LMCC/Sinusitis
< LMCC
- inflamation of mucous membranes in the nasal cavity and paranasal sinuses
- fluid within these cavities or the underlying bone
Etiology
edit- divided into
- acute: < 4 weeks
- recurrent: 4 or more episodes per year lasting at least 10 days
- chronic: > 12 weeks
- common pathogens are S. pneumoniae, H.influenza, M.catarrhalis
Risk Factors
edit- medical conditions: respiratory infections, allergic rhinitis cystic fibrosis or immunodeficiency
- anatomic: deviated septum, polyps, adenoid hypertrophy, tumour
- irritants: environmental, tobacco smoke, air pollution, chlorine
- iatrogenic: topical decongestant overuse, cocaine, trauma
History
edit- recent URTI
- nasal congestion/discharge
- fascial pain/swelling
- maxillary toothache
- fever
- headache worse with bending over
- poor response to decongestants
Acute Sinusitis Score
edit1 point each for:
- Maxillary toothache
- history of purulent nasal discharge
- poor response to decongestants
- abnormal transillumination
- purulent secretions
- 0-1 sinusitis unlikely
- 2-3 order x-ray (Water's view)
- 4-5 likely sinusitis, no x-ray needed, treat with antibiotics
Physical
edit- swelling and erythema over symptomatic area
- tenderness on palpation of paranasal sinuses
- periorbital swelling
- nasal speculum exam: hyperemia, edema, crusts, purulence, polyps
- tranillumination
- to evaluate frontal and maxillary sinuses
- of no diagnostic value in children, marginal in adults
- 55% with +'ve radiologic findings have abnormal transillumination
- must be in complete darkness
Investigations
edit- radiography only when diagnosis of sinusitis is in doubt
- all patients with pronounced frontal headaches should have radiograph performed
- CT scans are not routineley used for diagnosis
Management
edit- acute: 40% will recover spontaneously
Pharmacology
edit- 1st line: amoxicillin x 10 days or TMP-SMX if penecillin allergy
- 2nd line: Amoxil/clavulin, clarithromycin, ceflacor, cefixime
Adjunct therapy
edit- saline nasal spray with humidification
- topical or systemic decongestants; for short term use only
- antihistamines are contraindicated
- nasal corticosteroid spray for chronic sinusitis
Referal to ENT
edit- failure of 2nd line therapy
- >3 episodes/year
- development of complications (ie. mucoceles, orbital extension, meningitis, intracranial abscess, venous sinus thrombosis)
References
editToronto Notes 2005