1. Introduction
- Definition: Sinusitis, also known as rhinosinusitis, is the inflammation of the paranasal sinuses caused by infections, allergies, or structural abnormalities, leading to symptoms like nasal congestion, facial pain, and discharge.
- Epidemiology: Affects approximately 1 in 8 adults annually, with acute sinusitis being more common than chronic sinusitis.
- Significance: While usually self-limiting, untreated or recurrent sinusitis can lead to complications like orbital cellulitis or intracranial infections.
2. Causes and Risk Factors
- Causes:
- Viral infections (most common): Rhinovirus, influenza, parainfluenza.
- Bacterial infections: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.
- Fungal infections (in immunocompromised individuals).
- Risk Factors:
- Allergic rhinitis and nasal polyps.
- Structural abnormalities (e.g., deviated nasal septum).
- Smoking and air pollution.
- Asthma or immunosuppression.
3. Pathophysiology
- Obstruction of sinus drainage pathways due to inflammation or mucosal swelling leads to mucus stasis and microbial overgrowth. This triggers a local immune response, causing further inflammation and worsening symptoms.
4. Symptoms and Features
- Acute Sinusitis (duration <4 weeks):
- Nasal congestion or obstruction.
- Purulent nasal discharge (yellow-green).
- Facial pain or pressure, especially over the affected sinus.
- Fever, fatigue, and dental pain in severe cases.
- Chronic Sinusitis (duration >12 weeks):
- Persistent nasal congestion and discharge.
- Reduced or lost sense of smell.
- Mild facial pain or pressure.
5. Complications
- Orbital Complications: Orbital cellulitis, abscess, or vision loss.
- Intracranial Complications: Meningitis, brain abscess, or cavernous sinus thrombosis.
- Other: Chronic nasal obstruction, anosmia, or recurrent infections.
6. Diagnosis
- Clinical Features: Diagnosis is usually clinical, based on symptoms persisting beyond 10 days or worsening after an initial improvement.
- Imaging:
- CT scan of the sinuses for severe or recurrent cases to assess structural abnormalities or complications.
- MRI for suspected fungal infections or intracranial involvement.
- Laboratory Tests: Nasal swabs or cultures in cases unresponsive to standard treatments.
7. Management Overview
- Goals: Relieve symptoms, eradicate infection (if present), and prevent complications.
- Approach: Conservative management for viral sinusitis, antibiotics for bacterial cases, and surgery for structural abnormalities or chronic sinusitis.
8. Treatment Options with Cost (USD)
- Over-the-Counter (OTC) Therapies:
- Nasal saline irrigation: ~$5–$20 per bottle.
- Decongestant sprays (e.g., oxymetazoline): ~$5–$15 per bottle.
- Antibiotics (if bacterial infection is suspected):
- Amoxicillin: ~$10–$20 per course.
- Amoxicillin-clavulanate: ~$20–$50 per course.
- Adjunctive Therapies:
- Intranasal corticosteroids (e.g., fluticasone): ~$20–$40 per spray bottle.
9. Advanced Treatment Options with Cost (USD)
- Endoscopic Sinus Surgery: ~$10,000–$20,000 for chronic or refractory cases.
- Fungal Sinusitis Treatment: Antifungal medications (e.g., voriconazole): ~$1,500–$2,500/month.
- Allergy Management: Immunotherapy: ~$1,000–$3,000/year.
10. Pharmacological Treatment
- First-line: Amoxicillin or amoxicillin-clavulanate for bacterial sinusitis.
- Adjunctive: Intranasal corticosteroids to reduce inflammation and improve drainage.
- Symptomatic Relief: Decongestants and saline irrigation for viral or allergic sinusitis.
