10 minute consultation:sinusitis
Neil K Chadha and Rashmi Chadha discuss how you should handle this common problem in primary care
A 39 year old woman attends your surgery with a four day history of unpleasant yellowish nasal discharge, blocked nose, and severe pain across her cheeks and between her eyes. One week ago she had had a “bad cold” and she thought she was getting better, but then this started.
Sinusitis, now termed rhinosinusitis, is inflammation of one or more of the paranasal sinuses. It is clinically defined by at least two of the following symptoms: blockage or congestion; discharge or postnasal drip; facial pain or pressure; reduction or loss of smell. In acute rhinosinusitis symptoms persist for up to 12 weeks, with complete resolution; in chronic rhinosinusitis symptoms persist for more than 12 weeks without complete resolution. Viruses (coryza, rhinovirus, or influenza, for example) cause mucosal swelling and obstruct the sinus openings into the nose. The symptoms result from increased mucus production, reduced drainage, ciliary paralysis, and stasis of