From the Guidelines
To assess for a sinus infection, look for key symptoms including facial pain or pressure, nasal congestion, thick yellow or green nasal discharge, reduced sense of smell, and headache that worsens when bending forward, as these are the most common indicators of sinusitis, according to the most recent and highest quality study 1.
Diagnostic Criteria
The diagnostic criteria for assessing sinusitis include:
- Symptoms suggestive of acute sinusitis, such as nasal congestion, purulent rhinorrhea, postnasal drainage, facial or dental pain, headache, and cough, frequently with a more severe nocturnal component 1
- A history of persistent purulent rhinorrhea, postnasal drainage, and facial pain, which correlates with increased likelihood of bacterial disease 1
- Physical examination findings, such as tenderness over the sinuses, nasal discharge, and possibly using nasal endoscopy 1
Imaging Studies
Imaging studies, such as CT scans, are not usually needed for uncomplicated cases, but may be ordered for persistent or severe infections, or when complications are suspected 1
Treatment
Most sinus infections are viral and resolve without antibiotics in 7-10 days, but antibiotics like amoxicillin may be prescribed if symptoms are severe, last beyond 10 days, or worsen after initial improvement 1
Symptom Relief
For symptom relief, try saline nasal irrigation, over-the-counter pain relievers like acetaminophen or ibuprofen, and decongestants such as pseudoephedrine 1
Important Considerations
It is essential to note that sinus infections can be caused by viruses or bacteria, and the treatment approach differs depending on the cause, with viral sinusitis not benefiting from antibiotics, but some patients with bacterial sinusitis may get better faster with an antibiotic 1
From the Research
Diagnostic Criteria for Sinusitis
The diagnostic criteria for assessing sinusitis involve a combination of history, physical findings, and adjunctive tests. The primary goal of diagnosis is to confirm the presence of infection and determine the extent of disease in the paranasal sinus cavities 2, 3.
Clinical Presentation
Acute sinusitis is characterized by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and malaise, while chronic sinusitis presents with nonspecific symptoms such as facial pressure, headache, nasal obstruction, and drainage 3, 4. In children, sinusitis often presents with persistent cough and purulent rhinorrhea, rather than headache and facial tenderness 5.
Diagnostic Tests
The following diagnostic tests may be used to assess sinusitis:
- Nasal endoscopy to visualize the nasal cavity and sinuses 6, 4
- Sinus radiography to detect significant sinus membrane thickening or clouding 5, 4
- Nasal cytology to discriminate between allergic and infectious disease 5, 4
- Ultrasound studies to detect sinus disease 4
- Computed tomography to evaluate the extent of disease in the paranasal sinus cavities 4
Diagnostic Considerations
The diagnosis of sinusitis should be based on a combination of clinical presentation, physical findings, and adjunctive tests. A negative physical examination does not rule out the diagnosis, and adjunctive tests should be used in selected cases to confirm the presence and extent of disease 4. The clinician must sometimes decide on therapy when the diagnosis is not definitive, and antimicrobial therapy should be given for 3 to 4 weeks in many cases 5.