Acute maxillary sinusitis
EBM Guidelines
Dec 10, 2019 • Latest change Mar 29, 2022
Table of contents
Extract
- Nasal blockage, rhinitis and pressure symptoms over the cheeks are often present during a viral upper respiratory tract infection (URTI). These symptoms are associated with the viral infection and no antimicrobial therapy or further investigations are usually indicated Viral sinusitis may frequently occur in the early days of the common cold, and appears to be a self-limited illness.C.
- Diagnosis of acute sinusitis requires clinical examination of the nose and pharynx, in particular. Purulent secretions in the middle nasal meatus, nasopharynx or on the posterior wall of the pharynx suggests bacterial sinusitis.
- Ultrasonography of the maxillary sinus is the first-line imaging study due to its good availability and lack of adverse effects but it cannot be used to differentiate between viral and bacterial sinusitis.
- Imaging of the paranasal sinuses may be useful in the case of acute or chronic sinusitis to confirm the diagnosis.
- Antimicrobial treatment should only be considered for patients with severe symptoms suggesting bacterial infection.
- In recurring sinusitis, any predisposing factors should be identified and an ENT specialist consulted, as necessary.
- For maxillary sinusitis in children, see Sinusitis in children1.
Linked evidence summaries
- Viral sinusitis may frequently occur in the early days of the common cold, and appears to be a self-limited illness.C
- Sinus ultrasound has similar accuracy as sinus X-ray in the diagnosis of acute maxillary sinusitis.A↑↑
- Nasal saline irrigation might possibly have benefits for relieving the symptoms of acute upper respiratory tract infections (URTIs), but the evidence is insufficient.D
- Intranasal corticosteroids as a monotherapy or adjunct therapy are effective in acute sinusitis.A
- EMLA cream instilled with a suction needle and syringe appears to produce similar anesthesia as lidocain-adrenaline solution and be better tolerated by patients.B
Search terms
Amoxicillin, Amoxicillin-Potassium Clavulanate Combination, Caldwell-Luc operation, Child, Doxycycline, Infectious diseases, J01.0, Maxillary Sinusitis, Otorhinolaryngology, Radiology, Sinusitis, Surgical Procedures, Operative, antimicrobial therapy, functional endoscopic sinus surgery, local anesthesia