CC Jan 2016 Treatment of Chronic Rhinosinusitis

echoecho's version from 2016-03-17 05:10


Question Answer
Chronic Rhinosinusitis with or without nasal polyps is a common problem with a estimated prevalence of what?: 2-16%
While numerous etiologic agents / factors have been proposed, what is the exact pathophysiology? Unknown
Etiology? Infections, inflammation, environmental factors, airway remodeling
List the cardinal symptoms of chronic Rhinosinusitis?1) nasal blockage, obstruction of congestion. 2) purulent nasal discharge 3) disorder if smell. 4) facial pain/ pressure
Diagnosis is made?if two of the above symptoms are present and persistent for 12 weeks AND there is evidence of mucosal involvement either in endoscopy (polyps, much purulent discharge from primarily the middle meatus and or obstruction of the middle meatus or CT (polyps or mucosal changes).
How does the primary treatment of acute and chronic sinusitis vary?acute is treated its antibiotics while chronic must take into account the presence or absence of nasal polyps
*** What is the first-line maintenance therapy for CRS with or without polyps?intranasal corticosteroids
The benefit of intranasal steroids is most marked in those with polyps. List the benefits?1) reduction in polyp size 2) improvement in nasal congestion and obstruction, rhinorrhea and postnasal drip and sense of smell
Is there also symptomatic improvement by using intranasal steroids in those without polyps?yes
What other treatment as an adjunct to intranasal steroid therapy improves symptoms in patients with and without polyps?nasal saline irrigation
Which is more efficacious, high volume saline irrigation ( > 100 mL) or low-volume saline nasal sprays?high volume saline irrigation
Is chronic use of decongestants recommended?no
What medication are beneficial for patients with nasal polyps?leukotriene antagonists (montelukast (Singular)
What treatment is used for allergic rhinitis and may be of benefit for those with polyps and asthma?Immunotherapy
Intermittent use of short-course (1-3 weeks) systemic corticosteroids is beneficial for what type of patient?those with CRS and either severe nasal polyps or acute inflammatory exacerbations
What is the evidence for benefit of systemic steroids in those without polyps?less clear and risks may outweigh the benefits
What is the antibiotic treatment for CRS with polyps?Doxycycline x 3 weeks
What is the antibiotic treatment for CRS without polyps?short course therapy (<3 weeks) may be indicated if there is purulence
List other therapeutic options?1) Augmentin 2) Cipro 3) Cephalosporin
There evidence that long term (>12 weeks) of a macrolide therapy is beneficial for what type of patient?CRS with polyps
In addition to antibacterial effects, what do these antibiotics have?immunomodulatory actions and improve ciliary function
When should antibiotics be initiated?only if there is inadequate response to intranasal steroids and saline irrigation
Is long-term use of macrolides in patients with CRS and polyps recommended?no
*** SUMMARY = Chronic rhinosinusitis (CRS) treatment is different if there are _____ present?polyps
*** SUMMARY = What 2 treatment options are useful in patients with or without polyps?1) intranasal steroids 2) saline irrigation
*** SUMMARY = Intermittent systemic steroids are useful in what CRS patient type?CRS with polyps
*** SUMMARY = Antibiotics should only be used if there are signs of what?infection (example is fever)