What is acute sinusitis?
- Resolves completely within 12 weeks
Increase in symptoms of a common cold after 5 days, persistence beyond 10 days, but less than 12 weeks
What is chronic sinusitis?
- Symptoms last for more than 12 weeks
What are causes of sinusitis?
Viruses - Rhinovirus, parainflueza, influenza
- Followed by bacterial infection
Bacteria - Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus
What is the pathophysiology of sinusitis?
- Sinus mucosa oedema obstructs the sinus ostia
- Reduced mucociliary action allows secretions to stagnate
- Gives bacteria a suitable environment to grow
What is the cause of chronic sinusitis?
- More likely to be inflammatory than infectious
- Inflammation, infection and obstruction of sinus ventilation
- Staph aureus and Pseudomonas dominate
What are complications of sinusitis?
Orbital - Cellulitis, abscess, cavernous sinus thrombosis
Intracranial - Meningitis, encephalitis, abscess, venous thrombosis
Bony complications - Osteomyelitis
What are symptoms of acute sinusitis?
- Nasal blockage/discharge
- Facial pain or pressure
- Reduction or loss of sense of smell
- Altered speech
- Cough
What examinations would you do?
- Inspect and palpate the maxillofacial area to elicit swelling and tenderness
- Anterior rhinoscopy to look for nasal inflammation, mucosal oedema and purulent nasal discharge
- Temperature, pulse and BP
What are red flags that require referral?
- Unilateral polyp or mass
- Bloody nasal discharge
What is the management for acute sinusitis?
Systemically unwell - Admit
Symptoms <10 days -
- No antibiotic prescription
- Symptomatic management
Symptoms >10 days -
- High nose nasal corticosteroids for 12 days
- Back up antibiotic prescription (phenoxymethylpenicillin) but mostly self limiting
What is management for chronic sinusitis?
- Admit if systemically unwell, has orbital or intracranial involvement
- Symptoms may last months if they also have asthma/allergic rhinitis
- Consider nasal irrigation with saline solution
- Course of intranasal corticosteroids for up to 3 months
- Referral to specialist if lasting over 3 months of treatment
