Updated: 12/29/2016

Sinusitis

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Introduction
  • Infection of the paranasal sinus due to undrained collection of pus
    • maxillary sinuses most commonly involved in adults
    • ethmoid sinuses most commonly involved in children
  • Etiologies
    • acute viral respiratory tract infection
    • smoking
    • septal deviation
    • diabetes
      • ketoacidosis be associated with mucormycosis infection
  • Common pathogens
    • Viruses
    • S. pneumonia
    • Haemophilus influenzae
    • Moraxella cattarrhalis
    • anaerobes (e.g bacteroides)
    • fungi (aspergillus, mucormycosis)
Presentation
  • Symptoms
    • fever
    • facial pain (over infected sinus)
    • headache
    • purulent rhinorrhea
  • Physical exam
    • facial tenderness with palpation
Evaluation
  • CT
    • most sensitive test
Treatment
  • Medical 
    • decongestants
    • analgesics
    • saline irrigation
    • avoid antibiotics early in symptom course unless high risk patient
      • most infections are viral in origin
      • consider after 10 days of symptoms
        • empiric antibiotic should cover most common organisms (listed above)
    • little data supporting use of systemic corticosteroids
Prognosis, Prevention, and Complications
  • Most resolve with supportive treatments
  • Extra-sinus complications
    • orbital abscess, meningitis, epidural abscess, brain abscess
  • Can be fatal in diabetic or immunocompromised patients
 

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