Prognosis
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Richtlijn acute rinosinusitisPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2023Guide de pratique clinique rhinosinusite aiguëPublished by: Groupe de travail Développement de recommandations de première ligneLast published: 2023In general, acute rhinosinusitis is a self-limiting disease and generally resolves within 1 month. However, the use of antibiotics in appropriately selected patients may limit the length and severity of symptoms.
Recurrence
Patients with structural anatomic variants (e.g., concha bullosa, deviated septum, infraorbital ethmoid cell) are more prone to develop recurrent acute rhinosinusitis and even persistent rhinosinusitis. Recurrence is also dependent on exposure to an exacerbating condition such as a viral upper respiratory tract infection.
Complications
Complications are more commonly seen in the pediatric population, and occur due to direct extension of the infection into neighboring structures. One database review in the US estimated the incidence of hospital admissions for acute rhinosinusitis among children and adolescents (ages <20 years) was 8.92 per 10,000 in 2016.[73] Severe complications are more common among boys.[73][74]
Orbital spread of infection with orbital cellulitis or orbital abscess represent the most common complications. Intracranial spread of infection resulting in meningitis or abscess is much less common.[74][75]
Concern about reducing the risk of serious complications can drive antibiotic prescribing for common infections such as acute rhinosinusitis, and use of antibiotics is the major driver of antibiotic resistance. One study found antibiotic use was associated with a lower risk of brain abscess following acute rhinosinusitis; however, thousands of patients would need to be treated to prevent a single instance of one complication.[75] In a stratified analysis, antibiotic prescribing was only associated with reduced odds of orbital cellulitis following acute rhinosinusitis, in those ages ≤20 years. Cases of brain abscess following acute rhinosinusitis only occurred in those ages >20 years, and antibiotic prescription was found to significantly reduce the likelihood of this outcome in this age group. Therefore, given the current threat from antibiotic resistance, lack of symptomatic benefit from antibiotic use for these conditions, and risk of adverse effects from antibiotics, these results should not change current recommendations not to prescribe antibiotics for the majority of cases of acute rhinosinusitis.[75]
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