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Acute Sinusitis

 Acute Sinusitis

 Acute Sinusitis Fact:  Acute sinusitis is inflammation and/or infection of one or more of the sinuses usually caused by a viral infection or an allergic reaction.

What is Acute Sinusitis?

Acute sinusitis infections are uncommon compared to viral rhinitis (the common cold). Sinusitis often times follows an acute respiratory infection, so they can be confused by patients, media, and physicians. In addition to the cold symptoms, the diagnosis of sinusitis requires clinical signs and symptoms that indicate involvement of the affected sinus or sinuses, such as pain and tenderness over the involved sinus.

Sinusitis occurs when an undrained collection of pus accumulates in the sinus cavity. Diseases that swell the nasal mucous membrane, such as viral or allergic, are usually the underlying cause. The lining of the nose becomes swollen causing obstruction of sinus drainage. The result is accumulation of mucous secretion in the sinus cavity that becomes secondarily infected by bacteria or several bacterias. Typical bacteria which cause sinusitis are often the same which cause ear infections. They include S. pneumoniae and other sreptococci, H. influenzae, S. aureus, M. catarrhalis.

What are the Symptoms and Signs of Acute Sinusitis?

* Pain and pressure over the cheeks (most commonly maxillary sinuses).

* Pain can radiate or refer to the upper incisors and canine teeth via nerves which line the floor of the sinuses. Maxillary sinusitis can result from a dental infection. Tender teeth should be examined for abscess.

* Discolored nasal discharge and poor response to over the counter decongestants may also suggest sinusitis.

* Pain and pressure over the nasal bridge which may radiate to the orbit (eye socket).

* Headache, in the front and middle of the head.

* Some experience overall body aches, fatigue, fever, bad breath, post nasal drip.

Is Imaging Helpful in Sinusitis?

Although it is often possible to make a diagnosis of sinusitis on clinical grounds alone, radiological confirmation allows a more definitive diagnosis and is an objective monitor of the course of infection. Standard sinus films, CT, and MRI are helpful diagnostic aids.

How is Sinusitis Treated?

Treatment depends on the level of complication. In uncomplicated sinusitis, outpatient management is usually successful. Patient is treated with decongestants, Nasal sprays, oral antibiotics. Antibiotic treatment should be continued for 2 weeks, with longer courses sometimes required to prevent relapses. Failure of sinusitis to resolve after an adequate course of oral antibiotics may necessitate hospitalization for IV antibiotics and possible surgical drainage and culture for atypical pathogens.

What are the Complications of Sinusitis?

* Osteomyelitis (infection of surrounding bone) requires prolonged antibiotics as well as removal of damaged bone. The frontal sinuses (over forehead) are most commonly involved with tender puffy swelling.

* Mucocele (a consequence of long-standing ductal obstruction), are more common in the supraorbital ethmoids and frontal sinuses and may become secondarily infected. They appear radiologically as smoothly expanded sinus filled with soft tissue density. Treatment is surgical, requiring drainage or excision.

* Intracranial complications of sinusitis occur either through hematogenous (infection spread through blood stream), as a clot, meningitis, or by direct extension such as a brain abscess. These complications are serious, fortunately they are not common. CT should be done for these patients.

* It should be kept in mind that paranasal sinus cancer is in the differential diagnosis of sinusitis. The presence of bone destruction on radiograph, cranial neuropathies, persistent pain, nose bleed, or a prolonged clinical course should raise the suspicion of possible cancer.

Is follow up necessary in Sinusitis?

Follow up is determined on a case-by-case basis. If you have been asked to return to the office, your should be compliant. If your sinusitis is getting worse, instead of better, you should return to the office. For some patients, prophylactic nasal steroids are appropriate. Recurrent sinusitis should prompt Ears, Nose, Throat consult. As always, discuss your concerns with your health care provider.

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