Nose - Sinusitis (Acute)
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Inflammation of air sinuses of the skull
Cause
- Allergy
- Foreign body in the nose
- Viruses, e.g. rhinovirus, often as a complication of URTI
- Dental focal infection
- Bacteria, e.g., Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes
Clinical features
- Rare in patients <5 years
- Pain over cheek and radiating to frontal region or teeth, increasing with straining or bending down
- Redness of nose, cheeks, or eyelids
- Tenderness to pressure over the floor of the frontal sinus immediately above the inner canthus
- Referred pain to the vertex, temple, or occiput
- Postnasal discharge
- A blocked nose
- Persistent coughing or pharyngeal irritation
- Hyposmia
Differential diagnosis
- Common cold, allergic rhinitis
- Foreign body in the nose
- Nasal polyps, adenoids
Investigations
- C&S of the discharge
- X-ray of sinuses
ManagementTreatment
General measures
- Steam inhalation may help clear blocked nose
- Analgesics e.g. Paracetamol
- Nasal irrigation with normal saline
If there are signs of bacterial infection (symptoms persisting > 1 week, unilateral facial pain, worsening of symptoms after an initial improvement)
- Amoxicillin 500 mg every 8 hours for 7-10 days
- Child: 15 mg/kg per dose
If there is a dental focus of infection
- Extract the tooth
- Give antibiotics e.g. Amoxicillin plus Metronidazole (see Gingivitis)
If there is a foreign body in the nose
- Refer to hospital for removal
Notes: Do NOT use antibiotics except if there are clear features of bacterial sinusitis, e.g., persistent (> 1 week) purulent nasal discharge, sinus tenderness, facial or periorbital swelling, persistent fever