Acute rhinosinusitis

Majority of cases of acute rhinosinusitis in adults and children are of viral aetiology.

Duration of symptoms more than 10 days often indicates bacterial cause.

Imaging is not required for diagnosis unless complications are suspected.

Condition is usually self-limiting; however, symptomatic therapy should be considered.

Antibiotics are only recommended in select patient groups (e.g., severe disease, persistent or worsening symptoms, or immunocompromised patients) because symptoms often resolve without intervention and there is a risk of antimicrobial resistance.

Complications are uncommon and their risk alone should not result in antimicrobial prescribing.

Acute rhinosinusitis (also commonly known as acute sinusitis) is a symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal sinuses, presenting with purulent nasal drainage accompanied by nasal obstruction, facial pain/pressure/fullness, or both for 4 weeks or less. 'Rhinosinusitis' is the preferred term as sinusitis is usually accompanied by nasal airway inflammation and is preceded by rhinitis in most cases.[1]Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1-39. https://journals.sagepub.com/doi/full/10.1177/0194599815572097 http://www.ncbi.nlm.nih.gov/pubmed/25832968?tool=bestpractice.com [2]Orlandi RR, Kingdom TT, Smith TL, et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021 Mar;11(3):213-739. http://www.ncbi.nlm.nih.gov/pubmed/33236525?tool=bestpractice.com It can be caused by either a viral or a bacterial infection.[1]Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1-39. https://journals.sagepub.com/doi/full/10.1177/0194599815572097 http://www.ncbi.nlm.nih.gov/pubmed/25832968?tool=bestpractice.com