U of U PA School ENT Rhinology, Sinusitis, and Nasal Obstructions

How to read a sinus CT scan, what do each colors mean, and what significant findings to look for

Look at name, date and left/right marker

Air - black

Bone - white

Fat/water - grey

Look for deviated septum, asymmetry of sinuses, abnormalities, or osteomeatal complex

What is viral rhinosinusitis?

Rhinoviruses that cause the common cold

What is the pathophsiology of viral rhinosinusitis?

Infection

Inflammation

Mucosal swelling

Increased mucus production

Signs and symptoms of viral rhinosinusitis

Low fever

Clear nasal drainage

Congestion

Sore throat

Cough

What is the treatment for viral rhinosinusitis?

Supportive care

Analgesics, decongestants, intranasal steroids and irrigation

What is bacterial rhinosinusitis? How to differentiate from viral?

Sinusitis from bacterial infection

Lasts longer than 10 days, is unilateral, or >3 days of purulent discharge

What may preceed bacterial rhinosinusitis?

Viral URI

What are the signs and symptoms of bacterial rhinosinusitis?

Purulent nasal discharge/obstruction

Facial pressure, pain, and fullness

Anosmia

Headache, toothache

What is the treatment for bacterial rhinosinusitis?

10 days of high dose amoxicillin (w/wo clavulanate)
-Doxycycline for PCN allergy

Supportive care

What is fungal rhinosinusitis?

Sinusitis from fungal infection
Can be due to allergy to fungus

What are the signs of fungal rhinosinusitis?

Severe chronic sinusitis and inflammation

What is the treatment for fungal rhinosinusitis?

Referral to ENT after 3 months of sinusitis for surgical removal of fungi

What can cause a nasal obstruction?

Deviated septum

Inferior turbinate hypertrophy

What history may preceed a nasal obstruction?

Sinusitis

Headache

Nasal trauma

OSA/snoring

What are the signs and symptoms of nasal obstructions?

Sinusitis

Headache

OSA/Snoring

What is the treatment for nasal obstructions?

Deviated septum - rhinoplasty

Inferior turbinate hypertrophy - nasal steroids, decongestants, surgery, or antihistamines

What are nasal polyps?

Benign mucous membrane masses that form slowly in response to repeated inflammation of the sinus or nasal mucosa.

What is Samter's triad? What do they increase the likelihood of?

1. asthma
2. nasal polyps
3. ASA/NSAID allergy

Increase chance of nasal polyps

What history can lead to nasal polyps?

Allergies

What are the signs and symptoms of nasal polyps?

Chronic sinusitis

Lack of smell

Rhinorrhea

Post nasal drip

How do nasal polyps look?

Grayish grape-shaped growth in the nasal cavity

What is the treatment for nasal polyps?

Systemic steroids followed by intranasal steroid spray

What causes ENT allergy symptoms?

Abnormal immune response to the environment

Immune response to ENT allergens

IgE antibodies bind mast cells and initiate an immune response

What are the signs and symptoms of ENT allergies?

Sneezing

Congestion

Postnasal drainage

Watery/itchy eyes/ears/nose

What testing can help determine ENT allergens?

RAST (Radioallergosorbent test)

Skin prick/intradermal test

What is the treatment for ENT allergies?

Antihistamines

Intranasal steroid spray

Decongestants

LTRAs

Immunotherapy

Exposure therapy