Sinusitis (Acute Bacterial)
Evaluation
General—inflammation of the paranasal sinuses and nasal mucosa for ≤4 weeks duration
Clinical—similar to an upper respiratory viral infection, but bacterial sinusitis is distinguished by the following:
Purulent nasal discharge
Unilateral maxillary tooth/facial pain (rule out dental abscess) and sinus tenderness
Symptoms worsen (congestion, cough, headache, malaise, fever, and so on) after 5 to 7 days
Etiology (see Table 2.48.1)
Risk factors—anatomic variation, viral infection, allergic rhinitis, smoking, nasal medications, diabetes mellitus, and so on
Imaging—radiographic findings include air-fluid levels, mucus thickening, and opacification
But, radiography (x-ray and/or computed tomography [CT]) and ultrasonography are of little use for routine diagnosis.
Management
Symptomatic therapy
Topical decongestants (effective, but limit use to 3 days to avoid rebound congestion)
Oxymetazoline nasal (Afrin) 0.05%—two to three sprays per nostril BID
Phenylephrine nasal (Neo-Synephrine) 0.25%—one to two sprays per nostril q4h
Oral decongestants
Topical anticholinergics (possibly effective; helpful in decreasing rhinorrhea)
Ipratropium nasal (Atrovent nasal) 0.06%—two sprays per nostril q6h
Antihistamines (possibly effective; typically combined with an oral decongestant)
Nasal corticosteroids (possibly effective; work by calming inflammation)
Flonase (fluticasone nasal) 50 μg per spray—two sprays per nostril daily
Mucolytic agents (possibly effective; works by thinning secretions)
