Sinusitis
Camilla Curren, M.D.
The Ohio State University College of Medicine
Division of General Internal Medicine
Camilla.curren@osumc.edu
Learning Objectives
 In adult patients with symptoms of illness, abnormal
physical findings, or abnormal lab findings, identify age
appropriate diagnoses.
 Identify the differential diagnoses for common issues in
ENT(hoarseness, pharyngitis, hearing loss, nasal
obstruction, epistaxis and inflammatory disorders of the
nose and nasal cavity).
Learning Resources
 Practice Guidelines, August 9, 2013. ACR Practice
Guidelines for the Performance of Computed
Tomography(CT) of the Extracranial Head and Neck in
Adults and Children.
 Sinonasal Disease, November 13, 2013, ACR
Appropriateness Criteria for diagnostic imaging.
 An Overview of the Treatment and Management of
Rhinosinusitus, 2012, US Pharmacist
 Chronic Sinusitis, Brooks, I. Updated 4/7/2014 from emedicine.com
Module Instructions
Articulate
Module
• Review
Module
content
• Complete
Quiz
• Utilize
Learning
Resources
Virtual Patient
• Interview
the patient
and obtain
a Full
Patient
History
IHIS Learn
• Access the
Patient
Chart
• Review
Physical
Findings
• Interpret
Patient
Data
• Place
Appropriate
Orders
• Document
Encounter
Patient Centered Medical Home Concepts
Enhance Access and Continuity
Identify and Manage Populations
Plan and Manage Care
Provide Self Care Support
Measure and Improve Performance
IHIS Instructions
1. View the articulate module associated with this activity, “Sinusitis” and review basic IHIS
navigation information including the creation and documentation of a patient encounter. You
may access the IHIS Ambulatory Modules via the NetLearning site at mylearning.osumc.edu.
Please be sure you are familiar with access to IHIS Learn before beginning.
2. Interview the patient “Alexander XX Spiros” by performing a full patient history for
documentation in your Progress Note. You may click on the blue oval link on the last slide to
access a hyperlink to meet the patient and perform your interview.
3. Access IHIS Learn and review your assigned patient chart “Alexander XX Spiros” documenting
Chief Complaint, Vital Signs, Allergies, Medication Documentation, History, and Progress Note
in the appropriate sections.
4. Review and document the Physical Examination findings using the dot phrase
“.EXAMALEXANDERSPIROS” in the Objective section of your progress note.
5. Review and document lab testing results using the dot phrase “.LABALEXANDERSPIROS.”
6. Review and document imaging results using the dot phrase “.IMAGEALEXANDERSPIROS.”
7. Create an assessment based upon the findings of the History and Physical Examination, lab
and imaging, and choose an appropriate diagnosis in IHIS Learn Dx and Orders.
8. Select additional orders as indicated, and associate a corresponding diagnosis to each order.
9. Create a plan in the Progress Note, documenting orders placed, medication ordered, patient
education and follow up instructions given in the appropriate sections. Remember to include
any plans you may have for the patient for routine preventive or self care and return
appointment.
10.Enter “NCNC” and desired follow up for the patient in the LOS &Follow-up section.
11.Close the encounter by clicking on the appropriate tab at the bottom of the Navigation bar on
the lower left column on the screen.
Sinus Disease
Rhinosinusitis
Acute
Chronic
Recurrent
Allergic
Sinus Disease
Causes
Fungal
Bacterial
Allergy
Viral
Complications of Sinus Disease
 Periorbital Cellulitis
 Abscess
Imaging
Congenital anomalies
Facial trauma
Proptosis on exam
Diplopia or visual field change
Chronic inflammation, infection or obstruction
Post surgery
Sphenoid involvement suspected
Referral
Infectious
Disease
Allergy
Otolaryngology
Pharmacy
Respiratory
Therapy
Treatment
Abx
Nasal
Saline
Antiinflammatory
Hydration, rest
Risk Factors For Chronic Disease
Anatomic
•
•
•
•
Intubation
Anomalies
Tumor obstruction
Kartagener
syndrome (ciliary
dyskinesia)
• Dental Disease
• GERD
Systemic
•
•
•
•
•
Cystic Fibrosis
Sarcoidosis
Granulomatosis
Vasculitis
Immunosuppressive
disease, HIV
• Immunotherapy
• Smoking
Immunologic
• Allergy
• Aspirin Sensitivity
• Hormonal
(Pregnancy, oral
contraceptives)
Summary






Acute, chronic and recurrent sinusitis
Common presentations and clinical findings
Risk Factors for Chronic Disease
Common Causes
Imaging and Referral Indications
Utilization of Care Teams For Patient Care
Thank you for completing this module
Questions? Contact me at:
Camilla.curren@osumc.edu
Interview Alexander Spiros
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