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Acute/chronic sinusitis
- An inflammation/infection of the sinuses
- Typically secondary to an upper respiratory infection or seasonal allergies
- Most common pathogens
- Strep pneumoniae
- Haemophilus Influenzae
- Moraxella catarrhalis
- Staph aureus
Predisposing Factors
- Anything that obstructs drainage from the sinuses
- Smoking – (decreases movement of cilia)
- Deviated septum
- Cystic fibrosis
- Large adenoids
Clinical Presentation
- I’ve had a cold for about a week and it is getting worse
- Headache
- Runny nose
- Sinus pain, tooth pain
- Fever
- General malaise
Labs, Studies and Physical Exam Findings
- Transillumination – putting a light up to the sinuses
- Tender over sinuses
- Nasal endoscopy may be helpful with chronic sinusitis lasting longer than 12 weeks
- CT may be helpful with chronic sinusitis lasting longer than 12 weeks
Treatment
- Nasal irrigation with saline
- Steam
- Hot packs
- Lots of fluids
- Humidifier
- Acetaminophen or ibuprofen
- Decongestant
- Phenylephrine for no more than five days
- Antibiotics after 10 days
- Amoxicillin
- Doxycycline
- Steroids
- Surgical correction to improve drainage of sinuses
Allergic rhinitis (Hay fever)
- Seasonal allergic inflammation of the sinuses
- Often found in conjunction with asthma and atopic dermatitis
Clinical Presentation
- Runny nose – typically clear mucus
- Itchy, watery eyes – bilateral
- Sneezing
Labs, Studies and Physical Exam Findings
- Allergy testing if necessary
Treatment
- Prevention! Avoid triggers
- No Cats in the bedroom
- Nasal irrigation with saline
- First line – Intranasal corticosteroids
- Require several days of treatment to achieve desired effect
- Antihistamines
- Decongestants
- Desensitization if severe
Nasal polyps
- Fleshy growths from the nasal mucosa
Causes or Predisposing Factors
- No true known cause
- Increased incidence with allergic rhinitis, asthma and aspirin allergy
Clinical Presentation
- Cold symptoms for several months
- Runny nose
- Nose feels congested
- Sense of smell is greatly reduced
Labs, Studies and Physical Exam Findings
- Endonasal scope
- CT
Treatment
- Topical nasal steroid for 1-3 months
- Oral steroid may be helpful
- Surgical removal is usually necessary
Epistaxis (Nosebleed)
- Anterior nosebleed is the most common and originates from Kiesselbach’s plexus
- Posterior nosebleed is less common and much more difficult to treat
Causes / Risk Factors
- Trauma
- Dry mucosa
- Chronic rhinitis
- Foreign body
- Clotting issue
- HTN
- Anticoagulation (aspirin, ibuprofen, warfarin, heparin, clopidogrel)
Clinical Presentation
- There is blood pouring out of my nose, and I can’t make it stop
Labs, Studies and Physical Exam Findings
- Initially a clinical diagnosis, but you may want to work up other suspicious medical issues
Treatment
- Direct pressure – pinch the bridge of the nose for 15 minutes
- Have patient lean forward to avoid swallowing blood leading to nausea and vomiting
- Topical vasoconstrictor ie cocaine or oxymetazoline
- If you can visualize the source silver nitrate may be used to cauterize the vessels
- Packing for 24 hrs if necessary
- Pneumatic tamponade
- Surgical correction