Diagnosis
Classification
Sinusitis (or rhinosinusitis) is defined as an inflammation of the mucous membrane that lines the paranasal sinuses and is classified chronologically into several categories:
Acute sinusitis – A new infection that may last up to four weeks and can be subdivided symptomatically into severe and nonsevere. Some use definitions up to 12 weeks. Recurrent acute sinusitis – Four or more full episodes of acute sinusitis that occur within one year
Subacute sinusitis – An infection that lasts between four and 12 weeks, and represents a transition between acute and chronic infection. Chronic sinusitis – When the signs and symptoms last for more than 12 weeks. Acute exacerbation of chronic sinusitis – When the signs and symptoms of chronic sinusitis exacerbate, but return to baseline after treatment.Roughly 90% of adults have had sinusitis at some point in their lives. Acute
Health care providers distinguish bacterial and viral sinusitis by watchful waiting. If a person has had sinusitis for fewer than 10 days without the symptoms becoming worse, then the infection is presumed to be viral. When symptoms last more than 10 days or get worse in that time, then the infection is considered bacterial sinusitis. Pain in the teeth and bad breath are also more indicative of bacterial disease.Imaging by either X-ray, CT or MRI is generally not recommended unless complications develop. Pain caused by sinusitis is sometimes confused for pain caused by pulpitis (toothache) of the maxillary teeth, and vice versa.
The FDA recommends against the use of fluoroquinolones when other options are available due to higher risks of serious side effects.A short-course (3–7 days) of antibiotics seems to be just as effective as the typical longer-course (10–14 days) of antibiotics for those with clinically diagnosed acute bacterial sinusitis without any other severe disease or complicating factors. The IDSA guideline suggest five to seven days of antibiotics is long enough to treat a bacterial infection without encouraging resistance. The guidelines still recommend children receive antibiotic treatment for ten days to two weeks. Corticosteroids
For unconfirmed acute sinusitis, nasal sprays using corticosteroids have not been found to be better than a placebo either alone or in combination with antibiotics. For cases confirmed by radiology or nasal endoscopy, treatment with intranasal corticosteroids alone or in combination with antibiotics is supported. The benefit, however, is small.For confirmed chronic rhinosinusitis, there is limited evidence that intranasal steroids improve symptoms and insufficient evidence that one type of steroid is more effective.There is only limited evidence to support short treatment with corticosteroids by mouth for chronic rhinosinusitis with nasal polyps. There is limited evidence to support corticosteroids by mouth in combination with antibiotics for acute sinusitis; it has only short-term effect improving the symptoms. Surgery
For sinusitis of dental origin, treatment focuses on removing the infection and preventing reinfection, by removal of the microorganisms, their byproducts, and pulpal debris from the infected root canal.