Sinusitis
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Sinusitis is an inflammation of the mucous membrane of the paranasal sinuses. It rarely occurs without concurrent inflammation of the nasal mucosa (rhinitis). Patients with asthma, cystic fibrosis, poor immune functions are more at risk of developing sinusitis.
Causes
- Viral (most common): rhinovirus, coronavirus, adenovirus, influenza, and parainfluenza viruses
- Bacterial: particularly pneumoniae, H. influenzae, M. catarrhalis, S. aureus, E. coli, and Klebsiella.
- Fungal: Aspergillus, Rhizopus oryzae
- Allergies
- Air pollution
- Structural problem of the nose
Signs and symptoms
- Acute bacterial rhinosinusitis should be suspected in patients with a pre-existing viral URTI and symptoms that do not improve after 10 days or worsen after initial improvement
- Thick nasal mucus
- A plugged nose
- Facial pain
- Redness of nose, cheeks, or eyelids
- Fever
- Headaches
- A poor sense of smell
- Sore throat
- Cough
Differential diagnosis
- Acute rhinitis (coryza)
- Allergic rhinitis
- Adenoids
Complications
- Meningitis
- Cavernous sinus thrombophlebitis
- Orbital cellulitis or abscess
- Brain abscess
Investigations
- Culture and sensitivity of the discharge
- X-ray of the sinuses
Treatment objectives
- Adequate drainage of the involved sinus
- Appropriate systemic treatment of the likely pathogens
Non-pharmacological treatment
- Humidification/vaporizer
- Warm compresses
- Adequate hydration
- Smoking cessation
- Balanced nutrition
Pharmacological treatment
Amoxicillin/clavulanate oral
Adult:
Mild to moderate: 500/125 mg every 12 hours for 10 days
Severe: 875/125 mg every 12 hours for 7-10 days
Referral
- Failure of treatment
- Onset of complications
- Suspected malignancy
- Need for surgical intervention