From the Guidelines
Acute bacterial sinusitis typically presents with nasal congestion, purulent nasal discharge, facial pain or pressure, and decreased sense of smell lasting for 10 days or more without improvement. Other common symptoms include fever, headache, fatigue, bad breath, dental pain, and ear pressure. The diagnosis is often made when symptoms persist beyond 10 days without improvement, worsen after initial improvement (double worsening), or are severe from the onset with high fever and purulent nasal discharge for at least 3-4 consecutive days. Bacterial sinusitis develops when viral upper respiratory infections block the sinus drainage pathways, creating a favorable environment for bacterial growth. The most common bacterial pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Distinguishing bacterial from viral sinusitis is important, as antibiotics are only effective for bacterial infections. Severe symptoms, such as high fever, periorbital swelling, visual changes, severe headache, or altered mental status, may indicate complications requiring immediate medical attention.
Some key points to consider when diagnosing acute bacterial sinusitis include:
- The American Academy of Pediatrics defines acute bacterial sinusitis as a persistent illness with nasal discharge of any quality and/or daytime cough lasting for >10 days without improvement, a worsening clinical course, a severe onset of symptoms with concurrent fever (temperature ≥ 39°C), and purulent nasal discharge for at least 3 consecutive days 1.
- The diagnosis of acute bacterial sinusitis is based on clinical presentation and physical examination findings, and imaging is not recommended in this context as it does not change management 1.
- A bacterial cause is more likely when symptoms persist for more than 10 days without clinical improvement, symptoms are severe (fever >39 °C, purulent nasal discharge, or facial pain lasting for >3 consecutive days), or symptoms worsen after an initial period of improvement (double sickening) for more than 3 days 1.
- The most common bacterial pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 1.
It's essential to note that distinguishing bacterial from viral sinusitis is crucial, as antibiotics are only effective for bacterial infections. Severe symptoms may indicate complications requiring immediate medical attention.
The clinical presentation of acute bacterial sinusitis can vary, but persistent nasal discharge, facial pain, and decreased sense of smell are common symptoms. Other symptoms, such as fever, headache, and fatigue, can also be present. The diagnosis is often made based on clinical criteria, and imaging studies are not typically recommended unless complications are suspected.
In terms of management, antibiotics are only effective for bacterial infections, and distinguishing bacterial from viral sinusitis is essential. The American Academy of Pediatrics recommends antibiotic therapy for acute bacterial sinusitis in children with severe onset or worsening course 1.
Overall, acute bacterial sinusitis is a common condition that requires careful diagnosis and management. By understanding the clinical presentation, diagnosis, and management of acute bacterial sinusitis, healthcare providers can provide effective care and improve patient outcomes.
From the Research
Signs and Symptoms of Acute Bacterial Sinusitis
The signs and symptoms of acute bacterial sinusitis include:
- Nasal congestion
- Rhinorrhoea
- Facial pain
- Hyposmia
- Sneezing
- Malaise
- Fever 2, 3 Additional symptoms may include unilateral facial pain or pressure, purulent nasal discharge with obstruction of the nasal passages, and fever greater than 102°F (39°C) 4.
Diagnostic Features
Acute bacterial rhinosinusitis is characterized by:
- Unilateral facial pain or pressure
- Fever greater than 102°F (39°C)
- Purulent nasal discharge with obstruction of the nasal passages 4 A clinical diagnosis is typically made based on these symptoms, as diagnostic testing for acute rhinosinusitis with antral puncture is impractical due to its invasiveness 4.
Distinguishing Between Bacterial and Viral Sinusitis
It is challenging to distinguish between the symptoms of bacterial and viral sinusitis, but bacterial sinusitis is more likely if symptoms worsen after 5-7 days or do not improve after 10-14 days 5.
Treatment and Management
Antibiotics should be considered for patients with 3 or more days of severe symptoms, significant worsening after 3 to 5 days of symptoms, or 7 or more days of symptoms 4. Supportive care, including saline irrigation, nasal steroids or antihistamines, and decongestants, may help reduce the severity of symptoms 4.