Sinusitis

Question 1

What is acute sinusitis?

Answer 1

• Resolves completely within 12 weeks

Increase in symptoms of a common cold after 5 days, persistence beyond 10 days, but less than 12 weeks

Question 2

What is chronic sinusitis?

Answer 2

• Symptoms last for more than 12 weeks

Question 3

What are causes of sinusitis?

Answer 3

Viruses - Rhinovirus, parainflueza, influenza
- Followed by bacterial infection
Bacteria - Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus

Question 4

What is the pathophysiology of sinusitis?

Answer 4

• Sinus mucosa oedema obstructs the sinus ostia
• Reduced mucociliary action allows secretions to stagnate
• Gives bacteria a suitable environment to grow

Question 5

What is the cause of chronic sinusitis?

Answer 5

• More likely to be inflammatory than infectious
• Inflammation, infection and obstruction of sinus ventilation
• Staph aureus and Pseudomonas dominate

Question 6

What are complications of sinusitis?

Answer 6

Orbital - Cellulitis, abscess, cavernous sinus thrombosis

Intracranial - Meningitis, encephalitis, abscess, venous thrombosis

Bony complications - Osteomyelitis

Question 7

What are symptoms of acute sinusitis?

Answer 7

• Nasal blockage/discharge
• Facial pain or pressure
• Reduction or loss of sense of smell
• Altered speech
• Cough

Question 8

What examinations would you do?

Answer 8

• 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

Question 9

What are red flags that require referral?

Answer 9

• Unilateral polyp or mass

- Bloody nasal discharge

Question 10

What is the management for acute sinusitis?

Answer 10

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

Question 11

What is management for chronic sinusitis?

Answer 11

• 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