Sinusitis

Question 1

What is sinusitis?

Answer 1

• Sinusitis is the inflammation of the mucous membranes of the paranasal sinuses.
• However, sinusitis is almost always accompanied by inflammation of the contiguous nasal mucosa
• Hence a more accurate term rhinosinusitis has superseded the terms rhinitis and sinusitis

Question 2

What are the clinical features of sinusitis in adults?

Answer 2

• nasal blockage or congestion
• nasal discharge
• dental or facial pain or pressure
• reduction or loss of the sense of smell.
• respiratory symptoms - pharyngeal, laryngeal, or tracheal irritation causing sore throat, change in voice, and cough

Question 3

Whilst sinusitis are typically triggered by viral URTIs - what features make a bacterial cause more likely?

Answer 3

• symptoms for more than 10 days
• discoloured or purulent nasal discharge
• severe localised unilateral pain (particularly pain over teeth and jaw)
• fever
• marked deterioration after an initial milder phase

Question 4

How are patients with sinusitis <10 days managed?

Answer 4

• Do NOT prescribe antibiotics
• Pain relief with paracetamol/ibuprofen
• Advise patients that the usual course is 2-3 weeks
• Re-assess if patient becomes systemically unwell or worsens rapidly
• Consider a different source i.e. is this a dental infection?

Question 5

How are patients presenting with symptoms for 10 days or more managed?

Answer 5

• High dose nasal corticosteroids for 14 days

- Consider no antibiotic prescription or delayed antibiotic prescription

Question 6

When should antibiotics be prescribed?

Answer 6

• Systemically unwell (consider secondary care referral)

- High risk complications e.g. cystic fibrosis/neurodegenerative disease

Question 7

How is chronic rhinosinusitis managed in primary care?

Answer 7

• Inhaled corticosteroids (with or without polyps)
• Oral steroids (effective for polyps)
• Saline irrigation/topical decongestants