Sinusitis Nice CKS | A4 Medicine

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SINUSITIS
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SINUS INFECTION ACCOUNTS FOR CLOSE TO 16 MILLION
OFFICE VISITS PER YEAR ( USA ). SINUSITIS IS
MORE COMMON FROM EARLY FALL TO EARLY SPRING.
IT IS MUCH MORE COMMON IN ADULTS THAN CHILDREN.
APPROXIMATELY 0.5 OF UPPER RESPIRATORY TRACT
INFECTIONS ARE COMPLICATED BY SINUSITIS. ACUTE
SINUSITIS IS THE SECOND MOST COMMON INFECTIOUS
DISEASE SEEN BY GPS ( ACUTE SINUSITIS CAN FAM
PHYSICIAN 2011). THIS REVIEW COVERS ACUTE
SINUSITIS PRESENTATION.
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SINUSITIS IS AN INFLAMMATION OF THE MUCOSAL
LINING OF THE PARANASAL SINUSES .
INFLAMMATION OF THE SINUS CAVITIES IS ALMOST
ALWAYS ACCOMPANIED BY INFLAMMATION OF THE NASAL
CAVITIES RHINOSINUSITIS IS A MORE SUITABLE
AND PREFERRED TERM
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OBSTRUCTION OF SINUS DRAINAGE PATHWAYS CILIARY
IMPAIRMENT ALTERED MUCUS QUANTITY AND QUALITY
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• CAUSES RISK FACTORS VIRAL INFECTION- MOST
  COMMON CAUSE AND INCLUDE SYNCYTIAL VIRUS
• RHINOVIRUS

• RESPIRATORY

• PARAINFLUENZA
• INFLUENZA WITH RHINOVIRUS ACUTE BACTERIAL
  INFECTION FOLLOWING AN EPISODE OF VIRAL
  SINUSITIS 0.5 TO 2 CASES WILL PROGRESS TO
  ACUTE BACTERIAL SINUSITIS SINUSITIS IS ONE OF
  THE COMMONEST REASONS A HEALTHCARE PROFESSIONAL
  WILL PRESCRIBE AN ANTIBIOTIC
• MOST COMMONLY IMPLICATED BACTERIA ARE
• STREPTOCOCCUS PNEUMONIA
• HAEMOPHILUS INFLUENZAE ALLERGIC AND NON-ALLERGIC
  RHINITIS ANATOMICAL VARIATIONS
• ABNORMALITY OF OSTEOMEATAL COMPLEX
• SEPTAL DEVIATION
• CLEFT PALATE
• CONCHA BULLOSA PNEUMATIZED ( AIR FILLED )
  CAVITY WITHIH A TURBINATE IN THE NOSE ( GOOGLE )
• HYPERTROPHIC MIDDLE TURBINATES CIGARETTE SMOKING
  gt CAN DAMAGE CILIA ASTHMA
• CHRONIC SINUSITIS AND NASAL POLYPS DIABETES
  RISK CHRONIC SINUSITIS SWIMMING , DIVING , HIGH
  ALTITUDE CLIMBING DENTAL INFECTIONS AND
  PROCEDURES DIAGNOSED MORE FREQUENTLY
• IN WOMEN THAN MEN ASPIRIN SENSITIVITY.CYSTIC
  FIBROSIS NEOPLASIA MECHANICAL VENTILATION
• USE OF NASAL TUBES SUCH AS NG FEEDING TUBES
  SARCOIDOSIS IMMUNODEFICIENCY WEGENERS
  GRANULOMATOSIS SINUS SURGERY IMMOTILE CILIA
  SYNDROME

