#239 Sinusitis: It’s Not That Tricky

A runny nose won’t have you running in circles this cold season with our fantastic overview of rhinosinusitis in all its forms! We discuss etiology and presentation of viral versus bacterial rhinosinusitis, practical counseling tips for guiding patients on nasal irrigation, and working up chronic rhinosinusitis! Our guest is the fabulous Dr. Dink Jardine, a general otolaryngologist, Commander in the US Navy, and Director for Professional Education (DPE) and Designated Institutional Official (DIO) at Naval Medical Center Camp Lejeune (NMCCL).

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).

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Credits

• Written and Produced by: Paul Williams MD, FACP, Beth Garbitelli
• Cover Art: Kate Grant MBChb, MRCGP
• Infographic by: Beth Garbitelli
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
• Editor: Molly Heublein MD (written materials); Clair Morgan of nodderly.com (audio)
• Guest: Dink Jardine, MD

Sponsors: National Internal Medicine Day

Help ACP celebrate National Internal Medicine Day on October 28th. Visit https://www.acponline.org/NIMD20 to learn how you can show your internal medicine pride. Be sure to tag @ACPInternists and use the hashtags #NationalInternalMedicineDay, #IMProud, and #IMEssential.

VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.

Time Stamps

• Sponsor – National Internal Medicine Day, The American College of Physicians
• Sponsor - VCU Health Continuing Education
• 00:30 Intro, disclaimer, guest bio
• 03:00 Guest one-liner, Favorite failure, Pick of the Week*: Still Life by Louise Penny
• Sponsor – National Internal Medicine Day, The American College of Physicians
• 09:30 Case 1 - Acute Viral Rhinosinusitis
• 10:40 Rhinosinusitis vs. Sinusitis
• 14:20 Physical exam in rhinosinusitis
• 20:40 Counseling patients about viral vs. bacterial infection
• 22:56 Sinus regimen/nasal irrigation - “Is there a sinus toilet”
• 27:10 Intranasal fluticasone and other intranasal medications
• 29:40 Rhinitis medicamentosa
• 30:40 Nasal spray positioning
• 33:50 Case 1 - Double Sickening
• 37:40 Worst case scenarios from rhinosinusitis
• 40:40 Antibiotic treatment for bacterial rhinosinusitis
• 43:20 Failed improvement on antibiotics? Second-line options
• 49:30 Case 2 - Chronic rhinosinusitis
• 52:28 Etiology of chronic rhinosinusitis
• 53:33 Making a diagnosis of chronic rhinosinusitis
• 55:25 Treating chronic rhinosinusitis
• 58:40 Vasomotor rhinitis
• 60:40 Sinus irrigation counseling and tips (YouTube)
• 65:30 Case 3 - Allergic Rhinitis
• 70:13 Oral medications for allergic rhinitis; Chronic allergic/non-allergic rhinitis
• 73:51 Take-home points

Links*

1. Still Life: A Chief Inspector Gamache Novel by Louise Penny, Chief Inspector Gamache series
2. “Dr. Adappa and Dr. Palmer teach you How to do Nasal Irrigation” https://www.youtube.com/watch?v=Br928VfiC1M

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goals

Listeners will develop an approach to the diagnosis and management of rhinosinusitis.

Learning objectives

After listening to this episode listeners will...

1. Classify rhinosinusitis, including acute, chronic, bacterial, and viral.
2. Discuss the microbiology and pathophysiology underpinning rhinitis and sinusitis.
3. Differentiate the presentation and management of acute bacterial and acute viral rhinosinusitis.
4. Develop an approach to the diagnosis and management of allergic rhinosinusitis.
5. Recognize and manage patients with non-allergic rhinitis.
6. Discuss the role of antibiotic therapy and surgery in the management of rhinosinusitis.

Disclosures

Dr. Jardine reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.

Citation

Williams PN, Garbitelli B, Jardine D, Heublein M, Watto MF.. “#239 Sinusitis: It’s not that tricky.” The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date October 26, 2020.

Tags

sinus, sinusitis, rhinitis, acute bacterial, rhinosinusitis, bacterial, viral, virus, nose, chronic sinusitis, ENT, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student