Acute Sinusitis Flashcards
What is sinusitis?
Inflammation of the mucous membranes of the paranasal sinuses
Which sinuses are most commonly affected?
Maxillary
Sinusitis is said to be acute if it lasts…
4-30 days
How long does sinusitis last of it is subacute?
4-12 weeks
Many people have a mild bout of sinusitis with..
A common cold
Is severe acute sinusitis common?
No, most people only have 1 or 2 episodes in their life
When do most people get acute sinusitis?
After a cold or flu
Virus causes mucosal oedema and reduced cilia action - impairing drainage of the sinuses into the nasal cavity ie there is stagnation of secretions in sinus = ideal for bacteria to grow
Other than previous viral infection, what other risk factors are there that can predispose sinusitis?
Direct spread - dental root infection, swimming in infected water
Blockage to sinus drainage channels - polyps, septal deviation, foreign object, facial injury or surgery
Allergic rhinitis - swelling of tissues making sinuses more susceptible to infection
CF
Inflammatory disorders e.f sarcoidosis
Smoking
Immunocompromised
What are the symptoms of acute sinusitis?
Facial pain - worse on benign forward Fever >38 Blocked nose Discoloured discharge - yellow or green Double sickening (deterioration after mild phase of illness) Reduced sense of smell Halitosis Headache Feeling of pressure or fullness in ears Malaise
What is halitosis?
Bad breath
The associated facial pain is typically worse when…
Bending forward
On pressure
How is it diagnosed?
Clinically
Occasionally bloods taken - elevated ESR, CRP
What are some differentials?
Non sinus pain- migraine, TMJ dysfunction, dental pain, neuropathic pain, temporal arteritis
What are the most common infective agents to cause acute sinusitis?
Streptococcus pneumoniae
Haemophilius influenzae
Staphylococcus aureus
Moraxella catarrhalis
In recurrent acute or chronic sinusitis what investigation can be done?
CT of paranasal sinsuses and nasal endoscopy- identify anatomical problems
How is it managed if a person has symptoms for 10 days or less?
Do not offer antibiotics
Advise that: acute sinusitis is usually caused by a virus (and is only complicated by bacteria in about 2/100 cases)
Takes 2-3 weeks to resolve
Fever and pain can be managed with paracetamol, ibuprofen
Consider nasal decongestants or nasal saline, intra nasal corticosteroids may be considered if symptoms present for more than 10 days
Generally: drink lots of fluids, rest, avoid allergic triggers and not smoking
Medical advise sought if symptoms worsen, systemically unwell, or do not improve in 3w
How do nasal decongestants work?
Reduce swelling of tissues and blood vessels that line nasal passageways
Should not use for more than 5-7 days as can cause rebound congestion in nose
What complications can occur?
Orbital cellulitis/ abscess
Intracranial involvement - meningitis, cavernous sinus thrombus, cerebral abscess
Mucocoeles
Osteomyelitis
If a person has had symptoms for 10 days or more with no improvement, how should they be managed?
Consider high dose nasal corticosteroid for 14 days
Consider no antibiotics or back up prescription
(Antibiotics advised if individual systemically unwell or sig comorbidities that pre dispose complications e.g COPD)
Corticosteroids may improve symptoms but not likely to affect how long they last
If an antibiotic is indicated, what would you prescribe?
Penicillin V
Clarithromycin if penicillin allergy
What factors may point towards bacterial cause?
Symptoms for more than 10 days
Discoloured or purulent nasal discharge
Severe, localised unilateral pain - particularly over teeth and jaw
Fever
Marked deterioration after initial milder phase
