Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

Sinusitis 1353

Culture

■Nasal swab inadequate; swab of purulent drainage taken on endo-

scopic exam or from maxillary sinus puncture needed

■Culture from maxillary sinus puncture

Other Tests

■Allergy testing may be needed as indicated by symptoms

differential diagnosis

■Rhinitis

■Allergy exacerbation

■Cystic fibrosis (should be tested in all children with nasal polyps)

■Sampter’s triad (nasal polyps, athsma, asprin sensitivity)

■Kartagener’s (immotile cilia) syndrome (chronic sinusitis, bron-

chiectasis, situs inversus)

■Facial pain syndrome (eg, tic doloureaux,)

■Headache syndrome (eg, cluster, migrane, tension headache, tem-

peromandibular joint syndrome)

■Dental origin (periapical or other abscess, pain of other dental origin)

■Wegener’s granulomatosis

■Sarcoid

■Facial cellulitis (rare)

■Nasal papilloma (eg, inverting papilloma)

■Neoplasm (nasopharyngeal cancer, maxillary sinus cancer, lym-

phoma, benign tumor)

■Foreign body

management

n/a

specific therapy

Treatment Options

■Acute Sinusitis

➣Adjunctive care only for viral causes mitigated by intensity or

persistence for >5 days

➣If bacterial cause suspected, add antibiotic

➣Antibiotics for 10–14 days (strep, H. Flu, M. Cat, Staph)

➣Immunocompromised patients may have other infectious

agents including fungus

➣First line: Amoxicillin, trimeth/sulfa, erythromycin, and others

➣Second line: Amoxicillin/clavulanate, cefaroxime, clarithro-

mycin, azithromycin, clindamycin, levofloxacin, gatifloxacin,

and others