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Non-allergic Rhinitis -ANSWER-1. Infectious
2. Irritant related (often in the workplace)
3. Vasomotor
4. Hormone related
5. Associated with medication use or overuse
6. Atrophic (mostly in geriatric patients)
Viral Rhinitis Clinical Presentation -ANSWER-Accompanied by malaise,
headache, sore throat, and occasionally fever
Allergic rhinitis Clinical Presentation -ANSWER--Itching in the nasal
passages, conjunctivae, and roof of the mouth
- Epiphoria (stringy, watery ocular discharge)
-Sneezing, coughing, and a sore or burning throat
Viral rhinitis: Management -ANSWER--Treat Symptomatically
-Fever and headache may be treated with acetaminophen
-Rhinorrhea may be treated with oral decongestants
,-Topical preparations
-Intranasal ipratropium (Atrovent) nasal spray
-Dextromethorphan for persistent coughs
Allergic Rhinitis: Management -ANSWER-- Avoidance or reduced
exposure to offending allergens
- Oral antihistamines: short-term treatment
- Intranasal corticosteroids: long-term management
- Leukotriene receptor antagonists
Acute Sinusitis -ANSWER-abrupt onset of infection and post-
therapeutic resolution of symptoms lasting no more than 4 weeks
Subacute Sinusitis -ANSWER-A purulent nasal discharge persists despite
therapy, lasting from 4 to 12 weeks
Chronic Sinusitis -ANSWER-episodes of prolonged inflammation with
repeated or inadequately treated acute infection lasting greater than
12 consecutive weeks
Sinusitis: Subjective -ANSWER--Gradual onset of symptoms
-Recurrent or chronic dull, constant pain over the affected sinuses
-Pain increases and becomes characteristically throbbing
, -Maxillary sinusitis: pain over the cheeks and upper teeth—may worsen
when standing erect
-Frontal sinusitis: pain over the eyebrows—may worsen with
recumbency
-Ethmoid sinusitis: pain over or behind the eyes associated with retro-
orbital pain
Sinusitis: Objective -ANSWER--Purulent nasal secretions
-Total opacification of affected sinuses on transillumination
-A red, swollen nasal mucosa
-A swollen pale mucosa with watery secretions, points to allergic
sinusitis or rhinitis
-Purulent secretions
-Black or necrotic material—mucormycosis-related rhinorrhea in
immunocompromised patients
-Ethmoid sinus involvement may result in chemosis (eyelid mucous
membrane edema), proptosis, conjunctival injection, extraocular
muscle palsy, or orbital fixation
-Tenderness on palpation over the sinuses
Sinusitis: Management -ANSWER--Because the vast majority of acute
sinusitis cases are caused by viruses, antibiotics are largely unhelpful
-Antimicrobial therapy indicated for acute uncomplicated bacterial
sinusitis