Sinusitis causes nasal congestion and drainage, headache, and tenderness over affected sinuses. Most cases resolve without antibiotic treatment. Focus on facilitating sinus drainage (oral and topical decongestants and nasal saline lavage) in mild to moderate cases.
CASES/YEAR
30,000,000 (US); 600,000,000 (Global)
OTHER NAMES
Sinusitis, acute; Sinusitis, subacute/chronic;
INCUBATION
1 to 10 days for viruses and bacteria and weeks to months for fungi;
INITIAL SYMPTOMS
Nasal congestion and drainage; Headache and tenderness over affected sinuses; Acute sinusitis (<4 weeks duration) may be worse when bending over or supine; [Harrison ID, p. 205]
COMMENTS
Most cases of acute sinusitis resolve without antibiotic treatment. It is difficult to distinguish bacterial from viral sinusitis. Tooth pain, halitosis, and severe unilateral facial pain are associated with bacterial infections. The most common sinus involved is the maxillary, followed by ethmoid, frontal, and sphenoid. [Harrison ID, 205] Bacterial infection more likely if >9 days of symptoms; Less than 10% of sinusitis cases are caused by bacteria. No testing is needed for acute sinusitis. Adjuvant therapy includes treatment of allergies (intranasal steroids); Routine decongestants and antihistamines not recommended; If treatment failure, consider culture by direct aspiration; Also consider noninfectious causes and structural abnormality or complication (sinus CT scan); Referral to allergy, ENT, or infectious disease specialists in some cases (immunocompromised, unusual pathogens, hospital acquired, >3-4 episodes/year); [ABX Guide] Dull facial pressure, worsening with dependency, is a sign of chronic sinusitis. [Cecil, p. 2549] Orbital cellulitis, brain abscess, meningitis, and cavernous sinus thrombosis are possible complications. [Cohen, p. 1637] Cranial nerve palsies (III, IV, & VI) are symptoms of cavernous sinus thrombosis. In one series of patients with chronic maxillary sinusitis, 16% had nasal polyps. [ID, p. 431]
DIAGNOSTIC
Clinical; CT for nosocomial cases and chronic sinusitis (>12 weeks duration); Biopsy for patients with suspected fungal infection; [Harrisons, p. 248]
SIGNS & SYMPTOMS
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>fatigue, weakness
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>fever
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E epistaxis
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E pharyngitis
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E rhinitis
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G nausea, vomiting
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N headache
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R cough
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R sputum production
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*brain abscess or lesion
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*cranial neuropathy
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*meningitis
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*osteomyelitis
TREATMENT
Focus on facilitating sinus drainage (oral and topical decongestants and nasal saline lavage) in mild to moderate cases; Antibiotics if severe disease. Consider antibiotics if no improvement in 10 days; [Harrisons, p. 248]
REFERENCES FOR CASES/YEAR
1. (US) For adults, bacterial sinusitis complicates 0.5-2% of acute viral upper respiratory tract infections; [Gorbach, p. 360] Affects >30 million US citizens/year; [5MCC-2020]
2. (Global) 30 million X 20 = 600 million;