Daily Bolus of LR: Sinusitis- Disease and Diagnosis

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July 20, 2011 by dailybolusoflr

Sinusitis- Disease and Diagnosis


·         Sinusitis is an inflammatory disease of the paranasal sinuses which results from infectious, allergic or auto-immune processes

·         The typical reason for the development of sinusitis is blockage of the ostiomeatal complex which is present within the middle meatus.  The frontal, anterior ethmoid and maxillary sinuses empty into the ostiomeatal complex.  Most acute sinus infections take place after a viral URI and result from inflammation blocking the ostiomeatal complex and leading to a good environment for the proliferation of bacteria.

·         The most common sinus affected is the maxillary sinus, followed by the ethmoid, frontal and sphenoid

·         A minority of sinus infections are related to local spread of dental infections (5-10%)

·         A position paper CDC, the American Academy of Family Physicians, the American Society of Internal Medicine, and the Infectious Diseases Society of America concluded that four signs and symptoms are the most helpful in predicting acute bacterial sinus infection (Note this has not been validated as a prediction rule):

o   purulent nasal discharge

o   maxillary tooth or facial pain (especially unilateral)

o   unilateral maxillary sinus tenderness

o   worsening symptoms after initial improvement


·         The following is a prediction rule in the literature:

o   The Canadian Sinusitis Symposium guideline recommend the Williams criteria

·         Rules in when at least four findings are positive

·         Rules out when there are less than two are positive

·         Sinus radiography is recommended when two or three findings are positive

·         The criteria are:

o   maxillary toothache

o   purulent nasal secretion

o   poor response to decongestants

o   abnormal transillumination

o   history of colored nasal discharge


Ref: http://www.aafp.org/afp/2004/1101/p1685.html#afp20041101p1685-t5

Harwood Nuss

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