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24 Cards in this Set
- Front
- Back
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What is an acute bacterial sinusitis?
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Infection of the paranasal sinuses with inflammation of the nose.
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How common is this clinical condition?
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It is one of the most common health problems in the United States according to insurance-reimbursement claims.
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How does acute bacterial sinusitis commonly develop?
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Complication of a viral URI
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What are the common symptoms of acute bacterial sinusitis?
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Nasal congestion, purulent nasal discharge, maxillary tooth discomfort, anosmia, cough, facial pain/pressure that is made worse by bending forward, headache and fever
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What are common physical findings of acute bacterial sinusitis?
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Failure of transillumination of the maxillary sinuses
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What is a challenging task in diagnosing bacterial sinusitis?
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Distinguishing viral from bacterial sinusitis.
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How can you distinguish viral from bacterial sinusitis symptomatically?
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Viral improves in 7-10 days and nasal discharge that is clear and thin. Bacterial lasts longer than 10 days or worsening of symptoms after 5 to 7 days. and nasal discharge that is yellow-green and thick.
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What are the major bacterial pathogens that are present in adults with sinusitis?
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Streptococcus pneumonia and Haemophilus influenza
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What are the potential complications of bacterial sinusitis?
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Local extension and spread of bacteria to the CNS
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How common are complications today?
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Very rare when antimicrobial treatment is routinely given.
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How is the clinical diagnosis of acute bacterial sinusitis made?
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Medical history, symptoms and physical findings.
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How can the definitive diagnosis of acute sinusitis be made?
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Radiological studies, but it cannot differentiate btwn viral and bacterial sinusitis.
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What type of radiological study provides a detailed view of the paranasal sinuses?
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Computed tomography (CT), but not routinely indicated in the evaluation of uncomplicated sinusitis.
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What is the treatment goal of acute sinusitis?
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Establish a normal nasal environment via moisturization (saline drops), humidification (humidifier) and a reduction in the viscosity of mucus
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Why are topical decongestants avoided?
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Use for more than 5 days lead to rebound symptoms.
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What is the goal of antibiotic therapy of acute bacterial sinusitis?
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Decrease the severity/duration of symptoms AND to preclude the development of complications.
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What is a cost-effective approach to the treatment of acute bacterial sinusitis?
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7-10 day of watchful waiting since symptoms in most patients resolve without the use of antibiotics and serious complications are rare.
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What are the presenting symptoms of severe sinusitis?
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Facial pain, intense periorbital swelling or change in mental status; should be treated aggressively
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How should severe sinusitis be worked up and treated?
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CT scanning to assess the extent of disease and the use of antibiotics
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How is allergic rhinitis related to acute sinusitis? How should this be treated?
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Antihistamines are recommended for patients with an underlying allergy; patients get acute exacerbation of sinusitis.
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What is the most common cause of acute sinusitis?
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Uncomplicated viral infection
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How do you treat acute viral sinusitis?
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Treat symptoms with decongestants, analgesics, antipyretics and reassurance is the preferred initial strategy for management; NOT radiological studies or antibiotic treatment
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When is it acceptable to use CT?
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For patients who present with dramatic symptoms such as maxillary pain, facial swelling and fever OR patients who have not responded to antiobiotic therapy
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43 year old man has a 2 week history of nasal congestion, postnasal drip, and fatigue. He used an OTC nasal decongestant and acetaminophen, without relief. During the past few days, facial pain and pressure have developed and have not responded to decongestants. In addition, his nasal discharge has turned from clear to yellow. How should he be treated?
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Treatment with amoxicillin 500mg 3x daily for 10 days, continued use of nasal saline and decongestant therapy (doxycycline or TMP-SMX); avoid sinus radiography. If symptoms do not improve in 72 hours then switch to a different antibiotic such as azithromycin.
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