Acute sinusitis is the inflammation of the membranes that line your nose and surrounding sinuses. Nasal sinuses are cavities containing air within the nasal/facial bones or other tissue. Acute sinusitis occurs with sudden onset and resolves within 4 weeks.

It is common disease with worldwide prevalence. About 0.5% of all upper respiratory tract infections are complicated by sinusitis, which is commonly found in adults (children do not have fully developed sinuses). Sinusitis is one of the most common diagnoses in primary care.

 

Causes of acute sinusitis

  • Infection; Acute sinusitis is usually preceded by upper respiratory tract infection which is commonly caused by viral infection such as rhinoviruses, coronaviruses, and influenza viruses. It can also be caused by bacterial infection such as; Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis or fungal infections (this occurs more in diabetic patients and patients with low immunity). There is subsequent bacterial sinusitis in about 0.5% to 2% of patients with viral sinusitis. It is thought that nasal irritation from nose blowing leads to the secondary bacterial infection.
  • Chemicals; acute sinusitis can result due to cigarette smoke and chlorine fumes.
  • Allergic reaction

 

Signs and symptoms

These are determined by the location of the affected sinus. The nasal sinuses are divided into;

  1. Maxillary sinus; located in the cheek area
  2. Ethmoidal sinus; located between the eyes.
  3. Frontal sinus; located in the forehead region.
  4. Sphenoidal sinus; located behind the eyes.

The general signs and symptoms  of acute sinusitis include;

  • Headache; it is typically worse around the affected sinus area. It is typically more prominent when the person tries to bend down.
  • Previous common cold
  • Facial pain
  • Fever
  • Post nasal drip; excessive mucous which irritates the throat
  • Sore throat
  • Tooth pain; due to pressure on surrounding nerves
  • Nasal congestion
  • Pain on chewing
  • Unilateral purulent nasal discharge (usually seen in bacterial sinusitis)
  • Halitosis; foul smell from the mouth

Diagnosis

Diagnosis is usually clinical. It can however be very difficult to diagnose. Cultures from the nose or the pharynx are usually not required. Sinus x-ray examinations have limited sensitivity. A needle aspiration (needle puncture) of the sinus might be done to get infected material to culture to determine what microbe is actually causing the sinus infection.

 

Complications of acute sinusitis that may develop are; meningitis, brain abscess, osteomyelitis, and orbital cellulitis. It can also become sub-acute (1-3 months) and chronic (>3months).

 

Treatment

Acute sinusitis caused by a virus is usually self-limiting. Recommended treatment to improve symptoms includes;

Rest

Drink enough water to thin the mucus

Steam inhalation

Use of nasal decongestants can also help to improve the symptoms. However, prolonged use of nasal decongestants beyond recommended time should be avoided.

There is no need for antibiotics use if it’s of viral origin but if there is purulent nasal discharge or the infection lasts for more than 7-10 days the patient can be given antibiotics.