Sinusitis

Question 1

What are the most common infectious agents seen in acute sinusitis?

Answer 1

• Viruses cause 98% of cases
• Acute Rhinovirus
• Bacterial
  
  • Streptococcus pneumoniae
  • Haemophilus influenzae

Question 2

What are some predisposing factors to sinusitis?

Answer 2

• Nasal obstruction e.g. Septal deviation or nasal polyps
• Recent local infection e.g. Rhinitis or dental extraction
• Swimming/diving
• Smoking

Question 3

What are some features of sinusitis?

Answer 3

• Facial pain: typically frontal pressure pain which is worse on bending forward
• Nasal discharge: usually thick and purulent
• Nasal obstruction: e.g. ‘mouth breathing’
• Post-nasal drip: may produce chronic cough

Question 4

How is acute sinusitis managed?

Answer 4

• Analgesia
• Good fluid intake
• Intranasal decongestants (
• Nasal douche
• Oral antibiotics are not normally required but may be given for severe presentations.
  
  • Amoxicillin 1 gram TDS is currently first-line.

Question 5

How long does it take for acute sinusitis to resolve?

Answer 5

2.5 weeks

Question 6

What can occur after the use of nasal decongestants?

Answer 6

Rebound congestion (rhinitis medicamentosa) if used for a prolonged period of time > 7 days.

Question 7

Which nasal decongestant is the least likely of the sympathomimetic nasal decongestants to cause rebound congestion?

Answer 7

Ephedrine nasal drops.

Question 8

Which nasal decongestants are more likely to cause a rebound effect?

Answer 8

• Oxymetazoline
• Xylometazoline

Question 9

How is chronic sinusitis managed?

Answer 9

• Treat similar to acute (Analgesia, nasal douching etc)
• Intranasal corticosteroids are often beneficial (DR ALAM’s Notes)
  
  • Beconase 3/52
  • Mometasole (Flixonase) 2 sprays OD
  • Avamys OD
  • Consider 500mg of Clarithromycin for 3/12 to see if improvement. (ENT will often give 1 gram for 3/12)
• Referral to ENT may be appropriate - if treatment ineffective after 3 months or recurrent episodes of acute sinusitis (3 or more requiring Abx a year)

Question 10

So in summary what is the difference between acute and chronic/recurrent sinusitis treatment?

Answer 10

Acute = Decongestants (Epinephrine)

Chronic or Recurrent = Antibiotics + Intranasal Steroids

Question 11

If someone is using Sudafed (pseudoepinpehrine), what should someone avoid and why/

Answer 11

Avoid MAOIs

Risk of hypertensive crisis.

Avoid pseudoepineprhine for 2 weeks after stopping MAOIs.