Sinusitis (Acute)

Avoid this diagnosis as much as possible, since it’s so easy to Rx antibiotics “just in case.”  But consider it if:

  • Normal URI had begun to resolve, then suddenly got worse (this is the main finding).
  • Fever PLUS unilateral purulent nasal discharge PLUS ipsilateral facial discomfort / sinus tenderness / maxillary tooth tenderness to percussion (with a tongue blade)
  • CNS signs or symptoms go straight to ER
  • Unilateral purulent discharge (visible to examiner) PLUS focal facial discomfort — soft call, but useful if Sx lasting 10 days without improvement
  • Have lower threshold for Dx if pt is immunocompromised

See Infectious Disease Society of America Guidelines for Dx & Tx of bacterial sinusitis.

See postings Nasal Congestion, also Infectious Disease – 2 re: Bugs & Drugs.