Sinusitis
Refers to inflammation of paranasal sinuses. Maxillary is most commonly affected. Acute sinusitis is the spectrum of symptoms lasting less than one month. Most commonly associated with viruses, S pneumonia, H influenza. Bacterial causes are rare and is characterised by purulent nasal discharge and facial tenderness. Chronic sinusitis is when symptoms persist for more than three months and is often caused by obstruction of sinus drainage as shown in picture and on going low grade anaerobic infection. Beware of invasive and life threatening fungal sinusitis caused by Mucor and Rhizopus in patients with poorly controlled diabetes, immune compromise or neutropenia. Potential complications of sinusitis include meningitis, frontal bone osteomyelitis, cavernous sinus thrombosis and abscess formation. It is diagnosed clinically. Transillumination shows opacification of sinuses(low sensitivity). CT is the test of choice but is preferred if symptoms remain after proper treatment. In most cases acute sinusitis is viral or self limited and is treated with symptomatic relief. In cases of acute bacterial sinusitis consider clarithromycin, azithromycin, trimethoprim-sulphamethoxazole (TMP-SMX) a fluoroquinolone, or a second generation cephalosporin for 10 days. In caes of chronic sinusitis adjuvant therapy with intranasal corticosteroids, decongestants and antihistamines may be useful to combat allergic components of disease. Surgical intervention may be required in extreme cases.