Acute pain management

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Sinusitis - Management
How should I diagnose acute sinusitis?

  • Acute sinusitis nearly always follows an upper respiratory tract infection and is diagnosed by the presence of nasal blockage (obstruction/congestion) or nasal discharge (anterior/posterior nasal drip) with facial pain (or pressure) and/or reduction of, or loss of, the sense of smell, lasting for less than 12 weeks.
    • Nasal discharge — a thick, purulent, coloured discharge (especially green) is more likely to indicate bacterial involvement (unlikely with a clear discharge).
    • Nasal blockage or congestion — usually bilateral and caused by rhinitis.
    • Facial pain — may be described as pressure and localized over the infected sinus, or it may affect teeth, the upper jaw, or other areas (such as eye, side of face, forehead). Pain in the absence of other symptoms is unlikely to be sinusitis.
    • In children, symptoms of rhinitis predominate, with facial pain being less prevalent. There may also be ear discomfort (Eustachian tube blockage).
  • Examination is of limited value but may reveal the presence of purulent discharge, swelling of the nasal mucosa, tenderness over the sinuses, and fever.
  • Investigations are not necessary to diagnose acute sinusitis.
  • If signs and symptoms are not typical of sinusitis, rule out analternative diagnosis.

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