TOC  | ID    Sinusitis 

Pathogenesis of Rhini-sinusitis (Vicious cycle):

Altered Sinus environment -> Bacterial growth -> Infection -> Mucosal Inflammation -> Mucosal edema -> Ostial obstruction ->Altered sinus environment.

Acute Sinusitis Treatment:

• Diagnose by history/physical examination
• Observation only
  - Low suspicion bacterial infection
  _ High suspicion bacterial infection, mildly symptomatic
• Antibiotics (10 days) for high suspicion bacterial infection, more than  midly symptomatic
  as: Amoxicillin or  Septra DS for uncomplicated acute bacterial sinusitis; Augmentin, Ceclor or Ceftin, or fluoroquinolones (Cipro).
• Topical steroids (Nasarel, Flonase, Beconase nasal sprays), decongestants, mucolytics, adjunctive treatments as indicated
• Endoscopy/culture in refractory cases
• Be wary of complicatios
  - Orbital, intracranial
• Reassess after 1 month, sooner with persistent symptoms or progression.

Chronic Sinusitis Treatment

• Diagnose by history/physical examination
• Antibiotics (~ 3 weeks)  , may need anaerobic coverage.
• Oral prednisone 40 mg taper down over 3 weeks
• Topical steroids, decongestants, mucolytics, nasal saline irrigation, adjunctive treatments as indicated
• Reassess after 1 month, sooner with persistent symptoms or progression.
  May need endoscopy-guided cultures to demonstrate pathogenic bacteria.
  Endoscopy/culture in refractory cases to rule out unsual infection, tumor, etc.
• Coronal Sinus CT scan in approximately 1 month (guided by history)
• Surgical treatment in refractory chronic sinusitis.

Johns Hopkins - Advanced Studies in Medicine journal  October 2003:   The Dx & Rx of Sinusitis

 11-22-2003