Treatment for acute rhinosinusitis

Is, of course, usually nothing because viral blah blah. However – if a patient has worsening symptoms after 5 days or persistent symptoms after ten days, then it’s worth giving them nasal steroids (if they’re systemically well) or 5 – 7 days antibiotics (if they’re unwell/have a temp >38 deg).

By the way, the symptom associated with nasal blockage/discharge may be disturbance of sense of smell rather than facial pain, and that combination of symptoms is still sufficient to diagnose rhinosinusitis.

In rare cases sinusitis can lead to severe complications by spreading to the meninges, face, or orbit. Signs requiring urgent same-day ENT review include:

  • Frontal swelling
  • Displacement of the eyeball
  • Ophthalmoplegia or diplopia
  • Reduced visual acuity
  • Focal neurological signs
  • Periorbital cellulitis or oedema
  • Meningism

(BMJ 2013;346:f2687)

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in BMJ, Credits 2013, ENT. Bookmark the permalink.

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