Sinusitis (overview)

Your Path

  • Sinusitis (overview)

Etiology

  • Viral: adeno, rhino, influenza, para-influenza, other
  • Bacterial: strep, h flu, moraxella, other
  • Fungal: mucor or aspergillous; overall uncommon
  • Allergic: response to allergen

Risk Factors

  • For fungal: Diabetic (in particular if poorly controlled), elderly and/or otherwise compromised hosts (e.g. chemotherapy, immune-modulating treatments)

Symptoms

  • Viral: acute onset; sometimes fever; cough, facial fullness/pain, colored d/c; typicallyself limited, resolving by 7-10d
  • Bacterial: acute, cough, persistent and progressive; colored d/c; sometimes fever; tooth or facial pain; lasting > 10d, or sx that improve initially and then worsen
  • Fungal: persistent and progressive facial pain; sometimes fever; congestion; numbness, local neurological signs (e.g. if cavernous sinus involvement/thrombosis); high mortality as these organisms are rapidly invasive and hosts typically compromised
  • Allergic: chronic nasal congestion, d/c, post nasal drip; chronic need to clear throat, cough

Physical Exam Findings

  • Nasal mucosa red, edematous, covered with d/c; pain upon percussion of sinuses
  • Post nasal drip evident on pharynx
  • Impaired transillumination of maxillary sinus (if affected)
  • Sometimes tooth pain (if tap on them and seated in the sinus)
  • Invasive Fungal or Bacterial: May be quite ill; sinus area pain; Sometimes evidence palatal or external necrosis over sinus; Neurological symptoms and findings are very worrisome and can include: Facial numbness, dilated pupil, impaired extra-occular movements, red eye--> involvement cavernous sinus
  • Allergic: chronic nasal mucosal edema, d/c; evidence post nasal drip, pharyngeal cobble stoning

Tests

Links