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PRESENTATION- MOST COMMON CAUSE OF ACUTE
SINUSITIS IS A VIRAL INFECTION USUALLY FOLLOWS
A COMMON COLD CLINICAL FINDINGS MAY INCLUDE PAIN
OVER CHEEK RADIATING TO FRONTAL REGION OR
TEETH ?? WITH STRAINING OR BENDING DOWN FACIAL
PAIN OR PRESSURE HEADACHE PERSISTENT COUGH ( ??
AT NIGHT ) TENDERNESS PRESSURE OVER THE FLOOR OF
THE FRONTAL SINUSES IMMEDIATELY ABOVE INNER
CANTHUS NASAL BLOCKAGE ( OBSTRUCTION / CONGESTION
) DISOLOURED NASAL DISCHARGE ( ANT / POST NASAL
DRIP ) HYPOSMIA REDUCED SENSE SMELL TOOTHACHE
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EXAMINATION- INSPECT AND PALPATE THE
MAXILLOFACIAL AREA CHECK NASAL CAVITY- RHINOSCOPY
FOR ?NASAL INFLAMMATION ? MUCOSAL OEDEMA ?
MUCUPURULENT NASAL DISCHARGE ? NASAL POLYPS ?
ANATOMICAL ABNORMALITIES EG DEVIATED NASAL
SEPTUM ? NASAL FOREIGN BODY ? SINONASAL
TUMOUR CAUTION- PERIORBITAL OEDEMA / ERYTHEMA
DISPLACED GLOBE DOUBLE VISION OPHTHALMOPLEGIA
REDUCED VISUAL ACUITY SEVERE FRONTAL HEADACHE
SWELLING OVER FRONTAL BONE SYMPTOMS AND SIGNS
OF MENINGITIS FOCAL NEUROLOGICAL
SIGNS MANAGEMENT- PARACETAMOL OR NSAID INTRANASAL
DECONGESTANT TOPICAL AGENTS PREFERRED OVER
SYSTEMIC UP TO 3-5 DAYS PREVENT REBOUND
CONGESTION EG OXYMETAZOLINE NASAL SPRAY
INTRANASAL CORTICOSTEROID PATIENTS WITH
CONGESTION LOW SYSTEMIC SES ADVISED MIN 1 MONTH
USE IRRIGATING NOSE WITH NASAL SALINE SOLUTION
WARM FACE PACKS ADEQUATE HYDRATION IPRATROPIUM
IF CONGESTED ( TOPICAL ANTICHOLINERGIC
) IMMUNOCOMPROMISED OR SEVERE ILLNESS-HIGH DOSE
AMOXICILLIN/ CLAVULANIC ACID - IST LINE ( IDSA )
AMOXICILLIN OR PHENOXYMETHYPENICILLIN ( CKS )
CLINDAMYCIN A 3RD GEN CEPHALOSPORIN (IF
ALLERGIC TO PENICILLIN ) DOXYCYLINE SUITABLE
ALTERNATIVE QUINOLONES MAY BE TRIED IF
TREATMENT WITH ABOVE NOT POSSIBLE
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IMAGING TESTING- CLINICAL DIAGNOSIS BASED ON
HISTORY AND EXAMINATION NO INVESTIGATION
INDICATED IN UNCOMPLICATED ACUTE SINUSITIS CT
EXAMINATION OF CHOICE NOT REQUIRED IN ACUTE
SINUSITIS MRI IF COMPLICATION IS SUSPECTED XR
OBSOLETE BUT CAN SHOW AIR FLUID LEVELS INDICATE
BACTERIAL CAUSE SIZE AND INTEGRITY OF PARA-NASAL
SINUSES ULTRASOUND CONFLICTING EVIDENCE CAN BE
COMBINED WITH RADIOGRAPHY SINUS CULTURE
ENDOSCOPIC OR SINUS PUNCTURE PRE-EXISTING
CO-MOTBIDITY AS ? SIGNIFICANT HEART , LUNG ,
RENAL , LIVER OR NEUROMUSCULAR DISEASE ?
IMMUNOSUPPRESSION ? CYSTIC FIBROSIS ACUTE COUGH
AND OLDER THAN 65 WITH TWO RISK FACTORS ACUTE
COUGH AND OLDER THAN 80 WITH ONE RISK FACTOR ?
HOSPITILIZATION IN PREVIOUS YEAR ? TYPE 1 OR 2
DIABETES ? CONGESTIVE HEART FAILURE ? ON ORAL
STEROID THERAPY CHRONIC RHINOSINUSITIS AMERICAN
ACADEMY OF OTOLARYNGOLOGY- HEAD AND NECK SURGERY
CRITERIA FOR DIAGNOSING CHRONIC RHINOSINUSITIS 12
OR MORE WEEKS OF 2 OR MORE OF THE FOLLOWING
SYMPTOMS - MUCOPURULENT DISCHARGE - NASAL
OBSTRUCTION - FACIAL PAIN/ PRESSURE / FULLNESS -
DECREASED SENSE OF SMELL AND INFLAMMATION BY ONE
OR MORE OBJECTIVE CRITERIA - ENDOSCOPY PUS ,
MUCOSAL EDEMA OR POLYPS - IMAGING SHOWING
INFLAMMATION OF THE PARANASAL SINUSES.
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IT IS ONE OF THE MOST COMMON DISEASES WITH AN
ESTIMATED PREVALENCE OF 4.5 TO 12 IN N
AMERICA AND EUROPEAN COUNTRIES IT IS THE IMPACT
ON THE GENERAL QOL WITH SYMPTOMS LIKE DIMINISHED
SLEEP , PRODUCTIVITY , COGNITION, MOOD AND
FATIGUE ( AS WELL AS SINONASAL SYMPTOMS ) WHICH
INFLUENCES PATIENTS DECISION TO ELECT A SURGICAL
INTERVENTION ETIOLOGY IS NOT UNDERSTOOD
COMPLETELY BUT INFLAMMATION RATHER THAN INFECTION
IS CONSIDERED TO BE THE DOMINANT ETIOLOGY TWO
MAJOR SUBTYPES OF CRS ARE RECOGNISED- CRS WITH OR
WITHOUT POLYPS AND IT IS THIS DISTINCTION WHICH
GUIDES MANAGEMENT ( AS PER LATEST EPOS GUIDELINE
) REFERRAL ENT-FREQUENT RECURRENT EPISODES
UNREMITTING OR PROGRESSIVE FACIAL PAIN NASAL
POLYPS CAUSING SIG OBSTRUCTION TRIAL OF
INTRANASAL STEROIDS FOR 3 MONTHS WITH NO BENEFIT
IMMUNODEFICIENCY COMPLICATION SUSPECTED SUSPECTED
ALLERGIC OR IMMUNOLOGICAL AETIOLOGY AND
ASSOCIATED CO-MORBIDITIES AS ASTHMA
STRUCTURAL ANOMALIES AS DEVIATED NASAL SEPTUM
SINUS SURGERY INDICATED
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REFERENCES

