Sinusitis

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CLINICAL DESCRIPTION

Sinusitis is inflammation of one or more paranasal sinuses. Predisposing risk factors are nasal obstruction from allergic rhinitis/polyp, dental infection/dental extraction, fractures involving sinuses, swimming in dirty waters. Mainly caused by virus (common cold) hence self- limiting. It can also be caused by Bacteria (group A haemolytic streptococci, S. Pneumoniaea, S. aureus H.influenzae, M.catarrhalis).

CLINICAL FEATURESSIGNS AND SYMPTOMS

  • Cough and nasal congestion (allergy symptoms)
  • Postnasal drip symptoms (throat irritation and throat clearing cough)
  • Fever/purulent and foul-smelling nasal discharge and halitosis (if bacterial)
  • Frontal headache/pressure in the face
  • Tenderness on sinuses area
  • If severe may have facial/periorbital swelling and fever

INVESTIGATIONS

  • Usually none needed unless complicated sinusitis not responding to treatment (may consider full blood count, parasinuses x-ray/CT scan)

TREATMENTNON-PHARMACOLOGICAL

  • Most sinusitis is viral and self-limiting, requiring no antibiotics
  • Steam inhalation may help drainage of blocked sinus

PHARMACOLOGICAL

  • Analgesia if pain/headache:
    • Paracetamol 1g 6 hourly or Ibuprofen 400mg 8 hourly PO or other
  • Antibiotic if signs of bacterial sinusitis:

Adult.

  • Amoxicillin 500mg 8 hourly for 7 days or Amoxicillin-clavulanic acid 625mg 8 hourly or Cefuroxime 250 to 500mg 12 hourly PO (alternatively Erythromycin 500mg 6 hourly or Azithromycin 500mg daily for 5 days if penicillin hypersensitivity)

Children. 

  • 6-12 years: Amoxicillin: 250 mg 8 hourly for 7 days
  • 1-5 years: 125 mg 8 hourly for 7 days
  • < 1 year: 62.5 mg 8 hourly for 7 days

Alternatively, 

  • Amoxicillin 15mg/kg 8 hourly for 7 days

Or     

  • Amoxicillin + Clavulanic Acid:
    • 6-12 years; 400/57 mg 8 hourly for 7 days
    • 1-6 years: 200/28.5 mg 8 hourly
    • 1 month-1 year: 200/28.5 mg 8 hourly
  • Cefuroxime: 
    • 3 months-12 years: 125 mg 12 hourly, double in severe infection.
  • Erythromycin: 
    • 2-8 years:  250 mg 6 hourly for 7 day
    • 1 month-2 years: 125 mg 6 hourly

Alternatively, 

  • Erythromycin 10mg/kg 6 hourly for 7 days

Neonate: 

  • Erythromycin 12.5 mg/kg 6 hourly Or Azithromycin: 10 mg/kg daily for 5 days  

Sinusitis prevention for patient undergoing tooth extraction Benzathine Penicillin 1.2g IM stat or Amoxicillin 3g orally stat 1hour prior to procedure and Metronidazole 400mg)

Complications of sinusitis

  • Periorbital swelling
  • Dental abscess  

Note: Patients with complications need referral to a specialist