Download Acute bacterial sinusitis

Acute bacterial sinusitis
Related Topics:
 Upper respiratory tract infection URTI (adult), page 227
1.
May present with:
 As per URTI - in addition,
 Significant facial pain and / or tenderness
 Systemically unwell, fever
 Mucopurulent nasal discharge for more than 7 days [6]
2.
Immediate management: not applicable
3.
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
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Clinical assessment:
Take patient history including past episodes / treatment received / medications used
Perform standard clinical observations, note if fever present
Perform physical examination

inspect the patient’s face for any swelling around the nose and eyes

palpate the frontal sinuses (above the eyes) by gently pressing the thumbs under the bony ridge
of the upper orbit (near where eyebrows start) – does the patient feel pain?

then palpate the maxillary sinuses (on each side of the nose to cheekbones), does the patient
feel pain?

percuss these areas using the middle or index finger of one hand onto the other finger – note the
sound – dullness indicates presence of fluid
4.
Management:
 Fever with significant facial pain and persistent mucopurulent nasal discharge for more than 7 days
suggest sinusitis [6]
 Consult MO who may advise:
 antibiotics (similar to bronchitis)
 Pseudoephedrine 60 mg tds for 5 days provided normal blood pressure and not pregnant
 an oral antihistamine can be given in addition to or instead of the Pseudoephedrine and may
especially be of benefit if patient has an allergic upper or lower airways history (eg. hay fever,
asthma)
 Symptomatic treatment as per URTI
5.
Follow up:
 Review next day. Consult MO if not improving
6.
Referral / Consultation:
 Consult MO on all presentations of acute bacterial sinusitis