| Acute Bacterial Rhinosinusitis |
|
Definition
• Most often preceded by a viral URI
• Similar symptoms...
• Consider in patients with symptoms of a viral URI that has not improved after 10 days or has worsened after 5 to 7 days or if symptoms are out of proportion to a typical URI (double worsening)
• > or = two major factors, or one major factor and two minor factors, or purulence on exam
• Fever or facial pain does not constitute a suggestive history in the absence of other nasal symptoms
- Physical exam provides limited information
• Change in color or characteristic of nasal drainage is not a specific sign of a bacterial sinus infection
• Facial tenderness and lack of transillumination similarly inconsistent
- Imaging is not recommended to diagnose uncomplicated cases of acute bacterial sinusitis
• 87% of subjects with experimentally-induced viral URI had CT findings indistinguishable from bacterial sinusitis |
|
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Term
| Acute Bacterial Rhinosinusitis: Treatment |
|
Definition
• First line: amoxicillin for 10–14 days
• Adjuncts: nasal saline irrigations, nasal steroids
• If no improvement or worsening by 7 days, reassess the patient to confirm diagnosis, exclude other causes of disease and detect complications |
|
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Term
| Acute Bacterial Rhinosinusitis: complications |
|
Definition
• Periorbital cellulitis
• Meningitis
• Brain abscess
• Cavernous sinus thrombosis
• In these cases,IV antibiotics +/– endoscopic sinus surgery may be required |
|
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Term
|
Definition
- Symptoms > 12 weeks
- Strong history
• Two or more major factors
• One major factor and two or more minor factors
• In absence of minor factors, facial pain alone is not considered a major factor |
|
|
Term
| Contemporary Diagnosis of Chronic Rhinosinusitis (CRS) |
|
Definition
• Continuous signs or symptoms for >12 weeks
• Identification of signs of inflammation • Anterior rhinoscopy
• Endoscopy
• Imaging |
|
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Term
| Treatment of CRS Chronic Rhinosinusitis |
|
Definition
• “Maximal medical therapy”
• Atleast3weeksofantibiotics
• Oral steroids
• Nasal steroids
• Nasal saline irrigations
• ?Allergyevaluation
• No appropriately powered placebo controlled trials of oral antibiotic treatment for chronic rhinosinusitis have been performed |
|
|
Term
|
Definition
• Biofilm
• Congenital factors • Functional factors • Fungi
• Allergy
• Superantigen
• Osteitis
• Bacteria |
|
|
Term
| Surgical Indicators for CRS |
|
Definition
Noncontroversial
• Failure of medical management in CRS and RARS
• Complications of ABRS
• Polyposis with obstruction
• Mucocele
• Neoplasm
• CSF Leak
• Dacryocystorhinostomy
• Orbital decompression
Controversial
• Chronic headache • Impaired olfaction |
|
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Term
|
Definition
• Think outside the box... • Cystic fibrosis
• Tumor
• Primary ciliary dyskinesia • Wegener’s granulomatosis • Sarcoidosis
• Churg-Strauss |
|
|
Term
| Anatomic Nasal Obstruction |
|
Definition
• Deviated nasal septum
• Hypertrophied inferior turbinates • Tumor
• Polyps
• Choanal atresia
• Enlarged adenoids
• Nasal valve collapse |
|
|
Term
| one nasal steroid that has a class B classification for use in pregnancy |
|
Definition
|
|
Term
| functional nasal obstructions |
|
Definition
• Mucosal edema/inflammation
• Allergic rhinitis
• Nonallergic rhinitis
• Vasomotor rhinitis (Atrovent nasal spray)
• Atrophic rhinitis
• Infectious rhinitis
• Rhinitis of pregnancy (hormonal)
• Rhinitis medicamentosa |
|
|
Term
| functional nasal obstructions treatments |
|
Definition
• Inhaled nasal steroids
• Inhaled antihistamines
• Oral antihistamines
• Nasal saline irrigations
• Leukotriene inhibitors
• Oral steroids
• Allergy desensitization
• Allergen avoidance |
|
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Term
|
Definition
Afrin
• Only use for 3 days
• May lead to rebound hypertrophy
• “Afrin addicts”
• Rhinitis medicamentosa
• Treatment:
• Must give patients some relief while they break the habit
• Iuse:
• Acknowledgement
• Double Medrol dose pack • Inhaled nasal steroids |
|
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Term
|
Definition
• Very common complaint
• Nasal cavity makes up to three liters of mucus
per day!
• Often swallowed and unrealized
• More awareness when mucus is thicker
• Attempt to decrease viscosity: nasal saline, Mucinex
• Association between reflux and postnasal drip: manage reflux as well in refractory cases |
|
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Term
|
Definition
• Occurs in 60% of people worldwide during lifetime
• 1 in 200 ED visits in the U.S.
• Peak incidence younger than 18; older than 50 |
|
|
Term
|
Definition
Local
• Digital trauma
• Mucosal dryness
• Chemical irritants (Rx and non-Rx)
• Trauma
• Rhinosinusitis
• Neoplasm
Systemic
• Hemophilia
• Von Willebrand
• Thrombocytopenia
• Chronic alcoholism • Chronic renal failure • Medications
• HHT
• Hypertension? |
|
|
Term
| medications that can cause epistaxis |
|
Definition
• Aspirin
• Warfarin
• Clopidogrel
• Ginseng
• Garlic
• Gingko biloba • Heparin
• NSAIDs
• Ticlodipine
• Dipyridamole |
|
|
Term
|
Definition
• ABC
• Focused history based on etiology
• Duration,laterality,frequency,severity • Trauma
• Family history
• Laboratory evaluation driven by history
• Physicalexam:
• Seeks to determine anterior vs. posterior • Oxymetazoline may aid in visualization
• Nasal endoscope needed for posterior |
|
|
Term
|
Definition
• Often self limited
• Control BP
• Apply direct pressure for 15 minutes (watch clock!)
• Head position unimportant, unless swallowing blood
• Cool washcloths no help
• May spray oxymetazoline prior to pressure
When Pressure and Afrin Fails:
• Cauterization with silver nitrate
• Good for specific source of bleeding
• Avoid bilateral cauterization (septal perforation) |
|
|
Term
|
Definition
• Posteriorpack(48 hours maximum)
• Embolization
• Endoscopic sphenopalatine artery ligation |
|
|
Term
|
Definition
• Nasal saline spray • Nasal saline gel
• Avoid digital trauma • Humidifier
• No nose blowing for two weeks
• No straining for two weeks
• No heavy lifting for two weeks
• Avoid nasal cannula (high humidity face tent) • Avoid chemical irritants |
|
|
Term
|
Definition
• Ifyoucanseeit,you can get it
• Any mucosal irritation can cause bleeding
• Alligator forceps
• Suction
• Positiveairpressure
• Balloon catheter
• May require sedation |
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