Diagnosis

Acute sinusitis

Infection of the paranasal sinuses/nasal mucosa, usually preceded by an upper respiratory infection, allergy, trauma, or dental infection.

Also known as: Acute bacterial rhinosinusitis, Acute bacterial sinusitis, Acute rhinosinusitis, Common cold

Etiology

Cause [krd]

Pathophysiology [krd]

  1. A viral infection triggers the inflammatory cascade (viral phase of 7-10 days, common cold)

  2. Inflammation may be prolonged (post-viral phase lasting more than 10 days)

  3. This inflammatory condition of the mucosa may facilitate a bacterial infection (bacterial rhinosinusitis in 0.5-2% of cases)

Complications [sc9]

Differentiate acute bacterial vs viral rhinosinusitis

  1. Persistent symptoms compatible with acute rhinosinusitis, lasting for ≥10 days without any evidence of clinical improvement

  2. Severe symptoms, high fever (≥39°C) and purulent nasal discharge or facial pain lasting for at least 3–4 consecutive days

  3. Worsening symptoms or signs characterized by the new onset of fever, headache, or increase in nasal discharge following a typical viral upper respiratory infection that lasted 5–6 days and were initially improving (“double-sickening”)

Epidemiology

Incidence per 100.000 [sc9][krd][hgs][v8k][enr][tap]

Epidemiology chart for Incidence

Symptoms & findings

Symptoms

Cough, Epistaxis, Fever, Halitosis, Headache, Malaise, Nasal discharge

Clinical findings

None listed.

Anamneses

None listed.

Localized findings

Pain
Radiates
MaxillofacialEarsThroat (pharynx and larynx)
Onset
Gradual (days)
Pattern
Constant
Severity
Mild (1-3)Moderate (4-7)

Approach

Diagnostic criteria for acute rhinosinusitis [krd]

≥2 of the following clinical findings:

  1. Nasal congestion/blockage/obstruction

  2. Rhinorrhea

  3. Facial pain/pressure

  4. Reduction/loss of smell, lasting up to 12 weeks

Diagnostic criteria for acute bacterial rhinosinusitis [krd]

≥3 of the following clinical findings:

  1. Fever (≥ 38 °C)

  2. Severe facial pain

  3. Double sickening

  4. Unilateral disease (with discolored mucus)

  5. Elevation of CRP/erythrocyte sedimentation ratio (ESR)

Treatment

  1. Prophylaxis: hygiene rules (hand washing, social distancing, facemask and eye guards) [krd]

  2. Usually self-resolving --> symptomatic relief: NSAIDs, paracetamol, antihistamines, nasal decongestants, Nasal saline irrigation

  3. Watchful waiting (without antibiotics)

  4. If bacterial etiology --> Amoxicillin for 5-10 days

  5. CT scanning when suspected serious complications (meningitis, orbital cellulitis, brain abscess and cavernous sinus thrombosis)

Differential diagnoses

Acute invasive fungal sinusitis, Allergic rhinosinusitis, Chronic sinusitis

References

[1] Jaume F, Valls-Mateus M, Mullol J. Common Cold and Acute Rhinosinusitis: Up-to-Date Management in 2020. Curr Allergy Asthma Rep. 2020 Jun 3;20(7):28.

[2] https://emedicine.medscape.com/article/232670-overview?form=fpf

[3] Wald ER, Nash D, Eickhoff J. Effectiveness of amoxicillin/clavulanate potassium in the treatment of acute bacterial sinusitis in children. Pediatrics. 2009 Jul;124(1):9-15.

[4] Marom et al. Acute bacterial sinusitis complicating viral upper respiratory tract infection in young children. Pediatr Infect Dis J. 2014 Aug;33(8):803-8.

[5] Smith et al. The prevalence of bacterial infection in acute rhinosinusitis: a Systematic review and meta-analysis. Laryngoscope. 2015 Jan;125(1):57-69.

[6] Gwaltney et al. Acute community-acquired bacterial sinusitis: the value of antimicrobial treatment and the natural history. Clin Infect Dis. 2004 Jan 15;38(2):227-33.

[7] [First Aid for the Surgery Clerkship]

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