Conditions of the Sinus and Nose

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Rhinosinusitis

Description

Rhinosinusitis is the inflammation of the nasal passages and sinuses extending beyond 7-10 days . It can be acute (lasting less than 4 weeks), subacute (4-12 weeks), chronic (over 12 weeks), or recurrent (four or more episodes per year).

Signs and Symptoms

  • Runny nose
  • Postnasal drip
  • Nasal congestion
  • Sinus pain or pressure
  • Headache
  • Toothache
  • Loss of smell
  • Halitosis (bad breath)
  • Cough (more common in children)

Treatment

Supportive

  • Nasal saline irrigation to reduce congestion and flush out

 Pharmacological

Pain Management: Acute Rhinosinusitis

  • Paracetamol (Acetaminophen):
    • Adults: 500 mg to 1 g every 4-6 hours as needed (maximum 4 g per day).
    • Children 6-12 years: 250-500 mg every 4-6 hours as needed (maximum 2 g per day).
    • Children 1-5 years: 120-250 mg every 4-6 hours as needed (maximum 1 g per day).
  • Ibuprofen:
    • Adults: 200-400 mg every 4-6 hours as needed (maximum 1.2 g per day).
    • Children 4-7 years: 150 mg every 8 hours (maximum 7.5-10 mg/kg daily).
    • Children 7-12 years: 200 mg every 8 hours (maximum 7.5-10 mg/kg daily).

Nasal Decongestants:

  • Pseudoephedrine:
    • Adults: 60 mg every 4-6 hours (maximum 240 mg per day).
    • Children over 6 years: 30 mg every 4-6 hours (maximum 120 mg per day).
  • Xylometazoline hydrochloride
    • Child 6–11 years: 1–2 drops 1–2 times a day as required for maximum duration of 5 days, 0.05% solution to be administered into each nostril
    • Child 12–17 years: 2–3 drops 2–3 times a day as required for maximum duration of 7 days, 0.1% solution to be administered into each nostril
    • Adult: 2–3 drops 2–3 times a day as required for maximum duration of 7 days, 0.1% solution to be administered into each nostril

Nasal Corticosteroids:

  • Fluticasone:
    • Adults: 100 mcg once daily into each nostril, can be increased to 100 mcg twice daily if necessary
    • Children: 50 mcg once daily into each nostril, can be increased to 50 mcg twice daily if necessary
  • Mometasone:
    • Adults: 100 mcg once daily into each nostril, can be increased to 200 mcg daily if necessary
    • Children: 50 mcg once daily into each nostril, can be increased to 100 mcg daily if necessary

Antibiotics: Acute Rhinosinusitis (If bacterial infection is suspected)

  • Amoxicillin:
    • Adults: 500 mg every 8 hours or 1 g every 12 hours for 7-10 days.
    • Children: 50 mg/kg/day in divided doses every 8 hours (not to exceed 1 g per dose) for 7-10 days.
  • Doxycycline:
    • Adults: 100 mg every 12 hours for 7-10 days