Sinusitis: Difference between revisions
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**Mechanical irrigation with buffered, hypertonic saline | **Mechanical irrigation with buffered, hypertonic saline | ||
**Topical glucocorticoids - Flonase | **Topical glucocorticoids - Flonase | ||
**Dexamethasone 10 mg PO x1 dose | |||
**Zicam | |||
**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 14:28, 22 June 2016
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
- Dexamethasone 10 mg PO x1 dose
- Zicam
- Topical decongestants (e.g. oxymetazoline for no more than 3d)
- Antihistamines
- Mucolytics
- Avoid antibiotics
- Part of ACEP Choosing wisely
>10 days of symptoms
- Suspicious for bacterial origin especially with:
- No clinical improvement after 10 days
- Severe symptoms or high fever and purulent nasal discharge or facial pain lasting for at least 3–4 consecutive days at the beginning of illness
- Onset with newly worsening that were initially improving (‘‘doublesickening’’)
- Acute bacterial sinusitis[1]
- First line is amoxicillin-clavulanate (over amoxicillin alone)
- Second line is fluoroquinolone or doxycycline
Antibiotic Failure
- Obtain culture
- Consider nosocomial bacterial sinusitis (e.g. after prolonged nasotracheal inbutation)
- Consider foreign body
- Consider fungal treatment
Disposition
- Typically outpatient
Complications
- Meningitis
- Cavernous sinus thrombosis (ethmoid/sphenoid)
- Intracranial abscess
- Orbital cellulitis (ethmoid)
- Frontal bone osteomyelitis (Pott's puffy tumor)
- Extradural or subdural empyema
See Also
References
- ↑ Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. IDSA Guidelines. 2012; Clinical Infectious Diseases e1-e41.