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Acute Sinusitis: A Nebulous Diagnosis with Fuzzy Treatment Principles

Acute sinusitis is a common medical problem, but unfortunately, the diagnosis is applied quite liberally by patients and physicians. Treatment decisions are often guided (or misguided) by incorrect assumptions about the etiology of the disease, shaky diagnostic criteria, and dubious benefits to antimicrobial therapy. Even when the diagnosis is carefully restricted to patients who are the most likely to have an acute bacterial illness, there are conflicting study data and disagreement among experts on the value of antibiotics.

In this regard, sinusitis resembles acute exacerbations of chronic bronchitis; there are no objective or easily applied diagnostic criteria. Many patients get…

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  Sinusitis Mimics: ED-relevant pearls and pitfalls

Clinically, the feature of sinusitis that most commonly presents as other conditions is facial pain and/or headache. This is due to the shared innervation of the various sinuses and other facial structures that create a varied presentation. Other symptoms such as fever, nasal drainage, anosmia, and cough also are nonspecific.

 Re-Thinking Acute Sinusitis Treatment in Adults: What Works and What Doesn’t

The usage of antibiotics is widespread and generally should be discouraged due to potential allergic reactions, antibiotic resistance, and unnecessary cost. Much safer therapies, such as nasal saline irrigation and intranasal corticosteroids, should be utilized since they show promise and have very low likelihood of harm. There is little evidence to support antihistamines, but oral and topical decongestants can be considered and used with caution in select patients to help with symptom relief. Oral corticosteroids are not typically used and are of limited benefit. The sensitivity and specificity of current diagnostic imaging is insufficient. Radiographic imaging is not recommended for distinguishing between ABRS and VRS, unless a complication or alternative diagnosis is suspected. Sinus puncture and culture are the gold standard for microbial identification, but routine use is not recommended.

Articles of Interest

An Uncommon Presentation of the Common Sinusitis

The ideal treatment for sinusitis depends on the etiology for the inflammation. In most cases, the etiology of the inflammation is secondary to the common cold from a viral infection. If this is the case, the sinusitis usually tends to cease on its own after about 10 days

Antibiotics in Acute sinusitis

When one considers that treating 18 patients will result in one patient cured of symptoms of sinusitis, while providing at least 2 patients with significant side effects (diarrhea, nausea, vomiting, abdominal pain, rash, etc.), the decision to withhold antibiotics becomes more appealing.

Are Antibiotics Effective in the Treatment of Acute Maxillary Sinusitis?

Moderate evidence suggests that antibiotics provide a small clinical benefit for the treatment of acute maxillary sinusitis, defined as a maxillary sinus infection with an onset of fewer than 4 weeks. However, approximately 80% of patients improve within 2 weeks without any antibiotic treatment.

Sinusitis in Peds

The ART of medicine is much more difficult to learn than the science of medicine; however, it is through becoming comfortable with the “grey areas” that we often experience our greatest ability to help others. It is also what prevents robots from taking our jobs.

Sinusitis: appropriate diagnosis and management

There is little evidence that antibiotics help with ABRS. In severe cases, they may be used ...

“I'm Calling It Sinusitis. Here's Your Antibiotic!”

Doctors who lavish antibiotics on patients with upper respiratory infections were far more likely to diagnose “sinusitis” than were others. Almost all upper respiratory tract infections are viral. The one exception to this generalization is sinusitis, which sometimes does have a bacterial component and, in severe cases, can benefit from empirical antibiotics.

Resources

Core EM

Bottom Line: Given the risk for adverse events associated with antibiotic use, the growing specter of resistance and the lack of significant differences in outcomes with antibiotic use, it is better to avoid antibiotics in most patients with ARS. Antibiotics should be considered in those with severe disease and in immunocompromised patients

International Emergency Medicine Education Project

Sinusitis is one of the most common infections treated by emergency physicians and affects about 1 in 8 adults in the north America. It is the fifth most common diagnosis for which antibiotics are prescribed.

Infectious Disease Advisor

Beware: there are other diseases that can mimic sinusitis...

MedBullets

Acute sinusitis supportive therapy for 7 days analgesia (tylenol), nasal saline irrigation, decongestants, adequate hydration no antibiotics unless no clinical improvement during observation period or temperature >38.3 C antibiotic for 10-14 days amoxicillin-clavulanate is first line.

StatPearls

Most cases of uncomplicated acute bacterial sinusitis can be treated as an outpatient with a good prognosis. Frontal or sphenoid sinusitis with air-fluid levels may require hospitalization with intravenous (IV) antibiotics.