Sinusitis: Difference between revisions
Kghaffarian (talk | contribs) (added choosing wisely) |
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*Consider CT only for toxic patients (to rule-out complication) | *Consider CT only for toxic patients (to rule-out complication) | ||
== | ==Management== | ||
===<10 days of symptoms=== | ===<10 days of symptoms=== | ||
*Symptomatic treatment b/c most likely viral | *Symptomatic treatment b/c most likely viral | ||
**Analgesia | **Analgesia | ||
**Mechanical irrigation with buffered, hypertonic saline | **Mechanical irrigation with buffered, hypertonic saline | ||
**Topical glucocorticoids | **Topical glucocorticoids - Flonase | ||
**Topical decongestants (e.g. [[oxymetazoline]] for no more than 3d) | **Topical decongestants (e.g. [[oxymetazoline]] for no more than 3d) | ||
**[[Antihistamines]] | **[[Antihistamines]] |
Revision as of 00:46, 4 September 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
- Migraine
- Craniofacial neoplasm
- Foreign body retention
- Dental caries
Diagnosis
- Consider CT only for toxic patients (to rule-out complication)
Management
<10 days of symptoms
- Symptomatic treatment b/c most likely viral
- Analgesia
- Mechanical irrigation with buffered, hypertonic saline
- Topical glucocorticoids - Flonase
- Topical decongestants (e.g. oxymetazoline for no more than 3d)
- Antihistamines
- Mucolytics
- Avoid antibiotics
- Part of ACEP Choosing wisely
>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)
- Consider amoxicillin
- Consider fluoroquinolone or amoxicillin-clavulanate if pt has had antibiotics in past 4-6wks
Antibiotic Failure
- Obtain culture
- Consider nosocomial bacterial sinusitis (e.g. after prolonged nasotracheal inbutation)
- Consider foreign body
- Consider fungal treatment
Complications
- Meningitis
- Cavernous sinus thrombosis (ethmoid/sphenoid)
- Intracranial abscess
- Orbital cellulitis (ethmoid)
- Frontal bone osteomyelitis (Pott's puffy tumor)
- Extradural or subdural empyema