What is sinusitis?
Also known as rhinosinusitis
Symptomatic inflammation of mucosal lining of paranasal sinuses and nasal cavity
How long does acute sinusitis last for?
Within 12 weeks
Symptoms of sinusitis
Nasal blockage/obstruction/congestion
Nasal discharge
Facial pain/pressure
Headache
Dental pain
Reduction/loss of smell
Sore throat
Hoarseness
Cough
Malaise
Fatigue
Fever
What typically causes sinusitis?
A viral URTI like the common cold
Can be complicated by a bacterial infection
Diagnosis of acute sinusitis
History
Examination
Sudden onset of at least 2 symptoms and sinonasal inflammation lasting less than 12 weeks
What history is important to diagnose acute sinusitis?
Predisposing factors like viral URTI
Symptoms, duration, treatments already tried
Typical allergy symptoms
PMHx - migraine, dental pain etc
What would be seen on examination in a patient with acute sinusitis?
Facial tenderness to gentle palpation
Post-nasal pharyngeal secretions
Tender maxillary dentition
Middle ear effusion
Anterior rhinoscopy - nasal signs, associated pathology, anatomical abnormalities
What diagnostic symptoms in adults are associated with acute sinusitis?
Nasal blockage/obstruction/congestion OR nasal discharge
Facial pain/pressure (headache)
Reduction/loss of smell
What diagnostic symptoms in children are associated with acute sinusitis?
Nasal blockage/obstruction/congestion
Discoloured nasal discharge
Cough
What is different when diagnosing chronic sinusitis?
Duration of time
12 weeks or more
Patients with symptoms lasting 10 days or less should be given what advice?
Usual duration of symptoms
Self care with analgesics
Re-assure antibiotics not needed
Nasal saline or decongestants - limited evidence to show helpful
What can be prescribed to patients with symptoms lasting 10 or more days with no improvement?
A high-dose nasal corticosteroid
Mometasone furoate
Fluticasone
What is a back-up prescription?
A post-dated prescription to be obtained a week later if symptoms don’t improve
When should an immediate antibiotic be given?
Systemically very unwell
Signs/symptoms of more serious illness/condition
High-risk of complications
Describe the antibacterial therapy given in sinusitis in a patient with no penicillin allergy
First-line:
Non-life threatening symptoms - pen-v
Systemically unwell, serious illness, high-risk - co-amoxiclav
Second line:
Non-life threatening symptoms - co-amoxiclav
Systemically unwell, serious illness, high-risk - consult local microbiologist
Describe the antibacterial therapy given in sinusitis in a patient with a penicillin allergy
First line:
Doxycycline or clarithromycin (erythromycin in pregnancy)
Second line:
Getting worse despite 2-3 days of treatment - consult local microbiologist
How do decongestants work?
Alpha-sympathomimetics bind to alpha 1 and alpha 2 adrenergic receptors (GPCRs) in nasal mucosa
Causes vasoconstriction - opening nasal passage
Which decongestant is less suitable for prescribing?
Pseudoephedrine
What decongestants act as sympathomimetics?
Xylometazoline
Pseudoephedrine
Phenylephrine
Describe nasal spray technique
Shake well and look down
Use right hand for left nostril
Put nozzle just inside nose, aiming for outside wall
Squeeze once or twice in different directions while breathing gently through nose
Do not sniff
Change hands
Repeat on other side
Describe nasal drop technique
Gently blow nose to try clearing it
Shake container well
Tilt head backwards
Place drops in nostril, gently squeeze container if necessary
Keep head tilted and gently sniff to let drops penetrate
Repeat on other side if needed
