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Symptoms:
- Facial pain and headache (site depending on sinuses involved)
- Nasal discharge and obstruction
- Fever
Causes:
often follows an upper respiratory infection
Streptococcus pneumoniae, Haemophilus Influenzae, Moraxhella catarrhalis and Staphylococci aureus
Management:
- Usually in the community
- Systemic antibiotics (see Pharmacology section)
- Nasal decongestants
- Analgesia

COMPLICATIONS OF ACUTE SINUSITIS

Orbital cellulitis and intracranial complications
These complications are unusual and occur predominantly in children.
Presentation:
Orbital complications
Recent URTI
Orbital cellulitis – swelling and proptosis, erythema of the eye.
Restricted eye movements with eye pain.
Possible loss of vision (severe cases).

Intracranial complications
Headache, nausea and vomiting
Subtle changes in personality may be seen with a frontal lobe abscess.
Examination findings:
Eye changes as above
Tenderness over sinuses, particularly the ethmoids.
Nasal discharge
Pyrexia
Special investigations:
CT scan of paranasal sinuses and brain
Management:
- Conservative:
In patients who have no intracranial or orbital abscess, intravenous antibiotics may be given.
Haemophilus influenzae and Staphylococcus aureus. Topical decongestants and steroids are also used to restore drainage. In there are no improvement after 24 hours, surgery to drain the sinuses is performed.
- Surgery:
This will involve draining the affected sinuses (usually ethmoids and frontal) by either trephine, wash out or formal fronto-ethmoidectomy.