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Sinusitis - Coggle Diagram
Sinusitis
acute sinusitis DX
take history of symptoms experienced, duration of symptoms and any treatment tired.
typical allergy symptoms
past medical history
examine the person: perform a thorough head and neck examination to identify facial tenderness to gentle palpation, post nasal pharyngeal secretions or exudate, tender maxillary dentition, middle ear effusion
perform an anterior rhinoscopy to identify nasal signs, nasal polyps, anatomical abnormalities, record news if person systemically well
diagnostic symptoms: nasal blockage/obstruction/congestion or nasal discharge, facial pain/pressure, reduction or loss of sense of smell
in children diagnostic symptoms: nasal blockage/obstruction/congestion, discoloured nasal discharge, cough
other features suggestive of acute sinusitis include: upper airway symptoms such as sore throat, hoarseness and cough. non specific systemic symptoms such as malaise, fatigue and fever
chronic DX
examine the person, inspect and palpate the maxillofacial area to elicit swelling or tenderness
perform an anterior rhinoscopy to identify: nasal signs, mucosal oedema, nasal polyps, anatomical abnormalities, record obs if systemically unwell
objective evidence of sinonasal inflammation
endoscopic or CT
other features suggestive of chronic sinusitis
oropharyngeal discomfort
otalgia
Halitosis
dental pain
cough
malaise
headache
fatigue
causes
upper viral respiratory tract infection
inflammatory oedema of the sinonasal mucosa
smoking
impaired ciliary function, cystic fibrosis and primary ciliary dyskinesia
allergic rhinitis
concurrent chroinc conditions
dental infection, NG tubes, immunodeficiency, impaired ciliary function, mechanical obstruction
predisposing factors
smoking, immunodeficiency, colonization with resistant bacteria, allergies, anatomical abnormalities
predisposing chronic factors
smoking, ciliary impairment, NSAID, exacerbated respiratory disease, asthma, COPD, allergic rhinitis, anatomic variations, occupational exposure, viral infection, bacterial infection,
differential
upper respiratory tract infection
allergic rhinitis
non allergic rhinitis
nasal foreign body
sinoasal tumour
turbinate hypertrophy
adenoiditis and tonsillitis
other causes
facial pain syndrome
giant cell arteritis
temporomandibular joint dysfunction
neuropathic or atypical facial pain
odontogenic infection
management of acute sinusitis
admit to hospital if the patient has any of the following: severe infection, signs of sepsis, intraorbital or periorbital complications, including periorbital oedema or cellulitis, a displaced eyeball, double vision, ophthalmoplegia or newly reduced visual acuity.. intracranial complications reduced consciousness
if hospital admission is not indicated: offer an immediate ABX of further investigation and management
if symptoms suggest neoplasm arrange urgent suspected cancer pathway
refer to appropriate specialist such as ENT or immunologist if the person is immunocompromised, allergic or immunological causes are suspected, there is anatomic defect or obstruction, comorbidity, no improvement after 10 days or symptoms recurrent or there is doubt about DX,
symptoms for 10 days or less
do not offer ABX, advise the person on usual cause and course of acute sinusitis, virus usually resolves within 12 weeks, and does not routinely need antibiotics
refer to NHS website
explain self management strategies such as paracetamol or ibuprofen, trial of nasal saline or nasal decongestion can be considered
seek medical advice if symptoms worsen rapidly or significantly or if symptoms do not improve after 3 weeks or they become systemically unwell
if symptoms rapidly worsen reassess consider alternative DX such as dental, any signs or symptoms suggesting a more serious illness or condition
for adults and children aged 12 years and over consider prescribing a high dose nasal steroid for 14 days, be aware that nasal steroid may improve symptoms but not likely to affect how long they last, could also cause systemic affects if people are already taking steroids, maybe difficult for people to use correctly
consider no ABX or back up ABX prescription, take into account, evidence that ABX make little difference to how long symptoms last or improve peoples symptoms, the possible adverse reaction to ABX,
back up ABX may be preferred when bacteria cause is more likely, take ABX if symptoms do not improve within 7 days or worsen rapidly or significantly over time, seek medical help if symptoms worsen while taking ABX or if ABX have been stopped due to not tolerated
choice of ABX will be assessed on individual bases ie. if allergy to penicillin or previous ABX not tolerated - seek guidance from local guidelines and gp ABX
definition
also known as rhinosinusitis, is a symptomatic inflammation of the mucosal lining of the paranasal sinuses and nasal cavity. acute sinusitis is defined by symptoms that completely resolve after 12 weeks. acute classification - acute viral less than 10 days, acute post viral - worsen after 5 days or persist for more than 10 days but less than 12 week, acute bacterial - secondary bacterial infection that develops in about 0.5%-2% of people with acute viral sinusitis
chronic management