Acute Sinusitis

Definition: sinusitis of <4 weeks' duration
Etiology: Infectious and noninfectious causes lead to sinus ostial obstruction and retention of mucus.
- - Infectious causes include viruses (e.g., rhinovirus, parainfluenza virus, influenza virus) and bacteria (e.g., S. pneumoniae, nontypable Haemophilus influenzae, and [in children] Moraxella catarrhalis).
  - In immunocompromised pts, fungi (e.g., Rhizopus, Mucor, and occasionally Aspergillus) can be involved.
  - Nosocomial cases are often polymicrobial and involve Staphylococcus aureus and gram-negative bacilli.
- - Noninfectious causes include allergic rhinitis, barotrauma, and exposure to chemical irritants.
Clinical manifestations: Common manifestations include nasal drainage and congestion, facial pain or pressure, and headache.
- - Tooth pain and halitosis can be associated with bacterial sinusitis.
- - Pain localizes to the involved sinus and is often worse when the pt bends over or is supine.
- - Advanced frontal sinusitis can present as “Pott's puffy tumor”: swelling and pitting edema over the frontal bone from a communicating subperiosteal abscess.
- - Life-threatening complications include meningitis, epidural abscess, and brain abscess.
Diagnosis: It is difficult to distinguish viral from bacterial sinusitis clinically, although viral cases greatly outnumber bacterial cases.
- - Only 40-50% of pts with symptoms of >10 days' duration, purulent nasal drainage, nasal obstruction, and facial pain have bacterial sinusitis.
- - If fungal sinusitis is a consideration, involved areas should be biopsied.
- - Except in nosocomial cases, sinus CT or radiography is not recommended for acute sinusitis. Nosocomial sinusitis should be confirmed by sinus CT, with sinus aspirates sent for culture and susceptibility testing (ideally before antimicrobial treatment is initiated).

Treatment: Acute Sinusitis

Most pts improve without antibiotic treatment.
For pts with mild to moderate symptoms, treatment should focus on symptom relief and facilitation of sinus drainage (e.g., oral and topical decongestants, nasal saline lavage).
Antibiotics should be given to pts with severe disease at presentation and considered for pts without improvement after 10 days.
- - See Table 58-1 for recommended regimens for adults.
- - For pts who do not respond to initial antimicrobial treatment, consultation with an otolaryngologist about possible sinus aspiration and/or lavage should be considered.
Surgery should be considered for pts with severe disease, intracranial complications, or invasive fungal sinusitis.

section name header

Information ⬇

Outline ⬆