Diagnosis and Management of Sinus Infection

Clinical Presentation

The American College of Allergy, Asthma, and Immunology recommends that nasal congestion, purulent rhinorrhea, facial/dental pain, post-nasal drainage, headache, and cough are the prominent symptoms of acute sinusitis 1
The Infectious Diseases Society of America notes that in adults, post-nasal purulent discharge and facial pain over the affected sinus that worsens with movement or percussion are cardinal symptoms, with fever occurring in less than 50% of cases 2
Children most commonly present with cough (80%) and nasal discharge (75%), with malodorous breath noted in approximately 50% of preschoolers 2

The American College of Allergy, Asthma, and Immunology recommends that computed tomography (CT) is the imaging technique of choice as it can demonstrate abnormalities in both the ostiomeatal complex and sinus cavities 1
Laboratory evaluation may include nasal cytology, nasal-sinus biopsy, or tests for immunodeficiency, cystic fibrosis, or ciliary dysfunction 1

The Infectious Diseases Society of America notes that Streptococcus pneumoniae and Haemophilus influenzae are responsible for >50% of acute sinusitis cases in adults 2
In children, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis account for two-thirds of cases 2

The American College of Allergy, Asthma, and Immunology recommends that antibiotics are the primary therapy for acute bacterial sinusitis, with a 10-14 day course generally adequate for acute disease 1
The American Academy of Otolaryngology recommends that amoxicillin or amoxicillin-clavulanate is recommended as initial therapy, although this citation is from Praxis Medical Insights, an alternative source is preferred 4
If no improvement occurs in 3-5 days, an alternative antibiotic should be considered 1

The American College of Allergy, Asthma, and Immunology recommends that when there is a need to clarify the allergic or immunologic basis for sinusitis, referral to a specialist is necessary 1
Potential complications include intraorbital and intracranial sepsis, which may be life-threatening 5
Diseases associated with sinusitis include otitis media and bronchial asthma 1