Related Subjects:
|Assessing Hearing Loss
|Benign Paroxysmal Positional Vertigo (BPPV)
|Cholesteatoma
|Epistaxis (Nosebleeds)
|Acute Mastoiditis
|Nasal polyps
|Acute Sinusitis
|Sudden Sensorineural Hearing loss (SNHL)
|Causes of Vertigo
🤧 Sinusitis (Rhinosinusitis) = inflammation of the paranasal sinuses, usually following infection or allergy.
Most cases are viral and self-limiting, but bacterial cases can lead to serious complications.
🦠 Aetiology
- Swelling of nasal mucosa from viral URTI (common cold) or allergic rhinitis.
- Obstruction of sinus drainage → mucus stasis → secondary bacterial infection.
- Anatomical factors: deviated septum, nasal polyps.
🩺 Clinical Features
- Facial pain/pressure (toothache-like), worse on bending forwards.
- Unilateral fullness & tenderness over affected sinus.
- Purulent nasal discharge (green/yellow).
- Headache & postnasal drip → can trigger cough/wheeze.
- Maxillary sinus: cheek/upper jaw pain (most common site).
- Frontal sinus: forehead pain.
- Ethmoid sinus: pain between eyes, risk of orbital spread.
- Sphenoid sinus: vertex/central head pain.
- Acute: 1–4 weeks. Chronic: >12 weeks.
🧫 Common Pathogens
- Streptococcus pneumoniae
- Haemophilus influenzae
- Staphylococcus aureus
- Other streptococci
🔍 Investigations
- Clinical diagnosis in most cases.
- CT (coronal, non-contrast) → opacification, air–fluid levels, mucosal thickening.
- MRI → if suspect fungal sinusitis or malignancy.
⚠️ Complications (red flags)
- 👁️ Orbital cellulitis/abscess: proptosis, diplopia, painful eye movements → emergency.
- 🦴 Osteomyelitis of facial bones.
- 🧠 Cavernous sinus thrombosis: ophthalmoplegia, chemosis, visual loss → life-threatening.
💊 Management
- Most are viral → symptomatic relief (analgesia, saline irrigation, decongestants).
- Antibiotics if persistent >10–14 days, severe pain, or fever:
- First-line: Amoxicillin or Doxycycline.
- Second-line: Amoxicillin-clavulanate or Levofloxacin.
- Consider intranasal corticosteroids in chronic/recurrent cases.
- ENT referral for recurrent/chronic disease, or complications.
📈 Prognosis & Follow-Up
- Most resolve spontaneously or with conservative management.
- Chronic/recurrent sinusitis may need surgical drainage (FESS = functional endoscopic sinus surgery).
- Patients with risk factors (diabetes, immunosuppression) need closer monitoring.
📚 References
