Introduction
Sinusitis describes an inflammation of the mucous membranes of the paranasal sinuses.
Epidemiology
- Incidence: 2500.00 cases per 100,000 person-years
- Peak incidence: 40-50 years
- Sex ratio: 1:1
| Condition | Relative incidence |
|---|---|
| Viral upper respiratory tract infections | 12.00 |
| Acute sinusitis | 1 |
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Pathophysiology
The sinuses are usually sterile - the most common infectious agents seen in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses.
Predisposing factors include:
Predisposing factors include:
- nasal obstruction e.g. Septal deviation or nasal polyps
- recent local infection e.g. Rhinitis or dental extraction
- swimming/diving
- smoking
Clinical features
Features
- facial pain: typically frontal pressure pain which is worse on bending forward
- nasal discharge: usually thick and purulent
- nasal obstruction
Management
Management of acute sinusitis
- analgesia
- intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited
- NICE CKS recommend that intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days
- oral antibiotics are not normally required but may be given for severe presentations. The BNF recommends phenoxymethylpenicillin first-line, co-amoxiclav if 'systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications'