Internal Medicine

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

Sinusitis 1355

Chronic sinusitis may be treated successfully with endoscopic

or open techniques to reduce frequency, duration, intensity of

infections

➣Side Effects

➣Medical

Allergy/reaction to antibiotic

Pseudomembranous colitis

Usual side effects of decongestants/steroids (see Rhinitis chap-

ter)

➣Surgery

Rare orbital/intracranial or other complications of sinus

surgery

Usual surgical complications (eg, bleeding, anesthesia related)

Rarely require hospitalization

follow-up

■Acute Sinusitis

➣1 month as needed. Reassess in 2–4 days if no improvement

➣May require second course of antibiotics or rarely, addition of

oral steroids

➣For recurrent infection, CT when patient at baseline (without

symptoms)

➣If diagnosis uncertain, CT during exacerbation (with symptoms)

■Chronic Sinusitis

➣Reassess in 4–6 weeks

➣May require additional courses of antibiotics or, rarely, chronic

oral steroids

➣CT approximately 1 month after therapy is completed (guided by

history)

complications and prognosis

■Acute Sinusitis

➣Rarely life threatening

➣Excellent prognosis for virtually all infections

➣Intracranial and orbital complications rare, but need to be diag-

nosed early for optimal outcome

■Chronic Sinusitis

➣Rarely life threatening

➣Can have intracranial or orbital complications

➣Quality of life compromised by chronic infection

➣Difficult to eradicate completely

➣Chronic treatments commonly needed