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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

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