BACTERIAL SINUSITIS

History of acute viral respiratory infection, dental infection, or nasal allergy; nasal congestion and purulent discharge; fever, chills, and frontal headache; pain, tenderness, redness, and swelling over involved sinus...

Diagnostic Summary

History of acute viral respiratory infection, dental infection, or nasal allergy; nasal congestion and purulent discharge; fever, chills, and frontal headache; pain, tenderness, redness, and swelling over involved sinus; transillumination shows opaque sinus; chronic infection may produce no symptoms other than mild postnasal discharge, musty odour, or non-productive cough.

General Considerations

Predisposing factor is viral upper respiratory infection (common cold); allergic rhinitis and other factors interfering with normal protective mechanisms may precede viral infection and are predisposing factors; any factor inducing mucous membrane oedema may obstruct meatal drainage; transudate serves as medium for bacteria – streptococci, pneumocci, staphylococci, and Haemophilus influenza are the most common; allergy is common in chronic sinusitis; 25% of chronic maxillary sinusitis involves underlying dental infection; vasoconstrictors and antihistamines give transient relief, but prolonged use contraindicated – reflex reaction following continual administration.

Therapeutic considerations

• Antibiotics: limited value; efficacy controversial; recent analysis; antibiotic treatment in acute maxillary sinusitis in general practice population is not based sufficiently on evidence; warranted in severe or unresponsive cases; newer; more potent antibiotics (lactam antibiotics) are more effective than penicillin, amoxicillin, and other less potent antibiotics; even less evidence of significant benefit in children; overuse of antibiotics in children with sinusitis or otitis media can generate antibiotic resistant bacterial pathogens; chronic sinusitis – antibiotics of little or no benefit; addressing underlying cause (respiratory or food allergens) plus supportive therapy (saline nasal sprays, immune-enhancing herbs, and natural decongestants) is the most rational approach.

• Allergy: 25-70% of cases of allergic associated with sinusitis; chronic sinusitis unresponsive to immune support and antibiotics warrants aggressive work-up for environment and food allergies; eliminate dust mites –warm water washing at temperature of at least 58 degrees C, air-filtering vacuum cleaners, air cleaner with HEPA filter, and humidity < 50%; remove all pets, carpeting and feather bedding, if necessary.

• Sick building syndrome: environmental chemicals within buildings can induce lethargy, headaches, and blocked or runny nose – symptoms of chronic sinusitis.