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Acute and Chronic Sinusitis

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“Sinusitis” © Laboratoires Servier CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

Sinusitis is the inflammation of the paranasal sinuses. It's classified into:

  • Acute - < 12 weeks

  • Chronic - > 12 weeks


Causes include:

  • Infection - especially following viral URTI

  • Allergy

  • Obstructed drainage e.g. nasal polyps, trauma, foreign body

  • Smoking


A rare, but severe complication that can occur here is Pott’s puffy tumour, which is frontal bone osteomyelitis with associated subperiosteal abscess and forehead swelling.

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“Detail of forehead, patient with Pott's puffy tumor, likely from chronic frontal sinusitis” © Fythrion CC BY-SA 4.0 ([https://creativecommons.org/licenses/by-sa/4.0/](https://creativecommons.org/licenses/by-sa/3.0/))

Presentation

Acute sinusitis:

  • Facial congestion, pain, or pressure

  • Nasal congestion

  • Headache

  • Facial swelling

  • Loss of smell

  • Usually preceded by a Viral URTI


Chronic sinusitis:

  • Similar to acute sinusitis, but is usually painless

  • Commonly associated with Nasal polyps


Management

Acute sinusitis:

  • If symptoms last < 10 days - Paracetamol, Nasal saline irrigation, Decongestants

  • If symptoms last > 10 days - Nasal steroids, Delayed Abx (Phenoxymethylpenicillin)


Chronic sinusitis:

  • Saline nasal irrigation

  • Steroid nasal sprays and drops

  • Functional endoscopic sinus surgery - removes obstructions e.g. polyps, and can open sinus up with balloons




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