Inflammation of the paranasal sinuses. Usually accompanied by inflammation of the nasal cavity - rhinosinusitis
- Acute < 12 weeks
- Chronic >12 weeks
There are four sets of paranasal sinuses:
- Frontal sinuses (above the eyebrows)
- Maxillary sinuses (either side of the nose below the eyes)
- Ethmoid sinuses (in the ethmoid Bone in the middle of the nasal cavity)
- Sphenoid sinuses (in the sphenoid Bone at the back of the nasal cavity)
Causes/Factors
- Infection - viral URTI
- Allergies
- Obstruction of drainage - foreign body, trauma, polyps
- Smoking
- asthma
Presentation
Someone usually with a recent viral URTI
- Nasal congestion
- Nasal discharge
- Facial pain or headache
- Facial pressure
- Facial swelling over the affected areas
- Loss of smell
Signs
- Tenderness to palpation of the affected areas
- Inflammation and oedema of the nasal mucosa
- Discharge
- Fever
- Other signs of systemic infection (e.g., tachycardia)
Investigations
Usually none needed. In patients with persistent symptoms investigations can include
- Nasal endoscopy
- CT scan
Viral vs Bacterial
Acute bacterial is defined by at least 3 of:
- Symptoms for more than 10 days
- Temperature 38
- Discoloured or purulent nasal discharge
- Severe local pain
- Marked deterioration after initial milder phase
Management
Advise on the natural course and cause of the condition. Simple symptom relieving measures
- Do not recommend antibiotics with symptoms for up to 10 days. Most are viral causes and resolve within 2-3 weeks
- After 10 days have the options of:
- High dose steroid nasal spray for 14 days (mometasone 200mcg TDS)
- A delayed antibiotic prescription if not improving 10 days after that
For chronic sinusitis:
- Saline nasal irrigation
- Steroid nasal sprays or drops
- Functional endoscopic sinus surgery - obstructions - swollen mucosa, Bone, polyps, deviated septum.