Acute Sinusitis (Sinusitis)

Acute Sinusitis (Sinusitis) – Treatment Options

Introduction
Acute sinusitis, or acute rhinosinusitis, is an inflammation of the paranasal sinuses lasting less than four weeks. It is commonly preceded by viral upper respiratory tract infections, with a minority of cases progressing to acute bacterial sinusitis. Typical symptoms include nasal congestion, purulent nasal discharge, facial pain or pressure, fever, and reduced sense of smell. The condition is usually self-limiting, but bacterial cases may require antibiotics.

1. General and Supportive Measures

• Symptomatic relief:

  • Analgesics (acetaminophen, ibuprofen) for facial pain and fever.

  • Saline nasal irrigation to promote drainage and reduce congestion.

• Decongestants:

  • Topical (oxymetazoline) or oral (pseudoephedrine).

  • Use topical agents for ≤3 days to avoid rebound congestion (rhinitis medicamentosa).

• Intranasal corticosteroids (fluticasone, mometasone): Reduce mucosal inflammation, particularly useful in allergic patients.

• Rest and hydration: Support mucociliary clearance and systemic recovery.

2. Antibiotic Therapy (for Suspected Bacterial Sinusitis)
Indications:

• Symptoms lasting >10 days without improvement.

• Severe symptoms (fever ≥39°C, purulent nasal discharge, facial pain >3–4 days).

• Worsening after initial improvement (“double sickening”).

First-line options:

• Amoxicillin-clavulanate (preferred over amoxicillin alone due to resistance).

• Doxycycline (alternative in penicillin-allergic adults).

• Respiratory fluoroquinolones (levofloxacin, moxifloxacin): Reserved for severe allergy or resistance.

Pediatric considerations:

• Amoxicillin or amoxicillin-clavulanate (weight-based dosing).

• Avoid fluoroquinolones unless no other options exist.

3. Complication Management

• Orbital cellulitis/abscess: IV antibiotics, ENT consultation, possible surgical drainage.

• Intracranial extension (meningitis, brain abscess): Urgent hospitalization, IV broad-spectrum antibiotics, neurosurgical involvement.

4. Chronic and Recurrent Cases

• Allergy management: Antihistamines, immunotherapy for allergic rhinitis.

• Nasal corticosteroids: For recurrent or chronic cases.

• ENT evaluation: For patients with ≥3–4 episodes per year, obstruction, or suspected structural abnormalities (e.g., deviated septum, polyps).

5. Lifestyle and Preventive Measures

• Avoid smoking and pollutants that impair mucociliary clearance.

• Manage allergic rhinitis and asthma optimally.

• Encourage good hand hygiene to reduce viral transmission.

6. Multidisciplinary Care

• Primary care physicians: First-line diagnosis and management.

• Otolaryngologists (ENT): For chronic, recurrent, or complicated cases.

• Allergists: If allergic triggers are suspected.

• Neurosurgeons/Ophthalmologists: For management of intracranial or orbital complications.