Acute Sinusitis
Definition
• Inflammation of the paranasal sinuses
• Usually viral or allergic
• Common bacterial etiologies: S. pneumoniae, nontypable H. influenzae, M. catarrhalis
• Pseudomonas is seen in HIV, cystic fibrosis, or after instrumentation
• Mucormycosis is invasive fungal sinusitis (Rhizopus) in diabetics or immunocompromised
Presentation
• Mucopurulent d/c, postnasal drip, cough, sinus pressure, HA, ±fever
• Typically progresses over 7–10 d & resolves spontaneously
• Sxs >7 d, worsening course, or worsening after improving, all suggest bacterial dz
• Consider sinusitis w/ positional HA that is worse when bending forward
• Sphenoid sinusitis is a difficult Dx, often presents late; classically worse w/ head tilt
Evaluation
• Clinical, no routine imaging. CT sens but not spec, can r/o cx.
• Cx to look out for orbital cellulitis, osteomyelitis, cavernous sinus thrombosis, cerebral abscess, meningitis, frontal bone abscess (Pott’s puffy tumor)
Treatment
• Supportive (analgesics, antipyretics, decongestants, antihistamines if allergic)
• Decongestants: Neo-Synephrine nasal spray TID × 3 d, Afrin nasal spray BID × 3 d
• Abx not routinely indicated. Reserve for pts w/ sxs >7 d, worsening sxs, fever, purulent d/c, or high risk for severe infection or cx.
• Amoxicillin 500 mg PO TID × 10 d, or TMP–SMX or azithromycin
• If no improvement: Amoxicillin–clavulanate, fluoroquinolone, clindamycin
Disposition
• Vast majority are managed outpt
• Admit if toxic, severe HA, high fever, immunocompromised, poor f/u
Pearl
• Sphenoid/ethmoid sinusitis is less common than maxillary sinusitis but has significant potential cx (eg, orbital cellulites, cavernous sinus thrombosis)