Sinusitis

Sinusitis, also known as rhinosinusitis, refers to inflammation of the sinuses that occurs with a viral, bacterial, or fungal infection.

Diagnosis

The diagnosis of sinusitis is often based on clinical presentation and the history of the condition. Symptoms typically include:

• nasal congestion
• facial pain/pressure
• purulent nasal discharge
• loss of smell
• cough
• fever

Acute sinusitis is when symptoms last less than four weeks and are often related to an upper respiratory tract infection.

Sub-acute sinusitis is considered when the symptoms persist for 4-12 weeks.

Chronic sinusitis is considered when the symptoms persist for more than 12 weeks.

Imaging and endoscopy are usually not necessary for the initial diagnosis, but can be helpful in chronic cases or when complications are suspected.

Differential Diagnosis

The differential diagnosis for sinusitis includes conditions that present with similar upper respiratory symptoms. These can include:

1. Allergic rhinitis: Characterized by sneezing, itching, and clear nasal discharge, without the facial pain typically associated with sinusitis.
2. Upper respiratory tract infection (URI): Often viral in origin, presents with similar symptoms to sinusitis but usually without the localized pain and tenderness over the sinuses.
3. Nasal polyps: These may cause nasal obstruction and discharge but are not usually associated with acute pain or fever.
4. Dental abscesses: Can cause pain in the upper jaw and may mimic sinusitis, as the roots of the upper teeth are close to the sinus floor.
5. Other causes of facial pain: Such as temporomandibular joint disorders, migraines, or cluster headaches.

Management of Sinusitis

Acute Sinusitis

Most cases of acute sinusitis are viral and resolve without antibiotics. Management may include:

Symptomatic Relief:

1. Saline nasal irrigation or nasal sprays
2. Nasal decongestants
   1. For a few days only to avoid rebound congestion (rhinitis medicamentosa)
   2. Oxymetazoline Hydrochloride (Drixine) for patients > 6
3. Analgesics for pain relief, such as acetaminophen or ibuprofen
4. Steam inhalation

Observation: A “watchful waiting” approach for about 7–10 days to see if symptoms improve without antibiotics.

Antibiotics: Considered if symptoms worsen after 5 days, symptoms are severe, or if a patient doesn’t improve after 10 days. The first-line antibiotic are amoxicillin, cefuroxime, doxycyline or amoxicillin-clavulanate.

Chronic Sinusitis

Chronic sinusitis management involves a longer course of treatment and may include:

1. Intranasal Corticosteroids: To reduce inflammation in the nasal passages and sinuses.
   1. Fluticasone furoate (Avamys)
   2. Mometasone (Nasonex)
2. Oral antihistamine ie loartidine (Claratyne)
3. Saline Irrigation: To help clear out mucus and reduce inflammation.
4. Extended-Course Antibiotics: If bacterial infection is suspected, a longer course of antibiotics may be needed, often guided by culture results.
5. Treatment of Underlying Causes: Managing allergies, nasal polyps, immune deficiencies, or anatomical obstructions (such as a deviated septum).
   1. Medical Polypectomy: Oral prednisolone
6. Surgery: In cases refractory to medical treatment, an ENT (ear, nose, and throat) specialist might recommend surgical intervention to improve sinus drainage.

Follow-up

Patients with sinusitis should be monitored for improvement and for any signs of complications, such as orbital cellulitis, abscess formation, or spread of infection to the central nervous system. If a patient’s symptoms persist despite initial treatment, further evaluation may be necessary, and referral to an ENT specialist should be considered.

Preventive measures, especially for those with recurrent sinusitis, include smoking cessation, management of allergies, and avoiding respiratory tract infections by hand hygiene and vaccination where appropriate.