ENT

S&S's

Major
Facial pain/pressure/fullness
Nasal obstruction/blockage
Coloured nasal or postnasal discharge
Hyposmia/anosmia
Fever (in acute rhinosinusitis only)


Minor
Headaches
Fever (other than acute rhinosinusitis)
Halitosis
Fatigue
Maxillary dental pain
Cough
Ear pain/pressure/fullness
Poor response to decongestants

Dx of rhinosinusitis based on:

presence of ≥ 2 major signs or symptoms or
1 major & ≥ 2 minor signs or symptoms or
nasal purulence on examination

Classification

Type	Criteria	Comments
Acute	Up to four weeks	Consider acute bacterial rhinosinusitis if symptoms worsen after 5 days, or persist ≥ 10 days, or symptoms out of proportion to those typical of viral infection.
Subacute	4-12 wks
Recurrent acute	≥ 4 episodes/year with each episode ≥ 7 days; absence of intervening S&S's.
Chronic	≥ 12 wks	Facial pain/pressure does not constitute a suggestive history in the absence of other nasal signs and symptoms.

Antibiotics for rhinosinusitis

Tx:

Abx:
1st line: amoxicillin 500mg PO TID x 10 days
2nd line (if no response after 3-4 days; Abx in previous 3 mos): 2nd gen cephalosporin, macrolide, fluoroquinolone

Analgesics:
acetaminophen
ibuprofen

Intranasal steroid:
Nasal irrigation: esp. important for CRS
Topical decongestant (max 3 days):

Streptococcal pharyngitis

no Cough	1
anterior cervical Lymphadenopathy	1
Age 3 - 14 y/o	1
Fever >38 C	1
Tonsillar exudate or swelling	1

0 - 1 no Tx
2 - 3 C&S or BAD GAS
4 - 5 Pen V x 10 days