Upload
toffy-toffe
View
225
Download
0
Embed Size (px)
Citation preview
8/16/2019 Review Sinusitis
1/24
Rhinosinusitis
Review for resident I
4 Aug 2015
8/16/2019 Review Sinusitis
2/24
• Rhinosinusitis
– Symptomatic inammation of mucosal lining ofthe paranasal sinuses and nasal cavity
•
ncomplicated rhinosinusitis – Rhinosinusitis without clinically evident e!tension
of inammation outside the paranasal sinuses andnasal cavity at the time of diagnosis
•
"revalence of pathogen in acute rhinosinusitis – #irus $0%$&'
– (acteria 2%10'
8/16/2019 Review Sinusitis
3/24
ARS de)nition *AA+%,-S.
8/16/2019 Review Sinusitis
4/24
A(RS de)nition *I/SA.
• Any of – +nset with persistent symptoms or signs compatile
with acute rhinosinusitis lasting for 3 10 dayswithout any evidence of clinical improvement
– +nset with severe symptoms or signs of high fever*3 $67. and purulent nasal discharge or facial painlasting for at least %4 consecutive days at theeginning of illness
– +nset with worsening symptoms or signs characteri8ed
y the new onset of fever headache or increase nasaldischarge following a typical RI that lasted 5%9 daysand were initially improving *doule sic:ening.
8/16/2019 Review Sinusitis
5/24
Rhinosinusitis de)nition*;"+S.
• – -asal polyps andor
– ?ucopurulent discharge from middle meatus andor
– ;demamucosal ostruction primarily in middle meatus
Andor
8/16/2019 Review Sinusitis
6/24
• 7< changes> – ?ucosal changes within the osteomeatal
comple! andor sinuses
• Acute *@ 12 w:. #s chronic *3 12w:.
8/16/2019 Review Sinusitis
7/24
7RS de)nition *AA+%,-S.
8/16/2019 Review Sinusitis
8/24
Symptom prevalence y day for
rhinovirus illness
05%2' of #RS A(RS
8/16/2019 Review Sinusitis
9/24
Batchful waiting *no A defering A
8/16/2019 Review Sinusitis
10/24
7hoice and duration of A
8/16/2019 Review Sinusitis
11/24
Eactor to consider plusclavulanate
8/16/2019 Review Sinusitis
12/24
,igh dose amo!icillin
• 4 gday or $0 mg:gday *divide twice daily.
• 7over penicillin nonsusceptile *"-S.
S pneumoniae *"(" mutation.
– ,igh endemic area *310'. – Severe infection
– Age @2 3 95
– Attendance at daycare
– Recent hospitali8ation
– Recent antiiotic within the past months
– Immunocompromised
8/16/2019 Review Sinusitis
13/24
Initial treatment failure
• Eailure to improved – ac: of reduction in presenting signssymptoms y D
days
• Borsening – "rogression of presenting signssymptoms or onset of
new signssymptoms
• Shorter period in I/SA guideline
• Re%evaluate
– ;ndoscopic guided 7S from middle meatus *drugresistant acteriaC.
– +ther diagnosisC
– 7omplicationC
8/16/2019 Review Sinusitis
14/24
A
8/16/2019 Review Sinusitis
15/24
A
8/16/2019 Review Sinusitis
16/24
Imaging
• nnecessary for diagnoses A(RS
• +tain when complication *softtissue orital or intracranial. issuspected
• 7< is proper in most cases *?RI inselected cases.
8/16/2019 Review Sinusitis
17/24
?odifying factors
• Asthma
• 7ystic )rosis *less common in
8/16/2019 Review Sinusitis
18/24
Summary of evidence%asedstatements
8/16/2019 Review Sinusitis
19/24
Summary of evidence%asedstatements
8/16/2019 Review Sinusitis
20/24
AA+%,-S I/SA
8/16/2019 Review Sinusitis
21/24
7RS
• 7RS with nasal polyps *7RSw-". – 7RS and ilateral endoscopically
visualised polyps in middle meatus
• 7RS without nasal polyps *7RSs-". – 7RS and no visile polyps in middle
meatus
8/16/2019 Review Sinusitis
22/24
8/16/2019 Review Sinusitis
23/24
8/16/2019 Review Sinusitis
24/24
References
• 7linical practice guideline > adultsinusitis *AA+%,-S 2015.
• 7linical practice guideline for acuteacterial rhinosinusitis in childrenand adults *I/SA 2012.
• ;uropean positional paper on
rhinosinusitis and nasal polyps*;"+S 2012.