NOSE AND SINUS INFECTIONS

• There is some evidence that being out in the cold increases some risks associated with getting an infection: 1.) vasoconstriction of nose vasculature; 2.) nasal mucosal temp. decreases; 3.) “increases risk” whatever that means.

• Bacterials Infections – nose naturally has corynebacterium, staph (1/2), alpha hempolytic strep.

• May include vestibulitis, folliculitis, cellulitis (erysipelas from staph/strep), or sinusitis.

• ACUTE SINUSITIS – the seat of sinusitis is in the anterior ethmoids, and amoxicillin are the first line of treatment (cepahalosporins, augmentin, fluoroquinones are second line)

  • Pus in the sinuses, often caused by Strep Pneumo., H flu, or M. catarrhalis; Dx by H&P, CXR, nasal endoscopy in some cases.

  • Treatment – Antibiotics – amoxicillin, TMP-SMX, cefuroxime, quinolones, topical decongestants for less than 3 d., mucolytics, antihistamines if allergy-related

  • Surgery used only as a last resort where complications arise in eye or brain. If unresponsive, aspirate the maxillary sinus for culture. If complications, more done.

• CHRONIC SINUSITIS – consider the underlying etiology of allergy, polyps, CF, immunodeficiency.

  • Organisms include Staph, gram negative rods, and anaerobes.

  • Dx – H & P, CT scans, nasal endoscopy.

  • Tx – manage underlying condition, antibiotics for longer periods (>3,4 wk), steroids, or surgery in some resistant cases.

Category: ENT Notes