Sinusitis
Sinus anatomy
Inflammation of sinuses
Allergic
Viral
Bacterial
Acute Bacterial RhinoSinusitis (ABRS)
Symptoms (chief complaint)
Dx
Rx of acute
Analgesia, antipyretics
Treat rhinitis
Intranasal corticosteroids
sodium chloride 0.9% nasal drops and sprays
steam inhalations
decongestants (intranasal or oral)
Antibiotics if any of
Amoxycillin
cefuroxime, cefaclor or doxycycline for 5 days
IF no responsive to amoxycillin, use amoxycillin with clavulanic acid for 7–14 days;
Refer to ENT if any of
Chronic: ?anaerobic ?fungal ?chronic allergic ?CF ?primary ciliary dyskinesia ?immunodeficiency
intranasal or systemic corticosteroids
nasal lavage
surgery
Biopsy
CT scan
Inflammation of sinuses
Allergic
Viral
Bacterial
Acute Bacterial RhinoSinusitis (ABRS)
- Acute: resolves in <30 days
- Subacute: resolves in 30-90d
- Recurrent: 3 acute, greater than 10d apart in 6m (or 4 in 12m)
Symptoms (chief complaint)
- Cough – 80% (25%)
- Nasal symptoms – 76% (33%)
- Fever –64%
- Headache – 33% (25%)
- Facial pain and swelling - 30% (7%)
- Sore throat – 23% (3%)
- Halitosis – 50%
Dx
- daytime cough AND/OR nasal symptoms
- AND any of
- symptoms present without improvement for >10 and <30 days OR
- Severe symptoms (ill appearance, temperature ≥39ºC, and purulent nasal discharge for ≥3 consecutive days) OR
- Worsening symptoms
Rx of acute
Analgesia, antipyretics
Treat rhinitis
Intranasal corticosteroids
sodium chloride 0.9% nasal drops and sprays
steam inhalations
decongestants (intranasal or oral)
Antibiotics if any of
- poor response to decongestants and intranasal corticosteroids
- maxillary toothache
- tenderness over the sinuses
- headache
- mucopurulent discharge for >1 week
- prolonged fever
Amoxycillin
cefuroxime, cefaclor or doxycycline for 5 days
IF no responsive to amoxycillin, use amoxycillin with clavulanic acid for 7–14 days;
Refer to ENT if any of
- poor response to antibacterials
- signs of abscess formation or infection spread beyond sinuses
- >3 acute attacks/year (i.e. acute recurrent)
- symptoms persist beyond 3months (i.e. chronic sinusitis)
Chronic: ?anaerobic ?fungal ?chronic allergic ?CF ?primary ciliary dyskinesia ?immunodeficiency
intranasal or systemic corticosteroids
nasal lavage
surgery
Biopsy
CT scan