I used to think sinusitis mere nuisance value, something attached on the end of a head cold or flu that caused some fullness in the front of the head and face and an annoyingly blocked nose.
But I have reason to critique my own estimation of sinus disease of late and have seen, in association with flu-like illnesses, some cases of quite potent secondary bacterial sinusitis; one that at first blush even mimicked a meningitis as it gave the febrile patient significant difficulty flexing her neck.
Acute bacterial sinusitis can give rise to significant headache pain, chills, and malaise and in the primary care setting should always be considered in a headache differential.
Of course, there are grades of severity. But when you see a florid case of acute bacterial sinusitis, it really makes you reappraise the condition, especially given how commonly sinusitis occurs. It pays dividends to bounce your fingers against the patients face (maxillary / ethmoidal and frontal sinuses) in the setting of acute headache, especially headache with fever.
In the setting of sinusitis, also look for a concurrent middle ear infection. That goes without saying. But generally sinusitis requires a longer course of antibiotic treatment (a seven or even ten day-course) than an isolated otitis media, .
Chronic sinusitis is also debilitating, particularly in those who suffer from allergic rhinitis (Hay Fever). And while on the subject, Allergic Rhinitis is a common and underestimated cause of morbidity.
Most of these conditions cause significant morbidity and should be treated aggressively.
My preference is for seven days of clarithromycin for acute sinusitis (250 mg bd).¹ My preference for allergic rhinitis is nasal corticosteroids, although I would warn against prolonged use here and suspect that, apart from epistaxis, because of their common use they may now be a common cause of gingival hypertrophy and oral thrush. Because of that, I generally recommend episodic use followed by throat gargles.
The other important point to consider is that sinus disease may be associated with disease also of the upper airways, including asthma, bronchiectasis, and cystic fibrosis.²
- Clarithromycin should be avoided in patients taking rosuvastatin
- Loebinger, M R et al. (2009) Upper airway · 2: Bronchiectasis, cystic fibrosis and sinusitis. Thorax. [Online] 64 (12), 1096–1101. [online]. Available from: http://search.proquest.com/docview/1781785938/.
