Acute sinusitis

Epidemiology

Sinusitis affects 1 out of every 7 adults in the United States, with more than 30 million individuals diagnosed each year. Sinusitis is more common from early fall to early spring. Rhinosinusitis affects an estimated 35 million people per year in the United States and accounts for close to 16 million office visits per year.

According to the National Ambulatory Medical Care Survey (NAMCS), approximately 14% of adults report having an episode of rhinosinusitis each year, and it is the fifth most common diagnosis for which antibiotics are prescribed, accounting for 0.4% of ambulatory diagnoses.

In 1996, Americans spent approximately $3.39 billion treating rhinosinusitis.The economic burden of acute sinusitis in children is $1.77 billion per year.

International prevalence

Acute sinusitis affects 3 in 1000 people in the United Kingdom. Chronic sinusitis affects 1 in 1000 people. Sinusitis is more common in winter than in summer. Rhinoviral infections are prevalent in autumn and spring. Coronaviral infection occurs mostly from December to March.

Acute sinusitis in children

An average child is likely to have 6-8 colds (ie, upper respiratory tract infections) per year, and approximately 0.5-2% of upper respiratory tract infections in adults and 6-13% of viral upper respiratory tract infections in children are complicated by the development of acute bacterial sinusitis.

Sex distribution for acute sinusitis

Women have more episodes of infective sinusitis than men because they tend to have more close contact with young children. The rate in women is 20.3%, compared with 11.5% in men.                                                        

Complications

Complications of sinusitis include acute and chronic sequelae. Acute distant effects include toxic shock syndrome. Acute local effects can also occur. Acute orbital complications include the following: cellulitis, proptosis, chemosis, ophthalmoplegia, orbital cellulitis, subperiosteal abscess, and orbital abscess.

Other acute complications include intracranial sequelae such as meningitis; encephalitis; cavernous or sagittal sinus thrombosis; or extradural, subdural, or intracerebral abscesses.

The incidence of intracranial complications in all patients hospitalized with sinusitis has been reported as 3.7%. Sinusitis is implicated as a source of subdural abscess in 35-65% of cases. Bony complications include dental involvement and osteitis or osteomyelitis. Potts puffy tumor refers to swelling of the scalp, caused by an underlying osteitis of the skull or extradural abscess. A classical cause of such a swelling is complicated frontal sinusitis. Toxic shock syndrome is an unusual complication of acute sinusitis. It occurs after surgery for foreign body removal and is associated with S aureus.Viral rhinosinusitis does not require antimicrobial treatment. Standard nonantimicrobial treatment options include topical steroids, topical and/or oral decongestants, mucolytics, and intranasal saline spray.                                                                                                                                                                                                                                                              Treatment                                                                                                                       Antimicrobial therapy is the mainstay of medical treatment in sinusitis. The choice of antibiotics depends on whether the sinusitis is acute, chronic, or recurrent.

Antibiotic efficacy rates are as follows

• Levofloxacin, moxifloxacin, and amoxicillin/clavulanate - Greater than 90%
• High-dose amoxicillin, cefpodoxime proxetil, cefixime, cefuroxime axetil, and trimethoprim-sulfamethoxazole - 80-90%
• Clindamycin, doxycycline, cefprozil, azithromycin, clarithromycin, and erythromycin - 70-80%
• Cefaclor - 50-60%

On the basis of the 2000 Sinus and Allergy Health Partnership treatment guidelines for acute bacterial rhinosinusitis, patients are divided into 3 groups, as follows:

• Adults with mild disease who have not received antibiotics: Amoxicillin/clavulanate, amoxicillin (1.5-3.5 g/d), cefpodoxime proxetil, or cefuroxime is recommended as initial therapy.
• Adults with mild disease who have had antibiotics in the previous 4-6 weeks and adults with moderate disease: Amoxicillin/clavulanate, amoxicillin (3-3.5 g), cefpodoxime proxetil, or cefixime is recommended.
• Adults with moderate disease who have received antibiotics in the previous 4-6 weeks: Amoxicillin/clavulanate, levofloxacin, moxifloxacin, or doxycycline is recommended.

Patients who remain symptomatic despite appropriate antibiotic therapy may be evaluated with sinus endoscopy, CT scanning, or sinus aspiration/culture.