Overview
Definition
Symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal sinuses lasting less than 4 weeks.
Epidemiology
Extremely common. The vast majority (98%) are viral in origin, complicating a standard upper respiratory infection.
Etiology & Risk Factors
- Viral (Rhinovirus, Adenovirus, Influenza)
- Bacterial (S. pneumoniae, H. influenzae, M. catarrhalis) - occurs when sinus ostia are blocked, allowing bacterial overgrowth
Clinical Symptoms
- Purulent (thick, yellow/green) nasal discharge
- Facial pain, pressure, or fullness (worse when bending forward)
- Nasal congestion/obstruction
- Maxillary tooth pain (highly suggestive)
- Anosmia (loss of smell)
Clinical Approach
Diagnosis
- Clinical diagnosis. Distinguishing Viral vs. Bacterial is key:
- Bacterial is likely if: (1) Symptoms last > 10 days without improvement, (2) 'Double sickening' (improves then worsens again), or (3) Severe symptoms (high fever + purulent discharge for >3 days straight)
Management
- Viral/Uncomplicated: Supportive care (Saline nasal irrigation, intranasal corticosteroids, oral decongestants like Pseudoephedrine, NSAIDs)
- Bacterial: Amoxicillin-Clavulanate (Augmentin) is first-line
- Avoid antihistamines (they dry out mucosa and thicken secretions)
Complications
- Orbital cellulitis (infection spreads through the ethmoid bone)
- Cavernous sinus thrombosis
- Intracranial abscess