SINUSITIS

(Acute)
Inflammation of air sinuses of the skull

Causes

  • 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

MANAGEMENT

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, section 23.2.5)

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