11. Medication Tables
Table 1: Doses and Side Effects
Drug | Indication | Dose | Common Side Effects |
---|---|---|---|
Amoxicillin | Bacterial sinusitis | 500–875 mg every 8–12 hours | Diarrhoea, rash |
Amoxicillin-clavulanate | Resistant bacterial sinusitis | 875/125 mg every 12 hours | GI upset, yeast infections |
Fluticasone spray | Nasal inflammation | 2 sprays per nostril daily | Nasal dryness, irritation |
Oxymetazoline | Nasal congestion | 2–3 sprays per nostril twice daily (≤3 days) | Rebound congestion (prolonged use) |
Saline irrigation | Nasal symptom relief | 1–2 rinses daily | Nasal irritation |
Table 2: Brand Names and Approximate Costs (USD)
Drug | Brand Names | Approx. Cost |
---|---|---|
Amoxicillin | Amoxil | $10–$20 per course |
Amoxicillin-clavulanate | Augmentin | $20–$50 per course |
Fluticasone spray | Flonase, Veramyst | $20–$40 per bottle |
Oxymetazoline | Afrin | $5–$15 per bottle |
Saline irrigation | NeilMed Sinus Rinse | $5–$20 per bottle |
12. Lifestyle Interventions
- Drink plenty of fluids to thin mucus.
- Use a humidifier to keep nasal passages moist.
- Avoid allergens or irritants, such as smoke or strong odours.
- Practice proper nasal hygiene with saline rinses.
13. Monitoring Parameters
- Symptom resolution, including reduced pain, nasal congestion, and discharge.
- Watch for complications like persistent fever, swelling, or worsening pain.
- Assess for side effects of medications, particularly with prolonged antibiotic or decongestant use.
14. Patient Counseling Points
- Explain that most cases of sinusitis are viral and self-limiting, requiring only symptomatic care.
- Stress the importance of adhering to antibiotic courses if prescribed for bacterial sinusitis.
- Advise against prolonged use of decongestant sprays to avoid rebound congestion.
- Encourage nasal saline rinses and hydration to promote sinus drainage.
15. Special Populations
- In Children: Use weight-based antibiotic dosing and avoid decongestant sprays.
- In Pregnancy: Prefer saline irrigation and intranasal corticosteroids; avoid certain antibiotics (e.g., doxycycline).
- In Elderly: Monitor for medication side effects, especially with corticosteroids or antibiotics.
16. Prevention
- Maintain good hand hygiene to prevent infections.
- Manage allergies with appropriate treatment.
- Avoid smoking and exposure to air pollutants.
- Consider flu and pneumococcal vaccinations for high-risk populations.
17. FAQs
- What is sinusitis?
Answer: Inflammation of the sinuses, often due to infections or allergies. - What causes sinusitis?
Answer: Viral, bacterial, or fungal infections; allergies; or structural abnormalities. - How is sinusitis treated?
Answer: Symptomatic relief for viral sinusitis; antibiotics for bacterial cases. - Can sinusitis go away on its own?
Answer: Yes, most viral sinusitis resolves within 10 days without treatment. - What are the symptoms of sinusitis?
Answer: Nasal congestion, facial pain, purulent discharge, and headache. - How is bacterial sinusitis diagnosed?
Answer: Symptoms persisting >10 days or worsening after initial improvement. - Are antibiotics always needed for sinusitis?
Answer: No, they are only prescribed for confirmed bacterial infections. - What is chronic sinusitis?
Answer: Sinusitis lasting >12 weeks, often with persistent symptoms. - Can allergies cause sinusitis?
Answer: Yes, allergies can lead to inflammation and mucus buildup, causing sinusitis. - Is saline irrigation effective?
Answer: Yes, it helps clear mucus and reduce symptoms. - What are the complications of untreated sinusitis?
Answer: Orbital cellulitis, brain abscess, or meningitis. - Can children get sinusitis?
Answer: Yes, especially following colds or allergies. - What is rebound congestion?
Answer: Worsened nasal congestion from prolonged use of decongestant sprays.
- When should I see a doctor for sinusitis?
Answer: If symptoms persist >10 days, worsen after initial improvement, or include fever or swelling. - How can sinusitis be prevented?
Answer: Good hygiene, managing allergies, and avoiding irritants.