Maxillary sinusitis Flashcards
Which is the most commonly infected sinus?
The maxillary sinus is the one most commonly infected.
Causes
It is important to determine whether the sinusitis is caused by:
- Most episodes are of viral origin
- Stasis following a URTI or acute rhinitis
- or by Dental root infection.
Clinical features (acute sinusitis)
Facial pain and tenderness (over sinuses)
Toothache • Headache • Purulent postnasal drip
Nasal discharge
Nasal obstruction
Rhinorrhoea
Cough (worse at night)
Prolonged fever
Epistaxis
suspect bacterial cause if high fever and purulent nasal discharge.
Clinical features (chronic sinusitis)
Vague facial pain
Offensive postnasal drip
Nasal obstruction
Toothache
Differential tenderness both identifies and localizes the main sites of infection
Diagnosing unilateral sinusitis
Transillumination; to assess the presence or absence of fluid in the frontal sinus, in the maxillary sinus (in particular).
A dull glow below the orbit indicates the antrum is air-filled.
It works best when one symptomatic side can be compared with an asymptomatic side.
It is necessary to have the patient in a darkened room and to use a small, narrow-beam torch.
For the maxillary sinuses remove dentures (if any).
Shine the light inside the mouth (with lips sealed), on either side of the hard palate, pointed at the base of the orbit.
- CT; mucosal thickening without fluid levels.
- Plain films are not indicated.
Management of maxillary sinusitis
Analgesics
Antibiotics (first choice) if evidence of bacterial infection:
- moxycillin 500 mg (o) tds for 7 d or
- amoxycillin clavulanate 875/125 mg (o) tds for 7 d, if resistance to amoxycillin is suspected or proven or poor response to above
- doxycycline or cefaclor if sensitive to penicillin
Nasal decongestants (oxymetazoline—containing nasal drops or sprays) only if congestion
Inhalations (a very important adjunct)
