Sinusitis

Obstruction of the osteomeatal complex. Goal of medical therapy for acute and chronic sinusitis is to control infection, reduce tissue edema, facilitate drainage, maintain patency of the sinus ostia, and break the pathological cycle that leads to chronic sinusitis.

Etiology:

Acute rhinosinusitis. Etiology is usually respiratory viruses. Bacterial pathogens include S. pneumonia, H. influenza, Moraxella catarrhalis, and anaerobes, only if the sx are severe and sx persists >10 days.

Chronic rhinosinusitis. Asthma, nasal polyps, allergies, or immune deficiency are possible contributing factors. Etiologic agents include those for acute sinusitis, as well as S. aureus, Corynebacterium diphtheriae, Prevotella species, and Veillonella species.

Dx:

CT of sinuses: need objective evidence of mucosal disease. Nasal endoscopy may permit direct inspection of the mucosa. Cultures are obtained from endoscopy or sinus puncture. Nasal swabs are not helpful.

Clinical Presentation:

Acute rhinosinusitis is a clinical Dx that present with cough, purulent nasal discharge, and sinus tenderness with or without fever, lasting for 4 wks.

Chronic rhinosinusitis involves nasal congestion and obstruction with sx >12 weeks. Secondary complaints include pain, pressure, anterior or posterior nasal discharge, and decreased sense of smell.

Tx:

Acute rhinosinusitis

• • Sx treatment is the mainstay of Tx: systemic decongestants and analgesics +/- short course of topical decongestant.

  • Empiric ABx Tx for severe persistent sx or failure of symptomatic tx. First line ABx:

  • Amoxicillin, 500 mg PO tid or TMP/SMX-DS PO bid x 10 days.

  • 2G cephalosporins, amoxicillin-clavulanate, and macrolides are good 2nd line agents in the case of primary Tx failure.

Chronic rhinosinusitis.

• • Tx usually involves topical and/or systemic glucocorticoids.

  • Role of antimicrobial is not clear. If used Amoxicillin-Clavulanate is the first-line Tx, with clindamycin for PCN-allergic Pts. Some chronic cases require endoscopic surgery.