Sinusitis

Question 1

Causes of sinusitis

Answer 1

• Most commonly viral
• Bacterial causes include:
  
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Morazella catarrhalis
  • Staphylococcus aureus

Question 2

Management of sinusitis

Answer 2

• Normaly lasts 2-3 weeks and resolves without treatment
• If no improvement after 10 days give 2 weeks of high-dose steroid nasal spray
• If no improvement after 10 days and likely bacterial cause consider antibiotics
• Penivillin V for 5 days is first line, second line is co-amoxiclav
• Can also use clarithromycin, erhtyromycin (pregnancy) and doxycycline in penicillin allergy

Question 3

Presentation of sinusitis

Answer 3

• Two of more of:
  
  • Nasal blockage/obstruction/congestion
  • Nasal discharge
  • Facial pain
  • Poor sense of smell
  • Endoscopic features or CT changes
• More likely bacterial cause if:
  
  • Discoloured discharge
  • Severe, localised facial pain
  • Pyrexia
  • Raised ESR/CRP
  • Deterioration after initial milder symptoms

Question 4

Classification of sinusitis

Answer 4

• Acute if <12 weeks
• Chronic if >12 weeks
• Can be with or without nasal polyps