Sinusitis

Question 1

Sinusitis

Answer 1

Acute sinusitis is a symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal sinuses
 (<4 weeks )
- mostly viral (<10 days) no Abs
- bacterial (>10days) give Abs
-symptomatic therapy 
-Self limiting 

Complications: cns infection like meningitis and brain abscess

Question 2

Etiology

Answer 2

The most common cause of acute sinusitis is a viral infection.
The 3 most common bacteria are:
1. Streptococcus pneumoniae
2. Haemophilus influenzae
3. Moraxella catarrhalis
Fungal causes: Aspergillus spp, Zygomyces ( mucor)

Question 3

Clinical manifestations

Answer 3

1. Purulent nasal discharge
2. Facial pain
3. Fever

Less common

1. Post nasal discharge
2. Headache
3. Nasal congestion
4. Loss of the sense of smell

Question 4

Diagnosis

Answer 4

• Diagnosis is based on history and physical examination.
• Laboratory tests and imaging studies are not indicated for
evaluation of routine, uncomplicated acute sinusitis.
• Imaging, nasal endoscopy, sinus culture may be warranted
in the case of recurrent episodes of sinusitis, suspected
anatomical abnormalities, complications are suspected.
• Radiologic : plain ( fluid level), CT scan.

Question 5

Management of Suspected acute viral sinusitis:

Answer 5

supportive therapy (analgesic/antipyretic, decongestant,
antihistamines, intranasal corticosteroid).

Question 6

Management of Suspected acute bacterial sinusitis

Answer 6

A. Immunocompetent nonsevere
• 1st watchful waiting for up to 10 days, or immediate
• commencement of antibiotics (amoxicillin/clavulanate, 5-7 day course)
• supportive therapy

B. Immunocompromised or with severe illness
• Antibiotic therapy (moxicillin/clavulanate, 10-14 day course)
• supportive therapy
• ENT specialist referral