Tessy KK K 22 NR511 WK 7 Adult Sinusitis (1)1222 ADULT SINUSITIS CHAMBERLAIN UNIVERSITY PROF. ALLEN OCTOBER 2021

Tessy KK K 22 NR511 WK 7 Adult Sinusitis (1)1222 ADULT SINUSITIS CHAMBERLAIN UNIVERSITY PROF. ALLEN OCTOBER 2021 ADULT SINUSITIS • Adult Sinusitis- Is a short-term inflammation of the lining of the paranasal Sinuses. • Causes: • About 80% caused by viral URTI, • Some are cause by allergic reactions • While other are cause by the Inflammation that create swollen Mucous membranes which block the natural drainage pathway of the sinuses. Prevalence • Approximately 28.9 million adults were diagnosed with Sinusitis in 2018 • 11.6% of US adults have Sinusitis • 2.1% of Americans are likely to be diagnosed with Sinusitis at any given time. • Prevalence peak in 60-70s (Bhattacharyya & Gilani, 2018) INCIDENCE • 1 in 8 American are affected. • More common in adults than it is in children • 47% of Sinusitis cases improve within a week without antibiotics. • Sinusitis complicates nearly 0.5% of URTI. More prevalent in males. 2021) (FastStats, • Occur in predisposed individuals, PATHOPHYSIOLOGY • Viral URTI or allergic reactions results in mucosal swelling with occlusion of the Sinus Ostia • Reduced O2 tension occurs resulting to decreased Mucociliary clearance of fluid into the Sinuses. • The inflammation results into viscous secretions and alterations in the Cilia beat frequency occurs. The sinus become obstructed leading to Acute Sinusitis • Acute viral rhinosinusitis –Begins with viral inoculation via direct contact with the nasal mucosa. • Acute Bacterial rhinosinusitis -occur when bacterial secondarily infect an inflamed sinus cavity. (Bachert et al., 2020) SIGNS AND SYMPTOMS • Stuffy nose • Thick discolored nasal discharge • Facial pain • Pain with eye movement • Fever (Acute Sinusitis alone) • Headache • Cough • Fatigue • Decreased sense of smell (Bachert et al., 2020) PUBLICATION AND APPLICABILITY IN PRIMARY CARE • Organization: The American Academy of Otolaryngology—Head and Neck Surgery • Publication: Clinical Practice Guideline (Update): Adult Sinusitis • Year of Publication: 2007 • Year Updated: 2015 Applicability and Use in primary care setting • The publication is straightforward, easy to understand, and improves the understanding of Adult Sinusitis diagnosis and management. • Clearly outlines a stepwise criteria for of Adult Sinusitis diagnosis and management. (Randel, 2007) KEY ACTION STATEMENT • Acute viral rhinosinusitis should be diagnosed in patients with typical symptoms of rhinosinusitis for less than 10 days and in whom symptoms are not worsening (level of Evidence A). • Clinicians should not obtain radiographic imaging for acute rhinosinusitis unless a complication or alternative diagnosis is suspected (level of Evidence B). • Clinicians may recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief of VRS or ABRS (level of Evidence C). (Rosenfeld et al., 2015) KEY ACTION STATEMENT • Clinicians should either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated ABRS., amoxicillin should be the first-line therapy (level of Evidence C). • If the patient fails to improve with the initial management option by 7 days after diagnosis or worsens during the initial management, the clinician should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications (level of Evidence B). • (Rosenfeld et al., 2015) APPLICATION IN CLINICAL ROTATION • Chief complain facial pain and Rhinorrhea • HPI - M.M is a 65 y/o male presents to the clinic with a complaint of facial pain, rhinorrhea and cough for the past 1 week. • HX. NTN, • ROS- He has had a headache in the past 24 hours, decreased appetite, and low energy level, C/O pain with eye movement ,vision change. • PE- AOX 4, HEENT + Stuffy nose, thick yellow nasal discharge, Lung,- clear on auscultation • heart, S1 S2 present • a He has fever T (39.50C), Periorbital edema, Maxillary sinus tenderness. APPLICATION IN CLINICAL ROTATION • Diagnosis: A diagnosis of acute sinusitis • Treatment at Clinic : Amoxicillin - Clavulanate 875 mg /125 mg PO BID X 14 days. • An adjuvant therapy with nasal saline drop • Practice guideline Recommendation.. 1 Tylenol for pain and fever, 2, Nasal steroid spray to reduce symptoms 3, slain Irrigation or washing out the nose with salt and water. • PLAN- ABT TX, Avoid food that increase production of mucus, Avoid food that contains histamines • F/U 10 days to ensure that symptoms are well controlled. APPLICATION IN CLINICAL ROTATION What was well done • The patient was diagnoise and antibiotic treatment was initiated with amoxicillin being the first line of treatment based on the key action statements by the The American Academy of Otolaryngology—Head and Neck Surgery. What could have been done better. • Nasal corticosteroids should have been prescribed. • Patient should be educated on the proper management of chronic conditions that would complicate Acute rhinosinusitis management. REFERENCES • Bachert, C., Marple, B., Schlosser, R. J., Hopkins, C., Schleimer, R. P., Lambrecht, B. N., Bröker, B. M., Laidlaw, T., & Song, W.-J. (2020). Adult chronic rhinosinusitis. Nature Reviews Disease Primers, 6(1), 1–19. • Bhattacharyya, N., & Gilani, S. (2018). Prevalence of Potential Adult Chronic Rhinosinusitis Symptoms in the United States. Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 159(3), 522–525. • FastStats. (2021, September 14). • Rosenfeld, R. M., Piccirillo, J. F., Chandrasekhar, S. S., Brook, I., Ashok Kumar, K., Kramper, M., Orlandi, R. R., Palmer, J. N., Patel, Z. M., Peters, A., Walsh, S. A., & Corrigan, M. D. (2015). Clinical Practice Guideline (Update): Adult Sinusitis. Otolaryngology–Head and Neck Surgery, 152(2_suppl), S1–S39.