Remember that the majority of cases of acute sinusitis occurring in healthy individuals usually follow viral upper respiratory tract infections. With mucosal swelling and altered ciliary function, mucous effusions collect in the sinuses and become secondarily infected. Primary pathogens include Streptococcus pneumoniae, H. Influenzae, Staph, M. Catarrhalis, and anaerobes. Selection of a Beta-lactamase resistant antibiotic increases the coverage for these organisms. Adjunctive medical treatment modalities include humidification of inspired air, saline nose spray, saline nasal douches, topical and oral decongestants, and in the case of allergic individuals, antihistamines and nasal steroid sprays.
Resolution is the rule rather than the exception.
In a patient with recurrent or refractory sinusitis it is important to rule out polyps, a dental abscess, allergy, or septal deviation and turbinate hypertrophy. Refer to an otolaryngologist for definitive treatment. Referral to an otolaryngologist is recommended in this case. Symptomatic frontal or sphenoid sinusitis persisting beyond 48-hours from initiation of oral antibiotic therapy represents a challenge. Because of the propensity for intracranial spread and complications, aggressive therapy is mandatory.