Acute Sinusitis: Place the patient at bed rest and give sedatives, analgesics, a light diet, and fluids. Oral nasal decongestants (eg. phenylpropanolamine, 25-50 mg 3 times daily) and systemic antibiotics frequently produce prompt resolution of the infection. Ampicillin or erythromycin, 1-2 g/d, is most commonly used. Other antibiotics may be used as determined by culture and sensitivity testing. Local heat, topical nasal decongestants (eg 0.25 phenylephrine), and gentle spot suctioning of the nasal discharge are helpful. The sinuses must not be manipulated during the acute infection. Antrum irrigation is of value after the acute inflammation has subsided. Acute frontal sinusitis is treated medically and conservatively; cannulation is rarely warranted. Trephining of the sinus floor may occasionally be indicated in acute fulminating infections. Acute ethmoid infections respond to medical management; if external fluctuation develops, incision and drainage are indicated.
