Difference between revisions of "Sinusitis"

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==Diagonsis==
 
==Diagonsis==
  
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'''Classic History & Physical'''
 
'''Classic History & Physical'''

Revision as of 07:41, 12 March 2011

Background

Rhinosinusitis - Inflammation of the lining of the paranasal sinuses

Acute (< 4 weeks)

  • Acute viral
  • Acute bacterial (0.5-2% of cases)

Subacute (4-12 weeks)

Chronic (>12 weeks)

Other causes

  • Fungal infections
  • Allergies

Diagonsis

Classic History & Physical

Feature
Viral
Bacterial

Duration (symptoms)

<10days
Usually >10 days OR worsening symptoms within 10 days after initial improvement

Color change (nasal discharge)

+/−
+++, quality usually yellow-green and thick

Maxillary dental pain

+++, often unilateral and associated with a particular sinus

Postnasal drip

More common

Fever, cough, fatigue

More common

Hyposmia/anosmia

More common

Basic Management

< 10 days symptomatic treatment b/c most likely viral

  • Analgesia
  • Mechanical irrigation with buffered, hypertonic saline
  • Topical glucocorticoids
  • Topical decongestants (e.g., oxymetazoline for no more than three days)
  • Antihistamines
  • Mucolytics


> 10 days or if pt gets better and then worse again (“double sickening”)

  • Mild bacterial sinusitis when pain is mild and temperature < 38.3˚C
  • Another seven days of observation
  • Severe bacterial sinusitis when pain is moderate-severe or temperature ≥38.3˚C
  • Consider antibiotics
  • If the patient is immunocompromised, has an underlying or complicating condition, or patient fails observation, antibiotics are indicated

Antibiotics

  • Choice of antibiotic depends on recent antibiotic therapy (past 4-6 weeks).
  • Amoxicillin (500mg PO TID for 10 days)
  • TMP-SMX
  • Erythromycin
  • Azithromycin
  • Cefpodoxime

* Cefdinir * Cefuroxime 

  • If initial antibiotic failure occurs consider further workup (e.g. CT) and/or further tx with either amoxicillin-clavulanate or respiratory fluoroquinolone
  • Nosocomial acute bacterial rhinosinusitis can occur (e.g., after prolonged nasotracheal intubation) and often is associated with gram-negatives; remove foreign bodies and use culture-directed antibiotic therapy


  • Immunocompromised patients at risk for acute fulminant fungal rhinosinusitis


Source

DeBonis, Kaji, UpToDate "Rhinosinusitis"