SINUSITIS
Definition-
- Sinusitis is the inflammation of the mucosal lining of the sinuses.
- Remember– not all sinus are present at birth. Some develop after birth
AGE OF DEVELOPMENT
- Birth- maxillary and ethmoid
- 3 years- Though sphenoid are present at birth, they get aerated at 3 years
- 6 years- Frontal sinus develops
TYPES OF SINUSITIS
- Acute sinusitis- Lasts up to 3 months
- Chronic sinusitis- lasts longer than 3 months
CAUSES
- Most times, it follows a viral upper respiratory infection
- Most common bacteria are Streptococcus pneumoniae, Haemophilus influenzae.
In chronic conditions, consider below
RISK FACTORS
- Allergic rhinitis
- Asthma
- Ciliary impairment- Consider cystic fibrosis.
- Immunocompromise
- Cigarette smoke exposure
PRESENTATION
- Nasal blockage
- Yellow, green nasal discharge
- Tenderness over the sinus
- Fever
- Nasal polyps
Differential diagnosis
- Allergic rhinitis
- Nasal foreign body
- Nasal/ Sinus tumour —(unilateral symptoms, blood discharge)
- Temporomandibular joint dysfunction,
- Dental pain (pain on chewing)
MANAGEMENT
- Paracetamol or ibuprofen —for pain and fever.
- An intranasal decongestant (maximum of 1 week )
- Nasal saline drops to decongest
If suspecting bacterial sinusitis (high temperature, looking unwell, yellow nasal discharge)
- High dose Amoxicillin for 7 days, or
- Phenoxymethylpenicillin for 7 days, or
- Erythromycin, or clarithromycin if allergy to penicillin, for 7 days.
If there is no improvement in 48 hours, consider 2nd line of treatment
- Co-amoxiclav for 7 days
- Azithromycin for 3 days (if allergic to penicillin).
IN CHRONIC SINUSITIS
- Consider a intranasal corticosteroids for up to 3 months, if suspicion of allergy
Referral to ENT Specialist especially when
- Sudden onset Severe facial pain
- Nasal polyps
- No response to treatment