Rhinosinusitis

ACUTE URTI RHINOSINUSITIS

Viral aetiology, esp. common cold.

Treatment

• Increased fluids

• Saline insufflation or steam inhalation ( 372)

• Simple analgesics for pain, e.g. paracetamol, and fever

• If swollen and inflamed: corticosteroid spray

• If superinfected: mupirocin 2% nasal ointment

Usually no indication for oral antibiotics unless mucopurulent discharge, sinus tenderness or prolonged fever.

Allergic rhinitis Hay fever, 282

RHINITIS MEDICAMENTOSA

Be wary of this reactive vasodilatation due to prolonged use (>2–4 d) of OTC decongestant nasal drops or sprays.

VASOMOTOR RHINITIS

Usually due to chemical or environmental irritants (e.g. smoke and noxious fumes, sprays, cosmetics). Aggravated by emotional upsets, chilly damp weather, air conditioning, etc.

Treatment

• Patient education

• Trigger avoidance (if possible)

• Inhaled corticosteroids

• Anticholinergics (e.g. ipratropium bromide nasal spray)

• Nasal surgery if nec. (e.g. electrocautery, cryosurgery)