The Curbsiders Internal Medicine Podcast

#239 Sinusitis: It’s Not That Tricky

19 snips

Oct 23, 2020

Joining the discussion is Dr. Dink Jardine, a general otolaryngologist and Navy Commander, passionate about medical education. He shares insights on diagnosing and managing rhinosinusitis, emphasizing the distinction between viral and bacterial infections. Practical tips on nasal irrigation and effective communication with patients are explored. The conversation also touches on chronic rhinosinusitis through a detailed case study, highlighting the importance of tailored treatment plans and proper follow-up care for improved patient outcomes.

Ask episode

AI Snips

Chapters

Books

Transcript

Episode notes

ADVICE

Use Precise Terminology: Rhinosinusitis

Use the term rhinosinusitis as it accurately describes inflammation of both nasal passages and sinuses.
Avoid using sinusitis alone since isolated sinus inflammation is uncommon.

ADVICE

Nasal Exam With Otoscope Tips

Examine the nasal passages using an otoscope angled away from the septum to avoid pain.
Look for inflamed, red, or boggy turbinates to assess the nasal mucosa condition.

ADVICE

Distinguish Viral vs Bacterial Sinusitis

Use symptom history like worsening after initial improvement and duration over 10 days to distinguish bacterial from viral rhinosinusitis.
Treat early bacterial infections conservatively with nasal irrigation and symptoms management before antibiotics.

Get the Snipd Podcast app to discover more snips from this episode

Get the app

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).

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*

Still Life: A Chief Inspector Gamache Novel by Louise Penny, Chief Inspector Gamache series
“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...

Classify rhinosinusitis, including acute, chronic, bacterial, and viral.
Discuss the microbiology and pathophysiology underpinning rhinitis and sinusitis.
Differentiate the presentation and management of acute bacterial and acute viral rhinosinusitis.
Develop an approach to the diagnosis and management of allergic rhinosinusitis.
Recognize and manage patients with non-allergic rhinitis.
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.