Sinus ailments frequently occur in middle-age individuals. Acute infection is usually located in the maxillary and frontal sinuses. Classically, infection in the maxillary sinus results from obstruction of the ostia found in the medial wall of the nose. Fever, malaise, a vague headache, and pain in the maxillary teeth are early symptoms. Reports of “fullness” in the face or exploding pressure behind the eyes often are elicited as well as increasing pain with bending over. Pressure and percussion over the malar areas can cause severe pain. Purulent exudates in the middle meatus of the nose or in the nasopharynx often are present. Five clinical findings are most useful in diagnosis: (i) maxillary toothache, (ii) poor response to nasal decongestants, (iii) abnormal transillumination, (iv) colored visible purulent nasal secretions, and (v) a history of colored nasal discharge. When four or more features are present, the likelihood of sinusitis is high, and when none is present, sinusitis is highly unlikely (2). Initial episodes of sinusitis do not require imaging studies; however, when persistent infections occur, studies and referral are indicated. Computed tomography of the sinuses demonstrated that 90% of patients with colds have radiological evidence of sinus disease that usually will resolve in 2 to 3 weeks. Radiographic changes do not reliably identify sinusitis secondary to bacteria. After sinus needle aspiration, about 60% of patients with abnormal radiographic images have positive cultures (3). Unless culture samples are obtained by direct needle drainage, they are contaminated by oropharyngeal ﬂora and are thus of no value. For this reason, therapy usually is empiric.
Systemic decongestants containing pseudoephedrine are useful in shrinking the obstructive ostia and promoting sinus drainage and ventilation. Topical decongestants should be used for no longer than 3 days because prolonged use may lead to rebound vasodilation and worsening of symptoms. Mucolytics like guaifenesin may help thin sinus secretions and promote drainage. Antihistamines should be avoided in acute sinusitis because of their drying effects, which can lead to thickened secretions and poor drainage of the sinuses. Analgesics are recommended for pain relief. Therapies to relieve symptoms include facial hot packs and analgesics. Topical nasal steroids may accelerate the recovery in patients with viral sinusitis and those with a history of chronic rhinitis or recurrent sinusitis who seek treatment of acute rhinosinusitis (4,5). Improvement should be apparent within 48 hours of treatment, but 10 days may be necessary for complete resolution of symptoms. When improvement is not rapid, resistance should be presumed, and other classes of antibiotics should be given (6). In persistent cases, referral to an otolaryngologist for sinus irrigation may be necessary (7).