These patients require consultation and admission for intravenous antibiotics. Do not ignore the toxic patient with marked swelling, high fever, severe pain, profuse drainage, or other signs and symptoms of a serious infection. See potential complications below. These patients require immediate consultation and intervention. Do not prescribe antihistamines, which can make mucous secretions dry and thick, and interfere with necessary drainage.
Antihistamines only cure sinusitis on television, or when it is due to allergic rhinitis.
Do not allow patients to use decongestant nose drops more than 3 days, thereby allowing their nasal mucosa to become habituated to sympathomimetic medication. Do not prescribe topical or systemic sympathomimetic decongestants to a patient who suffers from hypertension, tachycardia or difficulty initiating urination, all of which may be exacerbated. The paranasal sinuses drain through tiny ostia under the nasal turbinates which, if occluded, allow secretions and pressure differences to build up, resulting in pressure and pain of acute sinusitis, and the air-fluid levels sometimes visible on upright x rays. Sinus infections are relatively common and complications relatively rare, but the bony walls of the paranasal sinuses are so thin that bacterial infections can spread through them. Most sinusitis begins with mucosal swelling from a viral upper respiratory infection.