Acute Sinusitis

Overview/prevalence - 

Acute rhinosinusitis or sinusitis is an inflammation of the nasal cavity and the paranasal sinuses. The most common cause is due to viral infections, specifically, rhinovirus, influenza virus and parainfluenza viruses. Bacterial causes of acute sinusitis account for 0.5-2% of cases. One in seven people in the United States will get acute sinusitis in a year. 

Risk Factors

The risk factors for acute sinusitis include smoking, exposure to changes in atmospheric pressure such as diving, air travel, older age, swimming, decreased immune system, asthma, allergies and dental diseases. 

Symptoms

Symptoms include nasal congestion and obstruction, tooth discomfort, facial pressure that is worse with leaning forward and pus like nasal discharge. Symptoms usually last less than 4 weeks. There may also be fever, feeling tired, ear pressure, headaches and cough. 

The symptoms of acute sinusitis from viral and bacterial causes overlap, however viral acute sinusitis tends to resolve or improve within 7 to 10 days, whereas bacterial acute sinusitis usually has worsening of symptoms after an initial improvement. 

On examination there may be swelling and tenderness over the cheek or above the eye. There may be nasal drainage or drainage in the back of the throat. 

Diagnosis

The diagnosis of acute sinusitis is based on the history and examination. 

Acute rhinosinusitis is diagnosed with less than 4 weeks of pus-like nasal secretions plus severe nasal obstruction, facial pressure, pain or fullness.

Imaging is not needed for a patient without complications, however if there is concern about spread past the nasal cavity or sinuses then imaging should be done. 

Treatment

Acute sinusitis treatment involves pain relievers, saline rinses, nasal steroids, decongestants, antihistamines, anti-mucus medicines and anti-fever medicines. 

For bacterial sinusitis all of these medicines may be considered in addition to antibiotics. 

Complications 

Acute bacterial sinusitis may spread past the sinuses and nose and into the central nervous system and eye socket.