Humidification and saline douching are helpful. Antibiotics are indicated in purulent sinusitis but guidelines are controversial- 2 nd line drugs may be required if response is poor. Systemic steroid is used in severe cases. Antral washouts are rarely done now. After a trial of adequate medical treatment CT scans may be requested to assess suitability for surgery.
Mucosa is preserved wherever possible.
Paediatric considerations Nasal obstruction Unilateral choanal atresia may present in older children with unilateral obstruction and discharge. Adenoidal hypertrophy presents in younger children and may be associated with tonsillar hypertrophy. Sinusitis Chronic and recurrent acute bacterial sinusitis are commoner in children and often do not present with pain or systemic upset.