Acute Sinusitis Flashcards
Define acute sinusitis
Inflammation of mucosal lining of nasal cavity and paranasal sinuses, where clinical symptoms have been present for <4 weeks
Aetiology of acute sinusitis
Viral - can progress to bacterial sinusitis
Bacterial - strep pneumoniae, H influenzae, Moraxella catarrhalis
Pathophysiology of sinusitis
Infection and inflammation of mucosal lining of sinus
Increased mucus production, impaired mucociliary clearance, obstruction of sinus Ostia
Causes stasis of secretions and development of bacterial infection
Classification of sinusitis
Acute: = 4 weeks
Chronic: >12 weeks
Recurrent: >/=4 episodes per year
Clinical features of sinusitis
Symptoms <10 days: viral Symptoms >10 days: bacterial Symptoms that worsen after initial improvement: 2ndary bacterial Purulent nasal discharge Nasal obstruction Facial pain
Cough myalgia sore throat Hyposmia Oedematous turbinate
Investigations for acute sinusitis
Nasal endoscopy - If refractory to abx, abx resistance
Sinus culture - endoscopic, direct
CT sinuses - if complications, structural abnormalities
Lateral neck x Ray - for adenoid Hypertrophy
Management of viral sinusitis
Supportive: tried for 10 days
Analgesia
Decongestant - nasal oxymetazoline (alpha agonist)
Intranasal corticosteroid - congestion
Ipratropium nasal - rhinorrhoea
Intranasal saline - for congestion, reduce inflammation and thin mucus
Mucolytic
Management of bacterial sinusitis
Non severe:
Watchful waiting for 10 days
Amoxicillin PO - if immediate abx
Phenoxymethylpenicillin - if symptoms >10 days and systemically well
Severe/immunocompromised:
Amoxicillin/Clavulanate PO 10 days + supportive
ENT referral
Complications of acute sinusitis
Chronic sinusitis - symptoms >12 weeks
Bacterial meningitis
Subdural abscess
Peri-orbital cellulitis - does not affect vision, <3yo
Orbital cellulitis - affects vision, >3yo
Orbital abscess - presents w exophthalmos and peri-orbital erythema
Cavernous sinus thrombosis
