Difference between revisions of "Sinusitis"

(>10 days of symptoms OR if pt gets better and then worse again (“double sickening”))
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**Topical decongestants (e.g. [[oxymetazoline]] for no more than 3d)  
 
**Topical decongestants (e.g. [[oxymetazoline]] for no more than 3d)  
 
**[[Antihistamines]]  
 
**[[Antihistamines]]  
**Mucolytics  
+
**Mucolytics
 +
*Avoid antibiotics
 +
**Part of [[Choosing wisely ACEP|ACEP Choosing wisely ]]
  
 
===>10 days of symptoms===
 
===>10 days of symptoms===

Revision as of 04:17, 30 August 2015

Background

  • Acute (<4 weeks)
    • Acute viral
    • Acute bacterial (0.5-2% of cases)
  • Subacute (4-12 weeks)
  • Chronic (>12 weeks)
  • Other causes
    • Fungal infections
    • Allergies

Clinical Features

  • Defined as 2 or more of the following:
    • Blockage or congestion of nose
    • Facial pain or pressure
    • Hyposmia (diminished ability to smell)
    • Anterior or posterior nasal discharge lasting <12wk
  • Additional symptoms:
    • Tooth pain
    • Fever
    • Sinus pressure while bending forward to changing head position

Differential Diagnosis

Diagnosis

  • Consider CT only for toxic patients (to rule-out complication)

Treatment

<10 days of symptoms

  • 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 3d)
    • Antihistamines
    • Mucolytics
  • Avoid antibiotics

>10 days of symptoms

OR if pt gets better and then worse again (“double sickening”)

  • Mild bacterial sinusitis (pain is mild and temperature <38.3˚C)
    • Another seven days of observation
  • Severe bacterial sinusitis (pain is moderate-severe or temperature ≥38.3˚C)

Antibiotic Failure

  • Obtain culture
  • Consider nosocomial bacterial sinusitis (e.g. after prolonged nasotracheal inbutation)
  • Consider foreign body
  • Consider fungal treatment

Complications

References