Symptomatic inflammation of the paranasal sinuses, usually followed by a viral respiratory tract infection and is defined by symptoms that last for less than 12 weeks

Aetiology

• Most commonly preceded from rhinitis, but can spread from dentition
• Most common organisms include strep. pneumonae, H. infuenzae and Moraxella catarrhalis

Clinical presentation

• In adults, it is diagnosed by the presence of nasal blockage or nasal discharge with facial pain/pressure (or headache) and/or reduction of the sense of smell
• Severe pain and tenderness with purulent nasal discharge indicates secondary bacterial infection
• Toothache common

Investigations

• Clinical diagnosis

Management

• Usually self-limiting, can give analgesics and nasal decongestants
• Saline irrigation
• Consider prescribing a high-dose nasal corticosteroid if a person has had symptoms for around 10 days or more with no improvement
• Antibiotics for severe/deteriorating cases of >10 days duration - treat secondary bacterial infection
  • Phenoxymethylpenicillin first line
  • Doxycycline second line - contraindicated in children

Complications

• Spread of infection into important structures
  • Spread of infection from sinuses to orbit - cellulitis, periosteal abscess, orbital abscess
  • Thrombosis of retinal vein or cavernous sinus - infection spreads into superior saggital sinus and patient becomes very unwell