Chronic Rhinosinusitis¶
Jared Freitas
Background¶
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Inflammatory syndrome of the paranasal sinuses, with objective evidence of inflammation for > 12 weeks, typically in young to middle aged adults
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Symptoms: typically need two of the following:
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Anterior/posterior mucopurulent nasal drainage
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Presence of nasal fullness/congestion
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Facial pain/pressure, sometimes accompanied by headache (most prevalent but least specific)
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Reduction in sense of smell
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Red flag symptoms that require more emergent evaluation by ENT or NSGY
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Double vision
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Proptosis
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Ophthalmoplegia
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Severe headache
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Any focal neurologic deficits
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In addition to clinical history, patients need objective evaluation with nasal endoscopy or non-contrasted CT of sinuses (gold standard imaging modality) to confirm presence of inflammation and presence of nasal polyps
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Other conditions to consider on differential:
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Rhinitis without sinusitis (vasomotor, gustatory, allergic, idiopathic)
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Headache and facial pain syndromes
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Laryngopharyngeal reflux syndrome
Management¶
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Daily sinus rinses with saline can clear sinuses of secretions, irritants and allergens
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Utilizing daily intranasal corticosteroid sprays improve symptoms, better control when used in conjunction with sprays
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Short courses of macrolide antibiotics less than 3 weeks duration along with short course oral corticosteroids for acute exacerbations
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When to refer to specialist:
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ENT: Refractory symptoms necessitating rhinoscopy to look for nasal polyps, anatomical source of obstruction, ability to get direct culture from sinuses, or for sinus surgery as treatment
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Allergy/immunology: treatment of causal allergen or associated immunodeficiency that contributes to recurrent infections
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10-14 days of oral corticosteroids can also help in patients with nasal polyps shrink inflamed tissue and decrease obstructive symptoms but require ongoing nasal steroids to prevent recurrence
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Daily antileukotriene agents and antihistamines can provide benefit in patients with an allergic component
Smoking cessation can lead to symptom relief in CRS pts with and w/o nasal polyps