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te sinusitis
Acute sinusitis
A cute sinusitis is an infection of th e sinus m ucosa w ith purulent d isch arg e of nasal
(rh initis, allerg ies, obstruction) or d ental orig in. It m ay d ev elop into ch ronic sinusitis,
particularly in old er ch ild ren and ad ults.
Clinical features
– F acial pain or ach e and purulent nasal d isch arg e
Older children and adults
– P eri- orbital pain in frontal sinusitis; facial pain in m axillary and / or eth m oid al
sinusitis.
– P urulent nasal d isch arg e from th e sid e w ith pain, nasal obstruction and m od erate fev er.
– O n exam ination
• pain on pressure ov er th e foreh ead , und er th e upper bord er of th e orbit or ch eek,
• purulent secretions in th e m eatus and inflam m ation of th e m ucosa.
T h e m ost com m on causes are Haemophilus influenzae in ch ild ren und er 5 years and
pneum ococci in patients ov er 5 years.
Type specific to infants and small children
– A cute eth m oid itis: h ig h fev er, inflam m ation and sw elling of th e low er eyelid s and
th e
brid g e of th e nose, purulent nasal d isch arg e.
– R isk of infection spread ing to th e neig h bouring bony structures, orbits and th e
m ening es.
T h e m ost com m on causes are Haemophilus influenzae, pneum ococci and staph ylococci.
Treatment
– N asal irrig ation w ith 0 .9 % sod ium ch lorid e or R ing er L actate 4 to 6 tim es/ d ay to
clear th e airw ay.
– P ain and fev er: g iv e paracetam ol P O (see pag e 2 6 ).
– AamnotxiibciiolltinicPtreOatm: 8 0enmt, dgep/ekngd/indgayoninth2 eosr e3v derivityidoef dinfdeoctsioens:for 7 to 1 0 d ays
FeryotrhrpoamtiyecnintsPalOlerg: 3ic0totope5n0icimllin:g / kg / d ay in 2 to 3 d iv id ed d oses for 7 to 1 0 d ays
– F or sinusitis second ary to d ental infection: d ental extraction w h ile und er antibiotic
treatm ent.
– IcnefitnrfiaaxnotsnewIMith: 1e0th0 mm ogid/itkisg, s/ tdroanygina2ntiibnijoetcictiotrnesatfmor 1en0t disanyescessary:
oamr,pfiaciillilning I tVh a: t2, 0 0 m g / kg / d ay in 3 or 4 injections until im prov em ent is seen, th en
ch ang e to oral treatm ent w ith amoxicillin P O : 1 0 0 m g / kg / d ay in 2 or 3 d iv id ed
d oses
to com plete 1 0 d ays of treatm ent
50
Acute sinusitis
A cute sinusitis is an infection of th e sinus m ucosa w ith purulent d isch arg e of nasal
(rh initis, allerg ies, obstruction) or d ental orig in. It m ay d ev elop into ch ronic sinusitis,
particularly in old er ch ild ren and ad ults.
Clinical features
– F acial pain or ach e and purulent nasal d isch arg e
Older children and adults
– P eri- orbital pain in frontal sinusitis; facial pain in m axillary and / or eth m oid al
sinusitis.
– P urulent nasal d isch arg e from th e sid e w ith pain, nasal obstruction and m od erate fev er.
– O n exam ination
• pain on pressure ov er th e foreh ead , und er th e upper bord er of th e orbit or ch eek,
• purulent secretions in th e m eatus and inflam m ation of th e m ucosa.
T h e m ost com m on causes are Haemophilus influenzae in ch ild ren und er 5 years and
pneum ococci in patients ov er 5 years.
Type specific to infants and small children
– A cute eth m oid itis: h ig h fev er, inflam m ation and sw elling of th e low er eyelid s and
th e
brid g e of th e nose, purulent nasal d isch arg e.
– R isk of infection spread ing to th e neig h bouring bony structures, orbits and th e
m ening es.
T h e m ost com m on causes are Haemophilus influenzae, pneum ococci and staph ylococci.
Treatment
– N asal irrig ation w ith 0 .9 % sod ium ch lorid e or R ing er L actate 4 to 6 tim es/ d ay to
clear th e airw ay.
– P ain and fev er: g iv e paracetam ol P O (see pag e 2 6 ).
– AamnotxiibciiolltinicPtreOatm: 8 0enmt, dgep/ekngd/indgayoninth2 eosr e3v derivityidoef dinfdeoctsioens:for 7 to 1 0 d ays
FeryotrhrpoamtiyecnintsPalOlerg: 3ic0totope5n0icimllin:g / kg / d ay in 2 to 3 d iv id ed d oses for 7 to 1 0 d ays
– F or sinusitis second ary to d ental infection: d ental extraction w h ile und er antibiotic
treatm ent.
– IcnefitnrfiaaxnotsnewIMith: 1e0th0 mm ogid/itkisg, s/ tdroanygina2ntiibnijoetcictiotrnesatfmor 1en0t disanyescessary:
oamr,pfiaciillilning I tVh a: t2, 0 0 m g / kg / d ay in 3 or 4 injections until im prov em ent is seen, th en
ch ang e to oral treatm ent w ith amoxicillin P O : 1 0 0 m g / kg / d ay in 2 or 3 d iv id ed
d oses
to com plete 1 0 d ays of treatm ent
50
