Acute sinusitis

Question 1

Pathophysiology?

Answer 1

Inflammation of the mucous membranes of the paranasal sinuses

Question 2

Common infectious agents?

Answer 2

• Streptococcus pneumoniae
• Haemophilus influenzae
• Rhinoviruses

Question 3

Predisposing factors?

Answer 3

• nasal obstruction e.g. septal deviation or nasal polyps
• recent local infection e.g. rhinitis or dental extraction
• swimming/diving
• smoking

Question 4

Symptoms?

Answer 4

• facial pain (typically frontal pressure pain which is worse on bending forward)
• nasal discharge: usually thick and purulent
• nasal obstruction

Question 5

Management?

Answer 5

• Analgesia

- Intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited

Question 6

What treatment may be given if symptoms have been present for more than 10 days?

Answer 6

Intranasal corticosteroids

Question 7

When are oral antibiotics given? What oral antibiotics may be given?

Answer 7

Although these are not normally required, they can be given for severe presentations.
Phenoxymethylepenicillin = first line.
Co-amoxiclav = if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications’

Question 8

What is double-sickening?

Answer 8

It is where an initial viral sinusitis worsens due to secondary bacterial infection