[Infectious sinusitis and otitis]

Insight into the pathogenesis and knowledge of the microbial flora provide the basis for the treatment of sinus and ear infections. Reduced oxygen tension and impaired mucociliary transport are important factors that influence the pathogenesis of both acute and chronic sinusitis and otitis. Therefore, topical decongestion and antibiotic regimens belong to the main therapeutic principles. The choice of an antibiotic for treatment of acute infections is usually empiric; however, in chronic and recurrent infections identification of the microbiology by fluid aspiration from the sinus or middle ear is desirable before long-term antibiotic therapy is initiated. It is also important to recognize underlying predisposing conditions such as nasal polyps, anatomic deformities or tooth abscesses which should be corrected to prevent further recurrences. External otitis is a painful condition seen most frequently in the swimming season (swimmer's ear) and is often associated with the use of cotton swabs. Repeated removal of debris from of the external canal and ototopical antibiotics are mostly successful; however, in severe cases like in necrotizing external otitis antibiotic therapy is indicated.