choice. Alternatives are discussed in the section on acute otitis media. Antibiotic treatment for sinusitis should be continued for 2 weeks, with longer courses sometimes required to prevent relapses.
Failure of sinusitis to resolve after an adequate course of oral antibiotics may necessitate hospital admission for intravenous antibiotics and possible surgical drainage. Frontal sinusitis that does not promptly respond to outpatient care should be managed aggressively, because the posterior sinus wall is adjacent to the dura and because undertreated infection may lead to intracranial extension. If intravenous antibiotics fail to ameliorate symptoms, a frontal sinus trephine may be necessary to drain and irrigate the sinus. Persistent maxillary empyema may be cultured and relieved with a needle inserted through the lateral or anterior wall of the nose.
