Acute
sinusitis is one of the most commonly observed entities in clinical practice. Despite the frequency of the disease, diagnosis and
therapy often remain empiric. Most cases are secondary to sinus ostia obstruction associated with the
common cold or
allergies.
Maxillary sinusitis is most common. Because of the proximity of vital anatomic structures and venous drainage systems, serious complications frequently arise from sphenoid, frontal, and
ethmoid sinusitis. Clinical signs and symptoms most helpful in the diagnosis of
maxillary sinusitis are the presence of a maxillary
toothache, lack of improvement with
decongestants, a purulent nasal discharge,
cough, purulent secretions observed on nasal examination, abnormal transillumination, and sinus tenderness. Plain film radiographs are helpful, but do not adequately visualize the anterior ethmoid sinuses. Computed tomography provides superior visualization, but cost remains prohibitive for routine cases. Most
maxillary sinusitis in adults is secondary to Streptococcus pneumoniae or Hemophilus influenzae. Moroxella catarrhalis is common in children. Staphylococcus aureus is observed more frequently in frontal or sphenoid disease. Most patients with acute
sinusitis are treated without microbiological diagnosis and respond well to commonly used oral antimicrobials with activity against the usual pathogens. Complications of
sinusitis include
meningitis, periorbital
infections,
subdural empyema,
epidural abscess, brains
abscess,
cavernous sinus thrombosis, and
osteomyelitis.