Sinusitis: Diagnosis and Treatment

, Clinical Instructor in Medicine, Kansas University Medical Center, Kansas City, Kan.


Medscape General Medicine. 1997;1(2) 

In This Article

Abstract and Introduction


Current estimates are that 35 million Americans each year experience at least one episode of sinusitis. Acute sinusitis may present as an apparent viral upper respiratory infection that persists longer than expected, or unilateral or bilateral tenderness under the eyes, fever, and dull headache. Physical examination may reveal intranasal mucopus, or purulent postnasal mucus in the pharynx. Chronic sinusitis commonly presents with more subtle symptoms, such as nasal congestion with morning sore throat and without fever. Symptoms may be limited to intermittent hoarseness, sore throat and expectoration of mucus. Factors which may predispose to sinusitis include allergic rhinitis, upper respiratory infections, septal deviation, tooth extractions, nasal polyps, swimming and smoking. Physical examination should involve assessment of mucosal pallor or inflammation and presence and character of secretions. Many patients will have nasal exams that are within normal limits. Demonstration on radiograph of mucosal thickening >6mm (>3mm in children) or of complete opacification of a maxillary sinus indicates sinusitis. Rhinoscopy, computed tomography, and nasal smears are also helpful. Cultures are difficult to obtain and are unreliable without sinus puncture. Acute sinusitis is usually managed with a 10-day course of an appropriate antibiotic chosen empirically. Streptococcus pneumoniae and Haemophilus influenzae are common pathogens. Patients with chronic disease require at least a 21-day course of an antibiotic different from any used previously to treat sinusitis. Surgery for sinus disease is useful for those who fail medical management and continue to have radiographic and symptomatic evidence of sinusitis.


Current estimates are that 35 million Americans each year experience at least one episode of sinusitis, making it one of the most commonly encountered clinical disorders. Since the "classic" medical school presentation of sinusitis may be the least common, its incidence is probably underestimated. Patients with sinusitis perceive themselves to have worse health than do angina sufferers.[1] Failure to understand and identify predisposing causes often leads to chronic disease with persistent symptoms and poor quality of life for the sinusitis victim.