Acute Sinusitis


Blausen 0800 Sinusitis


Etiology

Diseases that swell the nasal mucosa viral or allergic rhinitis.
Obstruction of sinus drainage.

Clinical

  • Pain resembling toothache over the maxillary or relevant sinus.
  • Usually unilateral facial fullness, pressure and tenderness.
  • Green nasal discharge.
  • May be visible redness and swelling and tenderness over sinus.
  • Headache and postnasal drip can cause wheeze and asthma like symptoms.
  • Symptoms last 1-4 weeks.
  • Maxillary sinus most vulnerable – large and meatus is high preventing effective drainage.
  • Ethmoid sinus lies high lateral wall of nose and separated from eye by only thin lamina papyracea.
  • Frontal sinus gives pain over forehead.
  • Sphenoid sinusitis – pain in centre or points to vertex.


Organisms

  • Strep Pneumoniae.
  • Streptococci.
  • Haemophilus influenzae.
  • Staph aureus.

Investigations

  • Clinical diagnosis.
  • Non contrast Coronal CT – soft tissue swelling and opacification.
  • MRI – if malignancy suspected.

Complications

  • Orbital cellulitis and abscess – proptosis and orbital pain.
  • Osteomyelitis – IV antibiotics.
  • Cavernous sinus thrombosis – ophthalmoplegia, chemosis, visual loss. IV antibiotics.

Management

  • Oral or nasal decongestants.
  • Antibiotics if symptoms > 2 weeks or severe symptoms, facial pain, pyrexia.
  • 1st line – Amoxicillin, Doxycycline.
  • 2nd line – Augmentin, Levofloxacin.