Acute Sinusitis Differential Diagnoses

  • Author: Itzhak Brook, MD, MSc; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Apr 2, 2012
 
 

Diagnostic Considerations

Wegener granulomatosis involves angiitis associated with focal necrosis and granulomatous reaction, which initially affects the respiratory tract but which may progress to involve other organs.

Ataxia-telangiectasia is an autosomal recessive disorder associated with recurrent sinusitis, pulmonary infections, bronchiectasis, pulmonary fibrosis, tracheomegaly, diminished lymphoid tissue, and cerebral and cerebellar atrophy.

Cystic fibrosis is an autosomal recessive disorder associated with respiratory, GI, cardiovascular and sinus abnormalities, among others.

Immotile cilia syndrome is an autosomal recessive disorder associated with recurrent chest infections and/or pulmonary consolidation, sinusitis, bronchiectasis, and Kartagener syndrome.

Kartagener syndrome is an autosomal recessive disease associated with sinusitis, situs inversus, recurrent respiratory infections, and bronchiectasis, among other abnormalities.

Hyperallergic patients may have innumerable polyps filling the nasal cavity and obstructing the paranasal sinuses, giving a characteristic imaging appearance. This disease is closely associated with asthma. To see complete information on Asthma and Sinusitis, please go to the main article by clicking here.

Wiskott-Aldrich syndrome is an X-linked, recessive, immune deficiency disease associated with recurrent respiratory tract infections and/or pneumonia, sinusitis, and mastoiditis.

Yellow-nail syndrome is associated with recurrent pleural effusions, pericardial effusions, chylothorax, bronchiectasis, and sinusitis.

Young syndrome is associated with azoospermia secondary to epididymal obstruction and recurrent respiratory infections and sinusitis.

Other problems to consider include the following:

  • Gastroesophageal reflux
  • Cystic fibrosis
  • Immotile cilia syndrome
  • Dental abscess
  • Periapical abscess
  • Migraine headache
  • Sinonasal polyposis
  • Chemical rhinitis
  • Nasal foreign body
  • Chronic invasive fungal sinusitis
  • Sinonasal neoplasm
  • Upper respiratory tract infection
  • Primary ciliary dyskinesia
  • Unilateral choanal atresia
  • Adenoidal hypertrophy
  • Foreign body
  • Immune deficiency (immunoglobulin [Ig]A, IgG subclass)

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Itzhak Brook, MD, MSc  Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

Coauthor(s)

Brian E Benson, MD  Chief, Division of Laryngeal Surgery and Voice Disorders; Director, The Voice Center at Hackensack University Medical Center; Clinical Assistant Professor, Department of Otolaryngology/Head & Neck Surgery, UMDNJ, New Jersey Medical School

Brian E Benson, MD, is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, and Sigma Xi

Disclosure: Nothing to disclose.

Linas Riauba, MD  Assistant Professor of Clinical Medicine, Department of Medicine, Section of Infectious Disease, University Hospital, University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Linas Riauba, MD is a member of the following medical societies: American Medical Association and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Michael Cunningham, DO Sr Clinical Instructor, Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry

Michael Cunningham, DO is a member of the following medical societies: American College of Emergency Physicians, American Osteopathic Association, Medical Society of the State of New York, and National Association of EMS Physicians

Disclosure: Nothing to disclose.

Tracey Quail Davidoff, MD Senior Clinical Instructor, Department of Emergency Medicine, Rochester General Hospital

Tracey Quail Davidoff, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Forensic Examiners, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Thomas E Herchline, MD Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, and Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Erhun Serbetci, MD Director, Department of Otolaryngology, Section of Nose and Sinus Surgery, Associate Professor, International Hospital of Istanbul, Turkey

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

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Sagittal section of the lateral nasal wall demonstrating openings of paranasal sinuses. Conchae have been cut to depict details of meatal structures.
Air-fluid level (arrow) in the maxillary sinus suggests sinusitis.
CT cuts for a limited CT study.
Table 1. Dosage, Route, and Spectrum of Activity of Commonly Used First-Line Antibiotics*
Antibiotic Dosage Streptococcus pneumoniaeHaemophilus influenzaeMoraxella catarrhalisAnaerobic bacteria
SensitiveIntermediateResistant
Amoxicillin500 mg PO tid++++++++++++



(except beta-lactamase producers)



Clarithromycin250-500 mg PO bid+++++++++++
Azithromycin500 mg PO first day, then



250 mg/d PO for 4 days



+++++++++++
*+, low activity against microorganism; ++, moderate activity against microorganism; +++, good activity against microorganism
Table 2. Dosage, Route, and Spectrum of Activity of Commonly Used Second-Line Antibiotics*
Antibiotic Dosage Streptococcus pneumoniaeHaemophilus influenzaeMoraxella catarrhalisAnaerobic bacteria
SensitiveIntermediateResistant
Amoxicillin/



clavulanate



500 mg PO tid+++++++++++++++
Cefuroxime250-500 mg PO bid+++++++++++++
Cefpodoxime



+



cefixime



200 mg PO bid



400 mg/d PO



-



++



+++



-



++



-



+



+++



+++



+++



++



-



Ciprofloxacin500-750 mg PO bid++++++++++
Levofloxacin500 mg/d PO+++++++++++++++++
Trovafloxacin200 mg/d PO++++++++++++++++++
Clindamycin300 mg PO tid++++++++--+++
Metronidazole500 mg PO tid-----+++
*+, low activity against microorganism; ++, moderate activity against microorganism; +++, good activity against microorganism; -, no activity against microorganism
Table 3. Dosage, Route, and Spectrum of Activity of Commonly Used Intravenous Antibiotics (Second-Line)*
Antibiotic Dosage Streptococcus pneumoniae † Haemophilus influenzaeMoraxella catarrhalisGram-negative Anaerobic bacteria
Piperacillin3-4 g IV q4-6h++++-++++++
Piperacillin/tazobactam3.375 g IV q6h++++++++++++++
Ticarcillin3 g IV q4h+++--+++++
Ticarcillin/clavulanate3.1 g IV q4h++++++-+++++
Imipenem500 mg IV q6h+++++++++++++++
Meropenem1 g IV q8h+++++++++++++++
Cefuroxime1 g IV q8h+++++++++++++
Ceftriaxone2 g IV bid++++++++++++++
Cefotaxime2 g IV q4-6h++++++++++++++
Ceftazidime2 g IV q8h++++++++++++++
Gentamicin1.7 mg/kg IV q8h-++++++++-
Tobramycin1.7 mg/kg IV q8h-++++++++-
Vancomycin1 g IV q6-12h+++---++
*+, low activity against microorganism; ++, moderate activity against microorganism; +++, good activity against microorganism; -, no activity against microorganism †Does not take into account penicillin-resistant types.
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