Acute bacterial sinusitis. (Women's Health Adviser).

Each year, more than 30 million American adults are diagnosed with acute rhinosinusitis--infections that occur within the dosed confines of the sinus cavity.

Acute bacterial rhinosinusitis is most often a complication of a viral upper respiratory infection (URI), occurring in about 2% of cases. Inflammation of the nasal mucosa can constrict the openings between the sinuses and nasal cavities. When this is severe, negative pressure in the sinuses can actually draw in infectious secretions during nose blowing, coughing, or sneezing. The sinus cavity becomes acidic and hypoxic, providing an excellent growth medium for bacteria. Chronic allergies can create this same infection-prone environment in the sinuses.

Diagnosis. The most appropriate diagnostic approach is a thorough history and physical exam. Patients will most frequently describe a URI with symptoms of malaise, nasal congestion and discharge, moderate fever, and/or a sense of pressure in the face. This is most often a viral URI. Acute bacterial rhinosinusitis is more probable if the symptoms persist for 10 days or more, or if they worsen 5-7 days after onset, sometimes after brief improvement. The patient may also present with maxillary pain or tenderness and purulent nasal discharge.

Since the infection is more common during pregnancy a high index of suspicion is warranted for pregnant women whose Urns are not resolving.

Sinus aspiration, which provides samples for culture, is impractical in most primary care settings. Imaging studies for uncomplicated rhinosinusitis are not recommended.

Treatment. About 50% of acute bacterial rhinosinusitis will resolve without antibiotic therapy Additionally because the infection must be inferred from symptoms and there is usually uncertainty about the causative organism, antibiotic treatment can be inappropriate and/or ineffective.

The American Academy of Family Physicians recommends watchful waiting and supportive therapy with follow-up in patients who are likely to comply with a follow-up visit.