Sinusitis

Aetiology

• Infection
• Allergy
• Chronic congestion

Data gathering

• History
  • Fevers
  • Purulent unilateral nasal discharge
  • Facial fullness
  • Facial pain
  • Nausea, vomiting
  • Myalgia
  • Watering eyes
  • Smell disturbance
  • Previous treatments
• Examine
  • Temp | HR
  • Nose – anterior rhinoscopy (using otoscope)
    • nasal polyps, mucosal swelling, septal changes

Clinical management

• Treatment
  • Mild
    • paracetamol, saline nasal irrigation, warm face pads, fluids, rest
  • Moderate
    • intranasal steroids for up to 3 months
  • Severe (discoloured discharge, severe local pain, fever, worse after initial recovery)
    • Intranasal steroids
    • Antibiotics
  • Chronic
    • Nasal saline
    • Intranasal steroids (consider PO prednisolone 30mg for 7 days if polyps present)
• Follow-up / Safety-net

Intranasal steroids

• 1st line
  • Beclometasone dipropionate 50mcg nasal spray
    • 2 sprays each nostril BD
• 2nd line
  • Mometasone furoate 50mcg nasal spray
    • 2 sprays each nostril OD
• 3rd line
  • Fluticasone furoate (Avamys)
    • 2 sprays each nostril OD
• NB: important to emphasise technique and duration of treatment