Sinusitis

ACUTE

Management

• Look for nasal pathology, such as polyposis and dental problems

• Analgesics

• Steam inhalations

• Pseudoephedrine tabs

If bacterial sinusitis (high fever, purulent nasal discharge):

• exclude dental root infection

• control predisposing factors

Guidelines for antibiotic treatment Consider in severe cases with at least three of the following:

• facial pain

• persistent mucopurulent nasal discharge

• poor response to decongestants

• tenderness over the sinuses

• tenderness on percussion of maxillary, molar and premolar teeth

Antibiotics (first choice):

• amoxicillin 500 mg (o) tds for 7 d or

• (if sensitive to penicillin) doxycycline 200 mg (o) statim then 100 mg daily for 7 d or

• cefaclor 375 mg (o) bd for 7 d or

• amoxicillin/clavulanate 875/125 mg (o) tds for 7 d (if poor response to above agents—indicates resistant H. influenzae)

If severe and persistent, surgical drainage may be necessary by atrial lavage or frontal sinus trephine.

CHRONIC

Sinusitis persisting longer than 2 wks, despite repeated antibiotic and decongestant therapy, is common in general practice. Postnasal drip with cough, esp. at night, is a feature. An empirical treatment that is effective is:

• steam inhalations with Friar’s balsam or menthol (best is menthol co APP inhalation)

• vitamin C (sodium ascorbate) 2–4 g daily (a powder can be obtained and mixed with orange juice)

If an allergic basis (pale, swollen mucosa), intranasal corticosteroids.