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Acute Sinusitis




General Features


  • Acute sinusitis is an inflammation of the paranasal sinuses usually due to a viral infection, but secondary bacterial infection can occur.
  • Often precipitated by an upper respiratory infection.
  • Inflammation causes swelling of the mucosa leading to obstruction and reduced clearance of mucus.
  • Common bacterial pathogens include: S. pneumoniae, H.influenzae, and Moraxella cattarrhalis.
  • Same bacterial etiology as those for otitis media.

Symptoms and Signs


  • Pain and pressure over affected sinuses
  • Worse when bending forward
  • Tenderness to palpation
  • Headache
  • Fever
  • Halitosis
  • Nasal congestion and obstruction
  • Purulent nasal discharge
  • Transillumination of the affected sinuses may demonstrate opacification

Diagnosis


  • Usually diagnosed clinically.
  • Acute bacterial sinusitis should be considered with persistent symptoms lasting longer than 10 days, severe onset of symptoms, or if symptoms worsen.
  • CT scan if complications are suspected or in refractory cases.
  • Rules out intracranial or orbital involvement.

Treatment


  • Supportive therapy
  • NSAIDs, warm compresses, decongestants, nasal saline irrigation, intranasal corticosteroids
  • Antibiotics if symptoms persist for 10-14 days or severe symptoms/signs are present.
  • Amoxicillin-clavulanate