Practice Paper 5: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Acute sinusitis is inflammation of the paranasal sinuses, which usually occurs following a bacterial upper respiratory tract infection. The pain of acute sinusitis is worse on bending and coughing, and may be accompanied by headache. The site of the pain depends on which sinus is affected. Acute maxillary sinusitis causes pain over the cheek, which may be referred to the teeth. Acute frontal sinusitis causes pain above the eyes. Acute ethmoid and sphenoid sinusitis can result in pain between or behind the eyes. In reality, however, the site of sinusitis may be very difficult to distinguish. In maxillary sinusitis, a skull X-ray may show a fluid level on the affected side. Treatment is with antibiotics (amoxicillin) and analgesia. Vasoconstricting nose drops (1% ephedrine) aid drainage of the sinus.
Medical Management for Rhinosinusitis
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
Acute rhinosinusitis is common, affecting 6–15% of the population each year. The vast majority of cases are viral, with bacterial infection estimated in less than 2% of cases; however there is significant overlap, with viral infection triggering inflammatory changes that facilitate secondary bacterial infection. Most cases resolve spontaneously within 10 days, and the incidence of complications is very low. Medical treatment may be antimicrobial or anti-inflammatory, with an aim of reducing the infective and inflammatory load to both reduce the severity and duration of illness, to prevent recurrence and complications, or reducing symptom severity alone.
Sinus headache and nasal disease
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache in Clinical Practice, 2018
Acute rhinosinusitis is sudden in onset, lasts from 1 day to 4 weeks, and there is complete resolution of the symptoms. Subacute rhinosinusitis is continuous with acute rhinosinusitis and lasts for 4–12 weeks;27 recurrent acute rhinosinusitis requires four or more episodes of acute rhinosinusitis, lasting at least 7 days each, in any 1-year period. Chronic rhinosinusitis requires that signs or symptoms persist for 12 weeks or longer and may be punctuated by acute infectious episodes.
Current and emerging treatment modalities for bacterial rhinosinusitis in adults: a comprehensive review
Published in Expert Opinion on Pharmacotherapy, 2022
Maria Gabriella Matera, Barbara Rinaldi, Vito de Novellis, Paola Rogliani, Mario Cazzola
To avoid needless antibacterial therapy, it is crucial to distinguish between ARS caused by viral upper respiratory infections and ARS caused by bacteria [2]. Additionally, this assists the physician in avoiding requesting superfluous diagnostic procedures, which lowers costs and raises the standard of treatment. The physician must suspect the presence of ABRS when the symptoms or signs of ARS (purulent nasal drainage combined with nasal obstruction, sinus pressure, pain, and fullness) continue for at least 10 days after the beginning of upper respiratory symptoms or worsen within 10 days following an initial improvement [2]. The American Academy of Otolaryngology – Head and Neck Surgery Foundation guideline update group stated, ‘A clinician should diagnose acute bacterial rhinosinusitis when symptoms or signs of acute rhinosinusitis persist without evidence of improvement for at least 10 days beyond the onset of upper respiratory symptoms’ [2].
What are the challenges in choosing pharmacotherapy for rhinosinusitis?
Published in Expert Opinion on Pharmacotherapy, 2020
Alkis J Psaltis, Erich Vyskocil
Despite the similar clinical manifestations of acute and chronic rhinosinusitis, the underlying pathophysiology and treatments of the two conditions are different. Acute rhinosinusitis is a pathogen-driven disease while chronic rhinosinusitis has a more complex and multifactorial etiology. Given that the majority of patients with ARS have an underlying viral etiology, treatment should remain supportive with the use of analgesia, saline sprays, and intranasal corticosteroids. Although there is little evidence to support the use of oral or topical decongestants, short-term use of these agents may lessen the intense nasal obstruction some individuals experience with ARS. Antibiotic use should be discouraged unless patients have evidence of complications, show worsening of their clinical picture after 5 days or have a protracted course lasting more than 7–10 days. If antibiotics are considered, B-lactam antibiotics will typically cover most upper airway pathogens and can be prescribed empirically without the need for bacterial cultures unless clinically indicated. Investigations are not typically required unless complications are suspected or patients fail to improve.
Current healthcare pathways in the treatment of rhinosinusitis in Germany
Published in Acta Oto-Laryngologica, 2018
Jonas Jae-Hyun Park, Claus Bachert, Stefan Dazert, Karel Kostev, David Ulrich Seidel
Every year, a large percentage of the world’s population is diagnosed with acute rhinosinusitis (ARS), which is mostly caused by viral infection with or without bacterial superinfection of the mucosa of the paranasal sinuses [1]. In cases that persist for more than 2–3 months, a diagnosis of chronic sinusitis (CS) is made [2]. Chronic rhinosinusitis (CRS) is epidemiologically important, as it affects over 10% of the European adult population [3,4]. Because of its epidemiological relevance, CRS is a common health problem with significant direct medical costs [5]. For example, a U.S. study conducted in 2003, which analyzed the healthcare data of more than 300,000 U.S. employees, found sinusitis to be one of the ten medical conditions with the highest health and productivity cost burden, along with other conditions such as back pain, arterial hypertension, diabetes mellitus, chronic obstructive pulmonary disease, and myocardial infarction [6]. Therefore, given its epidemiology and significant economic impact, rhinosinusitis is a disease that deserves to be further analyzed from a systematic, public healthcare perspective.
Related Knowledge Centers
- Fever
- Hyposmia
- Inflammation
- Nasal Mucosa
- Orofacial Pain
- Paranasal Sinuses
- Sore Throat
- Headache
- Nasal Congestion
- Phlegm