Acute Sinusitis/aka Acute rhinosinusitis: What is Sinusitis?

an inflamation of the mucosal lining of the paranasal sinuses with progression of symptoms for 4 -12 wks. Past 12 weeks is called chronic sinusitis. How does it occurr? Goblet cells of the sinus mucosa secrete fluid that is drained normally via ciilary action out of the ostia. Initial irritation of the nasal mucosa can be via virus, allergy, chemical irritiation can cause mucosal edema in the region fo the ostia causing them to close off. This results in stasis of sinus secretions/mucus and an easy medium for bacterial infeciton. The viral infection itself can be symptomatic and actually acounts for most episodes of rhinosinusitis. The implicated bviruses are mostly rhinovirus, but can also be coronavirus, influenza, parainfluenza, RSV, adenovirus, enterovirus. Only in 0.5-2% of adult cases does this viral sinusitis progress to bacterial sinusitis. However 2/3 of patients with acute sinusitis do end up growing 1 or more bacterial species. In children the most common organisms isolated bacterial organisms are Strep Pneumoniae, Hemophilus Influenzae, Moraxella Catarrhalis. Althought Strep Pneumo has been historically the most prevalent among these, vaccinations to Strep Pneumo and Hib, have allowed the increased relative prevalence of non-typable H Flu as a cause. For Nosocomial H Flu on mu st be cognizant of he increased prevalence of Pseudomonas, Ecoli, Proteus, klebsiella, etc Altered mucus quantity and quality can also predispose to sinusitis. (ie with CF) Another possability is if mucociliary clearance is impaired in some way the resulting stasis can also lead ot sinus infeciton(ie with Karrtagener's, ciliotoxins/smoking.) Other obstructive processes leading to sinusitis are nasal polyps, deviated septae, trauma, anatomical variations. Note: Sinusitis is seen in 18-32 %with prolonged intubation, seen as unexplained fever. Epidemiology and Risk factors 1 out of every 7 adults effected Women are twice as likely to have sinusitis, because they tend to be more in contact with young children. Prognosis and Complications 40% resolves with nothing at all. Almost 100% of viral sinusitis will resove on its own.

Complications are meningitis, Cavernous sinus thrombohlebitis, orbital cellulitis, brain abscess. Toxic Shock Syndrome, cellulitis, proptosis, chemosis, ophtlamoplegia Presentation: Toothpain, Erythema over effected area, Pain in temples, forehead or occiput(referred), postnasal discharge, stuffed-up nose, persistent cough, facial pain, hyposmia. if URTI lasts beyond a week suspect sinusitis, especially if pt has fever, periorbital edema and nasal discharge If URTI seems to be resolving but then gets worse again after 5-7 days. If bacterial sinusiitis: persietnent sx(>10 days), worsening sx(after 10 days). Resp sx >10 days , but less than 30 days. Differential. GERD, CF, CIlia, Dental Abscess, Migraine, Nasal Polyp, Chemical Rhinitis, Fungal Sinusitis, Cluster Headache, Tension Headache, Parainfluenza, Mucormycosis Workup: CT scan is the preferred method for rhintosinusitis. coronal view helps in differntiating orbital cellulitis. Delay untill antibotics cotnrol acute attack. For chronic pediatric sinusitis, use water's view. 3 main veiews are Waters view Caldwell view, and lateral view Treatment Intranasal Steroids seen to be fo benefit Mucolyitic have theoretic benefit topical vasoconstrictors can provide better drainage Amoxacillin, Azithromycin, and then maybe clarithromcin as first line Second line is Augmentin, ccefuroxime, cefpodoxime, pip/taz, Ticar, Mero, Gent, Rocephin If still not responding to medications, have sinus endoscopy , ct scan or sinus aspirate culture. allergic sinisutis: antihistamines, adenoid removal Follow Up