Acute sinusitis

Acute sinusitis is one of the most commonly observed entities in clinical practice. Despite the frequency of the disease, diagnosis and therapy often remain empiric. Most cases are secondary to sinus ostia obstruction associated with the common cold or allergies. Maxillary sinusitis is most common. Because of the proximity of vital anatomic structures and venous drainage systems, serious complications frequently arise from sphenoid, frontal, and ethmoid sinusitis. Clinical signs and symptoms most helpful in the diagnosis of maxillary sinusitis are the presence of a maxillary toothache, lack of improvement with decongestants, a purulent nasal discharge, cough, purulent secretions observed on nasal examination, abnormal transillumination, and sinus tenderness. Plain film radiographs are helpful, but do not adequately visualize the anterior ethmoid sinuses. Computed tomography provides superior visualization, but cost remains prohibitive for routine cases. Most maxillary sinusitis in adults is secondary to Streptococcus pneumoniae or Hemophilus influenzae. Moroxella catarrhalis is common in children. Staphylococcus aureus is observed more frequently in frontal or sphenoid disease. Most patients with acute sinusitis are treated without microbiological diagnosis and respond well to commonly used oral antimicrobials with activity against the usual pathogens. Complications of sinusitis include meningitis, periorbital infections, subdural empyema, epidural abscess, brains abscess, cavernous sinus thrombosis, and osteomyelitis.