Introduction
- Infection of the paranasal sinus due to undrained collection of pus
- maxillary sinuses most commonly involved in adults
- ethmoid sinuses most commonly involved in children
- Etiologies
- acute viral respiratory tract infection
- smoking
- septal deviation
- diabetes
- ketoacidosis be associated with mucormycosis infection
- Common pathogens
- Viruses
- S. pneumonia
- Haemophilus influenzae
- Moraxella cattarrhalis
- anaerobes (e.g bacteroides)
- fungi (aspergillus, mucormycosis)
Presentation
- Symptoms
- fever
- facial pain (over infected sinus)
- headache
- purulent rhinorrhea
- Physical exam
- facial tenderness with palpation
Evaluation
- CT
- most sensitive test
Treatment
- Medical
- decongestants
- analgesics
- saline irrigation
- avoid antibiotics early in symptom course unless high risk patient
- most infections are viral in origin
- consider after 10 days of symptoms
- empiric antibiotic should cover most common organisms (listed above)
- little data supporting use of systemic corticosteroids
Prognosis, Prevention, and Complications
- Most resolve with supportive treatments
- Extra-sinus complications
- orbital abscess, meningitis, epidural abscess, brain abscess
- Can be fatal in diabetic or immunocompromised patients