Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Investigation Strategy:
- Diagnosis is based on history and physical examination focusing on sinonasal inflammation symptoms lasting less than 12 weeks.
- In children, diagnostic criteria include nasal blockage/obstruction/congestion plus discoloured nasal discharge and/or cough.
- Take a history to identify predisposing factors, symptom duration, and previous treatments.
- Perform a thorough head and neck exam including facial tenderness, examination for post-nasal secretions, nasal mucosal signs via anterior rhinoscopy, and assessment for other pathologies like nasal polyps or anatomical abnormalities.
- Measure vital signs if systemically unwell.
- Do not routinely perform laboratory or imaging investigations in uncomplicated acute sinusitis cases; investigations are reserved for excluding complications or differential diagnoses.
Management Strategy:
- Advise about the natural course and viral cause of sinusitis.
- Recommend symptomatic relief with analgesics for pain and trials of nasal saline or decongestants for congestion.
- Advise seeking further medical attention if symptoms worsen rapidly, last longer than 3 weeks, or systemic illness develops.
- Antibiotics are not routinely indicated and should only be considered if acute bacterial sinusitis is suspected—characterized by at least three of: symptoms over 10 days, purulent nasal discharge, severe localised pain, fever >38°C, or marked clinical deterioration after initial improvement.
- If symptoms persist beyond 12 weeks, consider chronic sinusitis management, which may include high-dose nasal corticosteroids for children aged 12 years and over with persistent symptoms.
- Urgent hospital referral is warranted if there are signs of severe systemic infection, sepsis, complications such as orbital or intracranial involvement, or reduced consciousness.