Rhinosinusitis - Diagnosis and Management Summary
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Rhinosinusitis - Diagnosis and Management Summary

Acute (<1mo) vs. subacute (1-3mo) vs. chronic (>3mo, usually w/ anaerobes); recurrent (4 or more annual episodes)

Dx: rhinorrhea (viral - clear, bact - purulent) + nasal obstruction or facial pressure/pain/fullness. A/w anosmia, ear fullness, cough, H/A

Bacterial:

 • S. pneumo (41%), H. flu (35%), M. catarrhalis (4%), S. aureus (3%), anaerobes (7%), strep (7%)

 • Time Frame: >10 days, or worsening within 10 days after initial improvement (“double worsening”)

 • Tx: Watchful waiting* in pts w/ good followup vs. Augmentin 875mg BID** (Doxy 100mg BID in PCN-allergic) x 5-7d

Viral:

 • Time Frame: 7-10 days 

 • Tx: Symptom control, oral decongestant

Fungal: 

 • Mucor (invasive) in DM, immunocompromised

 • Acute(invasive) to more chronic (>3mo)

 • Tx: Surgical removal of fungal mucin or “fungal ball” (mycetoma). ENT emergency if invasive (destruction of sinus, erosion into orbit or brain)

Dx: ONLY if concern for complications or other etiology suspected: CT scan with contrast +/- MRI

Complications: Meningitis, periorbital/orbital cellulitis (pain, edema, proptosis, painful eye movement, diplopia), subperiosteal/intracranial/epidural abscess, osteomyelitis of the sinus bones, septic cavernous sinus thrombosis.

Alarm symptoms: persistent fevers >102F; periorbital edema, inflammation, or erythema; CN palsies; abnormal extraocular movements; proptosis; vision changes (diplopia, impaired vision); severe headache; AMS; meningeal signs.



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