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November 23, 2020 09:45pm
Practitioners should get a detailed medical history and conduct a thorough physical to treat sinus infections.
Practitioners in primary care and retail health are very familiar with patients complaining about sinus infections multiple times a day during the fall, winter, and spring. Some of the most difficult visits practitioners handle are for the chief complaint of sinus pain. Having specialized knowledge of the different types of rhinosinusitis, getting a patient’s detailed medical history, and conducting a thorough physical exam are a few tools that will make for a successful consultation. Educating patients and guiding them to appropriate treatment plans of which they approve and invest in is a whole other ballgame.
Rhinosinusitis refers to the inflammation of the nasal cavity and paranasal sinuses. The term is the preferred use in the medical community, over sinusitis, because inflammation of the sinuses rarely occurs without inflammation of the nasal mucosa.1This common condition affects an estimated 35 million people per year in the United States and accounts for nearly 16 million office visits per year.2
Rhinosinusitis is classified based on symptom duration as follows3:
<4 li="">ARS is then further broken down by and clinical manifestations and etiology3:
In this article, we will focus on AVRS, the most common presentation in primary care. Recalling and applying these classifications will help guide practitioners to an efficient and successful treatment plan. Common symptoms of ARS, both ABRS and AVRS, include nasal congestion, purulent nasal discharge, maxillary tooth discomfort, and facial pain that is worse when bending forward.
Other signs and symptoms can include anosmia/hyposmia, cough, ear fullness/pressure, eustachian tube dysfunction, fatigue, fever, and headache.4The symptoms of ABRS and AVRS are quite similar, and there are no clinical criteria that have been validated to distinguish between them. However, ABRS and AVRS have different clinical courses, which should provide a strong influence on the treatment plan.5
PATIENT DISCUSSIONS ON AVRS
The majority of ARS cases are the result of a viral infection.4Rhinovirus, influenza virus, and parainfluenza virus are the most common pathogens found to cause AVRS.6Treatment focuses on symptomatic management, as it typically resolves AVRS in 7 to 10 days. In some cases, symptoms may not be completely resolved in 10 days, but it is expected that they will improve.5One of the most important tasks of an AVRS visit is to be honest and transparent with the patient about the length of illness. If it is day 2, be honest that the symptoms are just starting and are expected to last another week. If it is day 5, be empathetic and encouraging, sharing that days 4 to 6 are typically when the symptoms are at their worst but that the condition should improve soon.3If it is day 7, reassure the patient that the illness is winding down. Also, provide a basic description of what is happening within the sinuses and how that can affect the ears, nose, throat, etc. When patients have a rudimentary understanding of their illness, they feel more involved in their care and more invested in their treatment plan.
After an honest description of the anticipated length of illness and the simple pathophysiology that is at play, it is important to remind patients that there are treatments that can improve their symptoms. These include the following:
It is also important to impress upon patients that antibiotics are not helpful for AVRS because they only work on bacteria. This can help the patient have a better understanding of the treatment plan. Avoid dismissive statements during discussions, such as “It’s only a virus.” Be empathetic and understanding in terms of patient complaints and generous and truthful with knowledge. As a practitioner sees a patient investing in the treatment plan because of the extra education and knowledge they received, this may change from one of the most challenging visits to one of the most rewarding.
Bethany Rettberg, NPC, is a family nurse practitioner at a CVS Minute Clinic in Mokena, Illinois.