Sinusitis

Question 1

Define sinusitis

Answer 1

Symptomatic inflammation of the paranasal sinuses (maxillary)

Question 2

Types of sinusitis

Answer 2

Acute = resolves within 12 weeks
Recurrent = 4 or more annual episodes of sinusitis without persistent symptoms in the intervening periods
Chronic = >12 weeks
Uncomplicated = inflammation does not extend outside the paranasal sinuses and nasal cavity to involve nervous or ophthalmologic structures or soft tissues

Question 3

Aetiology of sinusitis

Answer 3

Preceding viral URTI e.g. rhinovirus, RSV, parainfluenza, influenza
Sinus mucous oedema + obstruction of the sinus ostia + reduction in mucociliary action → secretions stagnate → bacteria can grown in a suitable environment
Bacterial infection (2 in 100) with Strep. Pneumoniae, H. influenzae, Moraxella catarrhalis, S. aureus

Chronic: more inflammatory
- S. aureus, enterobacteriaeceae spp, pseudomonas

Question 4

Risk factors for sinusitis

Answer 4

Asthma
Allergic rhinitis and atopy
Smoking
Anatomic variation or mechanical obstruction e.g. deviated nasal septum, nasal polyps, trauma, foreign body
Early months of the year
Impaired ciliary motility e.g. cystic fibrosis
Immunocompromise
Previous sinus surgery

Question 5

Epidemiology of sinusitis

Answer 5

Acute sinusitis has a prevalence of 5-15% in adults
Chronic sinusitis affects 1 in 10 adults
Frontal sinuses do not develop until late childhood, so frontal sinusitis uncommon until after 10yo

Question 6

Symptoms of sinusitis

Answer 6

Preceding cold → INCREASING symptoms after 5 days or PERSISTENCE of symptoms past 10 days

Nasal blockage
Nasal discharge
Facial pain/pressure or headache
anosmia/reduction in sense of smell
Altered speech (nasal obstruction)
Tenderness, swelling, redness over the cheekbone or periorbital areas
Cough

Question 7

What symptoms suggest a bacterial sinusitis

Answer 7

Unilateral symptoms
>10 days of symptoms
Discoloured/purulent nasal discharge
Severe local pain
Fever >38
Marked deterioration after an initial milder form (double sickening)
Raised inflammatory markers

Question 8

Management for acute sinusitis

Answer 8

Analgesia
Intranasal decongestants
Nasal saline

> 10 days → intranasal corticosteroids
Severe → phenoxymethylpenicillin or co-amoxiclav