Sinusitis

Inflammation of the paranasal sinuses; maxillary sinuses MC affected

• History / PE:
  Fever, facial pain/pressure, HA
• Diagnosis:
  Clinical diagnosis
  CT is test of choice for sinus imaging
  MRI to differentiate soft tissue (eg. tumor) from mucous
• Treatment:
  Acute bacterial sinusitis (usually < 7 days) Augmentin 500 mg PO TID X 10 days (or clarithromycin, azizthromycin, Bactrim , fluoroquinolone, or second generation cephalosporin X 10 days)
  Chronic sinusitis (4-12 wks) Adjuvant therapy with intranasal corticosteroids , decongestants, and antihistamines; consider a longer course of ABx
  
• Complications:
  Meningitis
  Frontal bone osteomyelitis
  Cavernous sinus thrombosis
  Abscess formation
• Notes:
  Acute sinusitis (symptoms lasting < 1 month) MC associated with viruses, S. pneumoniae, H influenzae, and M. catarrhalis; bacetrial causes rare, characterized with symptoms lasting < 1 week
  Chronic sinusitis (symptoms lasting > 3 months) represents a chronic inflammatory process, often from an obstruction; in DM patients, mucormycosis should be considered