ENT - Facial Pain = Sinusitis

Question 1

Sinusitis - what is it?

Answer 1

Sinusitis describes an inflammation of the mucous membranes of the paranasal sinuses

This is usually accompanied by inflammation of the nasal cavity and can be referred to as rhinosinusitis

Question 2

Sinusitis - what are the most common causative organsims?

Answer 2

The sinuses are usually sterile - the most common infectious agents:

Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses

Question 3

Sinusitis - what are the two forms of sinusitis?

Answer 3

• Acute (less than 12 weeks)
  
  • Chronic (more than 12 weeks)

Question 4

Sinusitis - what are some causes of the inflammation?

Answer 4

Inflammation of the sinuses can be caused by:

• Infection, particularly following viral URTI
• Allergies, such as hayfever
• Obstruction of drainage, due to a foreign body, trauma or polyps
• Smoking

Question 5

Sinusitis - what are some predisposing factors?

Answer 5

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

Question 6

Sinusitis - which group of patients are more likely to suffer from sinusitis?

Answer 6

Patients with asthma are more likely to suffer from sinusitis

Question 7

Sinusitis - clinical features?

Answer 7

facial pain - typically frontal pressure pain which is worse on bending forward

nasal discharge: usually thick and purulent

nasal obstruction

Question 8

Sinusitis - investigations?

Answer 8

In most cases, investigations are not necessary

In patients with persistent symptoms despite treatment, investigations include:

• Nasal endoscopy
• CT scan

Question 9

Sinusitis - management?

Answer 9

NICE recommend not offering antibiotics to patients with symptoms for up to 10 days

Most cases, caused by a viral infection, resolve within 2-3 weeks

NICE recommend for patients with symptoms that are not improving after 10 days, the options of:

• High dose steroid nasal spray for 14 days (e.g., mometasone 200 mcg twice daily)
• A delayed antibiotic prescription, used if worsening or not improving within 7 days (phenoxymethylpenicillin first-line)

Options for chronic sinusitis are:

• Saline nasal irrigation
• Steroid nasal sprays or drops (e.g., mometasone or fluticasone)
• Functional endoscopic sinus surgery (FESS)