Sinusitis

Notes

## Basic introduction

  • This is the inflammation of the paranasal sinuses that is caused by allergic reactions as well as infections by viruses, bacteria, or fungi
  • It is also known as rhinosinusitis as it is usually accompanied by the inflammation of the nasal mucosa
  • The paranasal air sinuses are lined with respiratory epithelium

## Pathophysiology

  • There is obstruction of sinus cavity that often causes infection

## Classification of paranasal sinuses according to the bones within which the sinuses lie:

  • Maxillary sinusitis (the largest)
  • Frontal sinusitis
  • Ethmoidal sinusitis
  • Sphenoidal sinusitis

## Classification of paranasal sinusitis according to the intensity and duration of the disease

  • Acute sinusitis (most of them are due to viral infections) and last for 7 - 30 days
  • Subacute sinusitis (lasts 4-12wks)
  • Recurrent sinusitis (at least 3 acute episodes of acute sinusitis that often last for more than 10 days)
  • Chronic sinusitis (persists for more than 90 days)

## Risk factors for sinusitis

  • Allergic rhinitis
  • Diabetes
  • HIV infection and other immunocompromised states
  • Nasal polyps
  • Nasogastric tube
  • Nasotracheal tubes
  • Severe burns
  • Previous history of trauma of nose and cheek
  • Asthma
  • Pregnancy
  • Sinus surgery
  • Swimming
  • Water diving
  • High-altitude climbing
  • Foreign body
  • GERD/Helicobacter pylori
  • Genetics

## Statistics

  • Chronic rhinosinusitis affects 5 - 15% of global population
  • 30 - 40% of patients with sinusitis actually have a bacterial infection.
Symptoms
  • Nasal congestion
  • Purulent rhinorrhea
  • Facial pain
  • Facial pressure
  • Fever
  • Headache
  • Malaise
  • Snoring
  • Lethargy
  • Mouth breathing
  • Hyponasal speech
Diagnosis
  • Clinical review
  • CT scan in case of suspected complications
  • X-rays, sometimes, to exclude other complications such as periapical abscess.
  • Culture
Differential
  • Rhinitis (allergic or non-allergic)
  • Adenoiditis
  • Migraine
  • Cystic fibrosis
  • Tumors of the nose, sinuses, and bones
  • Turbinate dysfunction
Prevention
  • Mitigation of the risk factors
Reference

1. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf

Management
  • Decongestants
  • Corticosteroid nasal sprays
  • Heat and humidity
  • Surgery to improve sinus drainage (if recurrent)

## Antibiotics

  • Caps Amoxicillin 500mg TID x 1/52 OR
  • Caps Doxycycline 200mg STAT then 100mg OD x 1/52

OR

  • Tabs clarithromycin 2/5250 mg to 500mg BD x 1/52

OR

  • Erythromycin

OR

  • Tabs Co-amoxiclav 625 TID x 1/52

OR

  • Tabs azithromycin 500mg OD x 3/7
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