Acute Rhinosinusitis

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Acute Rhinosinusitis by Mind Map: Acute Rhinosinusitis

1. Types

1.1. Acute

1.1.1. <4wks

1.2. Subacute

1.2.1. 4-12wks

1.3. Chronic

1.3.1. >12wks

2. Epidemiology

2.1. Prevalance

2.1.1. 20%

3. Etiology

3.1. ARS

3.1.1. Viral >90%

3.1.1.1. Rhinovirus

3.1.1.2. Adenovirus

3.1.1.3. Coronavirus

3.1.1.4. RSV

3.2. Bacterial sinusitis

3.2.1. Pneumococcus

3.2.1.1. Resistent strain altered pencillin binding site

3.2.1.1.1. overcome by increase the dose of amoxicillin

3.2.2. H. Influanzae

3.2.2.1. >50% produce B-lactamse

3.2.2.1.1. Add B-lactamse inhibitors (clavulin)

3.2.3. Morexella Catarrhalis

3.2.3.1. >90% produce B-lactamse

4. Symptoms

4.1. Major (2 or more)

4.1.1. Discharge

4.1.1.1. Anterior

4.1.1.2. Posterior

4.1.2. Blockage

4.1.3. Facial pain

4.1.4. Hyposomnia/anosmia

4.2. Objective findings

4.2.1. Endoscope

4.2.1.1. Polyps

4.2.1.2. Mucopurulant discharge from middle meatus

4.2.1.3. Obstruction at the middle meatus

4.2.2. and/or CT findings

5. Viral vs. bacterial

5.1. Think bacteria

5.1.1. Bad onset

5.1.1.1. Severe onset with fever and facial pain

5.1.2. Persistent

5.1.2.1. Persistent beyond 10days w/o improvement

5.1.2.1.1. If you culture beyond 10days, 60% will grow bacteria

5.1.3. Improvement followed by worsening

5.1.3.1. The best sign (double worsening)

6. Treatment

6.1. Abx

6.1.1. Amoxicillin (in canada) or beta lactam allergy, use either septra or macrolide

6.1.1.1. high dose amox if endemic of resistant pneumococcus

6.1.1.1.1. Add clav if beta lactase producing organism

6.1.2. Pencillin allergic

6.1.2.1. Fluroquinolone or doxycyclin

6.1.2.2. If type 1

6.1.2.2.1. Levofloxacin

6.1.2.3. If other type

6.1.2.3.1. in children

6.1.3. NNT is 18 and NNH is 8 (number need to harm(

6.2. Duration

6.2.1. 2wks for peds

6.2.2. 1wk for adult

6.3. INS

6.4. Nasal irrigation

7. Recurrent sinusitis

7.1. 4 or more /year

7.2. r/o underlying problem

7.2.1. PID

7.2.2. CF

7.2.3. AR

7.2.4. Structural

8. RF

8.1. Dental infections

8.2. Anatomic abnormalites

8.2.1. Septal deviation

8.2.2. Haller cells

8.3. Smoking

8.4. Pollotion

8.5. AR might be a RF

8.6. ICAM1 upregulation

8.6.1. Receptor for rhinovirus

8.7. ICU

8.7.1. Intubation

8.7.2. NG

8.8. CF

8.9. Immunodeficiency

9. Investigations

9.1. Culture

9.1.1. Number 1, it should be sinus culture not nasal because nasal culture has Poor correlation w/ sinus culture

9.1.2. Do enodscopy culture if patients failed medical management

9.1.2.1. Resistent

9.1.2.2. Unusual organism

9.2. CT

9.2.1. Is usually not indicated

10. Complications

10.1. Abx doesn't make a different in healthy population