Sinusitis

Introduction

Sinusitis is an inflammation of the mucosal lining of the paranasal sinuses.

It may be acute or chronic and affect one or more of the sinuses, most commonly the maxillary sinus or antrum (in very young children the ethmoidal sinuses).

Acute sinusitis is often sequel to acute rhinitis.

Common causative organisms are streptococcus, pneumococcus, and haemophilus. Chronic sinusitis is more insidious.

It may be associated with chronic rhinitis and allergy but other factors such as air pollution, smoking, dental sepsis and poor general health may be contributory.

Bacteriology is mixed: sometimes Gram negative and fungal organisms.

Symptoms and clinical features Sinusitis

Rhinorrhoea
Nasal obstruction
Fever with pain over affected sinus in acute cases
Less dramatic symptoms in chronic sinusitis
- Intermittent nasal obstruction and discharge over a long period
- Little pain
- Mucopurulent postnasal (“drip”) discharge.

Differential diagnoses

Acute rhinitis (coryza)
Allergic rhinitis
Vasomotor rhinitis

Complications of Sinusitis

Orbital cellulitis (complicating ethmoidal sinusitis)
Cavernous sinus thrombosis (sphenoidal sinusitis)
Intracranial infection
- Subdural abscess
- Meningitis
- Cerebral abscess
- Dural vein thrombophlebitis
Osteomyelitis of frontal or maxillary bones.
Chronic pharyngotonsillitis
Chronic laryngitis and bronchitis

Investigations

Nasal swab for microscopy, culture and sensitivity
X-ray of sinuses: four-view
Antrum roof puncture/lavage: specimen for culture
CT scan in complicated cases

Treatment for Sinusitis

Treatment objectives

Control and eradicate infection
Restore adequate drainage of sinuses

Non-drug treatment

Antrum wash-out/lavage
Trephining of frontal sinus
Radical surgery for non-responsive cases
- Intranasal antrostomy
- Caldwell-Luc operation
- Fronto-ethmoidectomy
Functional Endoscopic Sinus Surgery (FESS)

Drug treatment

A. Antibiotics

Amoxicillin

Adult: 500mg-1g orally every 8 hours for 5-7 days
Child: 40mg/kg orally every 8 hours for 5-7 days.

Or:

Amoxicillin/clavulanic acid

Adult: 500/125 mg orally every 12 hours

Child:

General: 0.25 mL/kg of 125/31 mg suspension orally every 8 hours; dose doubled in severe infections
1-6years: 5mL of 250/62 mg suspension every 8 hours; dose doubled in severe infections
6 – 12 years: 5 mL of 250/62 mg suspension every 8 hours; dose doubled in severe infections
12 – 18 years: one 250/125 mg strength tablet every 8 hours, daily increased in severe infection to one 500/125 strength tablet every 8 hours daily

Or:

Cotrimoxazole

Adult: 960mg orally every 12 hours

Child

6 weeks to 5 months: 120 mg orally every 12 hours;
6 months – 5 years: 240 mg every 12 hours;
6-12 years: 480 mg every 12 hours

Ceftriaxone

Adult: 1 g intravenously or intramuscularly every 12 hours for 7 days for patients with severe or nosocomial disease

Child: by intravenous infusion over 60 minutes

Neonates: 20 – 50 mg/kg once daily, by deep intramuscular injection, intravenous injection over 2-4 minutes, or by intravenous infusion
1 month 12 years (body weight
under 50 kg): 50 mg/kg once daily, up to 80 mg/kg in severe infections

B. Decongestant

Psuedoephedrine tablets.

Adult: 60 mg orally twice daily until
congestion