Questionnaire/history: Onset? - < 12 weeks ago (acute)? - > 12 weeks ago (chronic)? Nasal blockage? Nasal discharge? Facial pain/pressure (or headache)? Reduction in the sense of smell? Other features? - Altered speech indicating nasal obstruction? - Tenderness, swelling or redness over the cheekbone or periorbital areas? - Cough? Past medical history? Current medication? Drug allergies? Examination: Swelling at maxillofacial area? Tenderness at maxillofacial area? Anterior rhinoscopy? - Nasal inflammation? - Mucosal oedema? - Purulent nasal discharge? - Associated pathologies (eg nasal polyps, septal deviation)? Blood pressure? Pulse? T if systemically unwell? Management: Advised: - Acute sinusitis is usually caused by a virus and is only complicated by bacterial infection in about 2 in 100 cases, that it takes 2–3 weeks to resolve and most people will get better without antibiotics - Symptoms, including fever, can be managed with self-care measures such as paracetamol or ibuprofen for pain or fever - Trial of nasal saline or nasal decongestants can be tried (although evidence is lacking to support their use) If a person has had symptoms for around 10 days or more with no improvement to be considered: - Mometasone furoate nasal spray 4 sprays bd [off-label use] - Back-up antibiotic Rx for phenoxymethylpenicillin for 5 days to be used if symptoms worsen rapidly or significantly, or do not improve within 7 days - If symptoms worsening after the first-choice antibiotic has been taken for at least 2–3 days: co-amoxiclav 500/125 mg for 5 days Suspected bacterial sinusitis if: - Symptoms for more than 10 days - Discoloured or purulent nasal discharge (with unilateral predominance) - Several local pain (with unilateral predominance) - T > 38°C - Marked deterioration after initial milder form of the illness - To seek medical advice if complications, symptoms rapidly deteriorate or do not improve within 3–5 days of initial treatment Reference(s): NICE CKS: Sinusitis Information for patient/carer(s): NHS Health A to Z: Sinusitis