Acute Bacterial Rhinosinusitis ๐ (ABRS) : ENT Lectures
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Acute Bacterial Rhinosusitis (ABRS) -
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Definition : Acute bacterial rhinosinusitis (ABRS) is an infection of the paranasal sinuses caused by bacteria, leading to inflammation of the sinus linings.
Etiology :
1) Common Pathogens: Streptococcus pneumoniae (most common), Haemophilus influenzae , Moraxella catarrhalis .
2) Less commonly: Staphylococcus aureus, anaerobes, and Streptococcus pyogenes
Pathophysiology :
1) Blockage of Sinus Ostia: Obstruction of sinus drainage pathways due to inflammation or mucosal swelling. Leads to impaired clearance of secretions, creating a favorable environment for bacterial growth.
2) Mucociliary Dysfunction: Damage to the cilia or thickened mucus impairs the normal sinus drainage.
3) Secondary Bacterial Infection: Often follows viral upper respiratory infections that disrupt normal sinus defense mechanisms.
Clinical Features :
Symptoms Duration: Persists for โฅ10 days without improvement.
Key Symptoms:
Nasal congestion or obstruction
Purulent nasal discharge (yellow or green)
Facial pain or pressure (worsens with bending forward)
Fever (in acute cases)
Cough, hyposmia (reduced sense of smell), headache, and ear pressure.
Diagnosis :
Clinical Diagnosis: Primarily based on history and physical examination.
Criteria:
Symptoms persisting โฅ10 days without improvement.
Severe symptoms (high fever, purulent nasal discharge, facial pain) lasting for at least 3-4 consecutive days at the onset.
Worsening symptoms after initial improvement (double-sickening).
Differential Diagnosis :
Viral rhinosinusitis (common cold)
Allergic rhinitis
Dental infections
Migraine or cluster headaches
Management :
1) Antibiotic Therapy:
First-line: Amoxicillin-clavulanate
Alternatives for penicillin allergy: Doxycycline, respiratory fluoroquinolones (e.g., levofloxacin)
Duration: 5-7 days in adults; 10-14 days in children.
2) Adjunctive Treatments:
Saline nasal irrigation
Intranasal corticosteroids (for symptom relief)
Analgesics and antipyretics (for pain and fever)
Complications :
Orbital Complications: Orbital cellulitis, abscess, cavernous sinus thrombosis
Intracranial Complications: Meningitis, brain abscess, subdural empyema
Chronic Rhinosinusitis: Prolonged inflammation leading to chronic symptoms.
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