Sinusitis

Introduction

Acute rhinosinusitis (formerly referred to as sinusitis) is an inflammation of one or more of the paranasal sinuses.

• Up to 2% of patients will develop acute rhinosinusitis as a complication of the common cold.

Symptoms

It is clinically defined by at least two of these symptoms:

• Nasal blockage or discharge
• Facial pain/pressure (or headache)
• Reduction (or loss) of the sense of smell

Associated symptoms

• Altered speech is also common, indicating nasal obstruction.
• Bending forward often exacerbates the pain (moving the eyes from side to side and coughing or sneezing can also increase the pain), and sinuses will be tender when gently palpated.
• If the ethmoid sinuses are involved, retro-orbital pain (behind the eye) is often experienced.

Nearly all cases are caused by viruses and only 2 in 100 cases will be complicated by bacterial cases.

• If this happens, more persistent pain arises in the sinus area and there may be fever and purulent nasal discharge.

Management

Most cases of sinusitis are improving by day 10 and resolve in 2-3 weeks.

• Analgesics for pain relief and oral or nasal sympathomimetics to remove the nasal secretions can be tried.
• Saline nasal irrigation (also called nasal douching) may improve symptoms.
• Antibiotics are not routinely recommended unless the person is systemically unwell, at risk of complications due to underlying medical conditions or has had symptoms for at least 10 days.