TOC
| ID
Sinusitis
Pathogenesis of Rhini-sinusitis (Vicious cycle):
Altered Sinus environment -> Bacterial growth -> Infection ->
Mucosal Inflammation -> Mucosal edema -> Ostial obstruction ->Altered
sinus environment.
Acute Sinusitis Treatment:
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Diagnose by history/physical examination
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Observation only
- Low suspicion bacterial infection
_ High suspicion bacterial infection, mildly symptomatic
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Antibiotics (10 days) for high suspicion bacterial infection, more than
midly symptomatic
as: Amoxicillin or Septra DS for uncomplicated acute bacterial sinusitis;
Augmentin, Ceclor or Ceftin, or fluoroquinolones (Cipro).
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Topical steroids (Nasarel, Flonase, Beconase nasal sprays), decongestants,
mucolytics, adjunctive treatments as indicated
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Endoscopy/culture in refractory cases
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Be wary of complicatios
- Orbital, intracranial
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Reassess after 1 month, sooner with persistent symptoms or progression.
Chronic Sinusitis Treatment
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Diagnose by history/physical examination
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Antibiotics (~ 3 weeks) , may need anaerobic coverage.
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Oral prednisone 40 mg taper down over 3 weeks
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Topical steroids, decongestants, mucolytics, nasal saline irrigation, adjunctive
treatments as indicated
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Reassess after 1 month, sooner with persistent symptoms or progression.
May need endoscopy-guided cultures to demonstrate pathogenic bacteria.
Endoscopy/culture in refractory cases to rule out unsual infection, tumor,
etc.
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Coronal Sinus CT scan in approximately 1 month (guided by history)
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Surgical treatment in refractory chronic sinusitis.
Johns
Hopkins - Advanced Studies in Medicine journal October 2003:
The Dx & Rx of Sinusitis
11-22-2003