• SINUSITIS IMAGING MEDSCAPE JAN 2016
• ACUTE SINUSITIS MEDSCAPE JAN 2017
  HTTPS//EMEDICINE.MEDSCAPE.COM/ARTICLE/232670-OVER
  VIEW
• RUDMIK L, SOLER ZM. MEDICAL THERAPIES FOR ADULT
  CHRONIC SINUSITIS A SYSTEMATIC REVIEW. JAMA.
  2015314(9)926939. DOI10.1001/JAMA.2015.7544
  HTTPS//JAMANETWORK.COM/JOURNALS/JAMA/ARTICLE-ABST
  RACT/2432168
• POCKET GUIDE EPOS EUROPEAN POSITION PAPER ON
  RHINOSINUSITIS AND NASAL POLYPS 2012
  WWW.RHINOLOGYJOURNAL.COM
• ROSENFELD, R. M., PICCIRILLO, J. F.,
  CHANDRASEKHAR, S. S., BROOK, I., ASHOK KUMAR, K.,
  KRAMPER, M., CORRIGAN, M. D.
• (2015). CLINICAL PRACTICE GUIDELINE (UPDATE)
  ADULT SINUSITIS. OTOLARYNGOLOGYHEAD AND NECK
  SURGERY, 152(2_SUPPL), S1S39.
  HTTPS//DOI.ORG/10.1177/0194599815572097
• BMJ BEST PRACTICE ACUTE SINUSITIS
  HTTPS//BESTPRACTICE.BMJ.COM/TOPICS/EN-GB/14
• A GUIDE TO THE MANAGEMENT OF ACUTE RHINOSINUSITIS
  IN PRIMARY CARE MANAGEMENT STRATEGY BASED ON BEST
  EVIDENCE AND RECENT EUROPEAN GUIDELINES BR J GEN
  PRACT 63 (616 ) 611-613
• HTTPS//WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC38094
  23/
• NICE CKS SINUSITIS OCTOBER 2013
  HTTPS//CKS.NICE.ORG.UK/SINUSITIS
• SINUSITIS AND ITS MANAGEMENT BMJ 2007 334358
• 10-MINUTE CONSULTATION SINUSITIS BMJ 2007
  3341165
• RACGP EAR , NOSE AND THROAT SINUSITIS VOLUME 45 ,
  NO 6 JUNE 2016 PAGES 374-377
• BSACI GUIDELINES FOR THE MANAGEMENT OF
  RHINOSINUSITIS AND NASAL POLYPOSIS CLINICAL AND
  EXPERIMENTAL ALLERGY , 38
• , 260-275 HTTPS//ONLINELIBRARY.WILEY.COM/DOI/PDF/
  10.1111/J.1365-2222.2007.02889.X
• DIAGNOSIS AND MANAGEMENT OF RHINOSINUSITIS A
  PRACTICE PARAMETER UPDATE ANNALS OF ALLERGY ,
  ASTHMA AND IMMUNOLOGY , 2014-10-01 , VOLUME 113
  , ISSUE 4 , PAGES 347-385
• VENEKAMP RP, THOMPSON MJ, HAYWARD G, HENEGHAN CJ,
  DEL MAR CB, PERERA R, GLASZIOU PP, ROVERS MM.
  SYSTEMIC
• CORTICOSTEROIDS FOR ACUTE SINUSITIS. COCHRANE
  DATABASE OF SYSTEMATIC REVIEWS 2014, ISSUE 3.
  ART. NO. CD008115. DOI 10.1002/14651858.CD00811
  5.PUB3.
• UPDATES IN THE MANAGEMENT OF CHRONIC
  RHINOSINUSITIS ANNA SLOVICK1, JENNIFER LONG1
  CLAIRE HOPKINS,1 1GUYS

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