Acute sinusitis is inflammation of the nose and sinuses lasting less than 4 weeks, most often caused by a common cold virus. Only a small share become bacterial, so the key skill is deciding who really needs antibiotics.
Key symptoms
- Nasal congestion and thick colored discharge
- Facial pain or pressure, worse when bending forward
- Reduced sense of smell
- Postnasal drip, cough and sometimes fever or upper tooth pain
What you find on exam
- Tenderness over the cheek or forehead sinuses
- Swollen nasal lining with pus on anterior rhinoscopy
- Throat for postnasal drip
- Eyes for swelling, redness or painful movement
Tests
- Diagnosis is clinical
- Think bacterial if symptoms last 10 days or more without improving, are severe for 3 days or more, or worsen after early improvement
- No routine imaging; CT for complications or recurrent disease
- Nasal endoscopy or ENT referral for chronic or recurrent cases
Treatment basics
- Saline rinses, intranasal steroid such as fluticasone and pain relief
- Avoid using decongestant sprays for more than 3 days (rebound congestion)
- Bacterial cases: amoxicillin-clavulanate for 5 to 7 days in adults
- Doxycycline or a respiratory fluoroquinolone if penicillin allergy
Red flags
- Swelling or redness around the eye, double vision or painful eye movement
- Severe headache, confusion or stiff neck
- Forehead swelling or high fever that does not settle
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.