Info
🌱 來自: Huppert’s Notes
Sinusitis🚧 施工中
Sinusitis
• Physical exam: Palpate the sinuses (frontal, ethmoid, maxillary); inspect the oropharynx and nasal cavities; perform a cranial nerve exam
• Differential diagnosis:
- Viral rhinosinusitis
• Epidemiology: Most common cause of sinusitis
• Symptoms: Nasal congestion, sore throat
• Physical exam: Patients are less sick and lack findings associated with bacterial infection
• Diagnosis: Clinical diagnosis (no specific labs/imaging required)
• Treatment: Supportive care, no antibiotics indicated
- Acute bacterial rhinosinusitis: S. pneumoniae, H. influenzae
• Symptoms: Facial pain/pressure/fullness, purulent nasal drainage, nasal congestion, fever
• Physical exam: Pain with palpation of the facial sinus, nasal turbinate edema, purulent drainage in the nasal cavity/posterior pharynx
• Diagnosis: Clinical diagnosis (no specific labs/imaging required) based on:
- Persistent symptoms >10 days, especially if severe/worsening symptoms >3 days; OR
- Initial improvement followed by worsening of symptoms
• Treatment: Consider observation for patients who are immunocompetent and have good follow-up; amoxicillin-clavulanate BID (typically not amoxicillin due to increasing resistance of S. pneumoniae, H. influenzae) for 5–7 days
• Complications:
- Chronic rhinosinusitis: Symptoms that last >12 weeks. Obtain CT scan and refer to ENT.
- Orbital cellulitis: Pain with extraocular movement of the eyes, diplopia, opthalmoplegia. Urgent management required.
- Cavernous sinus thrombosis: New headache, focal neurologic findings. Urgent imaging and intervention required.