Fever is uncommon, unless a nes infectious process develops. Headache and malaise are infrequent problems. Antibiotics are necessary to treat subacute sinusitis, and chronic sinusitis can result if resolution does not occur. Antibiotic options should include treatment with an agen appropriate for partially penicillin-resistant pneumococcus and for H. influenzae. Treatment should continue for a minimum of 14 days, and clinical reevaluation is necessary.
Supportive therapy can include oral or topical decongestants and sline nasal lavage.
When bacterial sinusitis exists for 6 weeks or longer, the resultant inflammation of the sinus mucosa and ostiomeatal complex provides limited chance of a spontaneous resolution. The symptoms consists of a chronic cough, nasal congestion, and sometimes headache. In younger children, it is likely that one or more new respiratory infections have occurred, causing considerably confusion in the clinical picture. Because of the chronic nasal congestion, mouth breathing is the rule, with additional symptoms of snoring, sore throats, and in some situations, reactive adenoidal hypertrophy. This situation can persist for months if not recognized and treated properly.