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SINISITUS - Coggle Diagram

- - - - If hospital admission is not required, offer an immediate antibiotic prescription (see the section on Antibiotic choice) or further appropriate investigation and management in line with the NICE guideline
      - If a person has had symptoms for 10 days or less:
        
        Do not offer an antibiotic prescription.
        
        Advise that:
        
        Acute sinusitis is usually caused by a virus and is only complicated by bacterial infection in about 2 in 100 cases. It takes 2–3 weeks to resolve, and most people will get better without antibiotics.
        
        Symptoms, including fever, can be managed with self-care measures such as paracetamol or ibuprofen for pain or fever. Some people may want to consider a trial of nasal saline or nasal decongestants (although evidence is lacking to support their use). The NHS information on Sinusitis (sinus infection) contains instructions on cleaning the nose with a salt water solution to ease congestion.
- - - - Aspirin sensitivity — there is an association between aspirin sensitivity and chronic sinusitis with nasal polyps.
      - Immunocompromise — dysfunction of the immune system can be associated with chronic sinusitis.
      - Genetic factors — chronic sinusitis without nasal polyps can run in families although no genetic abnormality linked to chronic sinusitis has been identified.
      - Cigarette smoking — chronic sinusitis is more common in people who smoke.
      - Iatrogenic factors — sinus surgery can result in an increased risk of persistent sinus infection.
- - - - Extra-sinus symptoms — such as sleep problems, fatigue, and depression.
      - Impact on employment — for example absenteeism, reduced effectiveness and productivity.
      - Reduction in social functioning.
      - High healthcare usage.
- - - - Suspect acute bacterial sinusitis when several of the following features are present:
      - Symptoms for more than 10 days
      - Discoloured or purulent nasal discharge (with unilateral predominance).
      - Severe local pain (with unilateral predominance).
      - A fever greater than 38°C.
      - A marked deterioration after an initial milder form of the illness (so-called 'double-sickening').
      - Elevated ESR/CRP (although the practicality of this criterion is limited).
      - Do not routinely request laboratory investigations or radiographic imaging for people who meet diagnostic criteria for acute uncomplicated sinusitis.
        If signs and symptoms are not typical of sinusitis and the diagnosis is in doubt, refer to an ear, nose and throat specialist to rule out an alternative diagnosis. Urgent referral for further investigation is required if symptoms suggest neoplasm (for example, unilateral polyp or mass, bloody nasal discharge).
- - - - In children:
        Diagnose acute sinusitis by the presence of nasal blockage (obstruction/congestion) or discoloured nasal discharge (anterior/posterior nasal drip) with facial pain/pressure and/or cough (daytime and night-time).
    - - Other features suggestive (but not diagnostic) of acute sinusitis include:
      - Altered speech indicating nasal obstruction.
      - Tenderness, swelling, or redness over the cheekbone or periorbital areas.
      - Cough.
- - - - Adenoiditis and tonsillitis (particularly in children) — adenoiditis can be difficult to differentiate from sinusitis in children as symptoms are similar.
      - Sinonasal tumour — suspect particularly if there are persistent unilateral symptoms, such as nasal obstruction, nasal discharge or nosebleeds, crusting, or facial swelling.
      - Turbinate hypertrophy — nasal obstruction is the predominant symptom.
      - Other causes of facial pain or headache (for more information, see the CKS topic on Headache - assessment) include:
        
        Migraine — for more information, see the CKS topic on Migraine.
        
        Giant cell arteritis (temporal arteritis) — for more information, see the CKS topic on Giant cell arteritis.
        
        Temporomandibular joint dysfunction. For more information, see the CKS topic on Temporomandibular disorders (TMDs).
        
        Neuropathic or atypical facial pain. For more information, see the CKS topic on Trigeminal neuralgia.