#239 Sinusitis: It’s Not That Tricky

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.8 • 3.1K Ratings

🗓️ 23 October 2020

⏱️ 75 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

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.

Transcript

Click on a timestamp to play from that location

0:00.0	This episode of The Curb Siders is sponsored by the American College of Physicians in celebration of National and Journal Medicine Day on October 28th.
0:07.0	ACP provides its 163,000 members with lifelong education, clinical support, practice resources, professional development, and advocacy resources.
0:17.0	The Curb Siders podcast is for entertainment, education, and information purposes only and the topics discussed should not be used solely at Diagnostree, or prevent any diseases or conditions.
0:27.0	For the more of the views and statements expressed on this podcast are solely those of those that should not be interpreted to reflect official policy or position of any entity inside from possibly, cash like more hospital and affiliate outreach programs.
0:34.0	If indeed there are any, in fact there are none. Pretty much we aren't responsible if you screw up, you should always do your own homework and let's know when we're wrong.
0:48.0	Hey Paul, we're back. Stuart's not here. Oliver is here though in his place. Oliver of course is your adorable black cat.
0:57.0	Yes, full name, Oliver P. Gunt Paulford.
0:59.0	And this is The Curb Siders to remind the audience. We have a partnership with VCU Health and there will be CME Credit available for this episode for free.
1:10.0	You can go to curbsiders.vCUHealth.org.
1:14.0	Paul, can you tell the audience what is it that we generally do on this show and then maybe you could tell them about our wonderful guest.
1:22.0	Well, thanks Matt. What we generally do on this show is what how do I tell the audience what we are instead?
1:28.0	We are the internal medicine podcast and what we generally do on this show is we use expert interviews to bring you clinical pearls and practice changing knowledge.
1:35.0	As per you, we have a fantastic guest. So the clinical pearls we bring to you are especially fantastic.
1:42.0	We have Dr. Dick Jardine who's going to talk us through her approach to sinusitis. We had a great discussion about her approach to acute bivalryneus sinusitis, bacterial sinusitis and then we segue beautifully and masterfully into chronic rena sinusitis.
1:57.0	We cover all the sinusitis disease or whatever the portal that would be. Shall I tell the audience a little bit about who our guest is Matt?
2:05.0	I think now is a great time.
2:09.0	So Dr. Dick Jardine is a general otolaryngologist and serves as the director of professional education and designated institutional official at the Naval Medical Center Camp LaJune where she maintains her clinical practice.
2:20.0	She is a commander in the U.S. Navy and holds faculty appointments as an assistant professor in the departments of surgery and a pediatrics at the uniform services university of the health sciences.
2:29.0	She is passionate about medical education, especially procedural skills and can often be found nerding out on teaching modalities and curriculum design.
2:37.0	So without further ado, why don't we get to the nose? Do you have a pun for us, Matt?
2:42.0	I don't. I feel like Stuart almost certainly would and we can all be glad that he has some sort of obligation this evening.
2:51.0	The views expressed in this podcast discussion are those of the presenters and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the U.S. government.
	...

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