Summary
Definition
History and exam
Key diagnostic factors
- symptoms <10 days (acute viral rhinosinusitis)
- symptoms >10 days but <4 weeks (acute bacterial rhinosinusitis)
- symptoms that worsen after an initial improvement (acute bacterial rhinosinusitis)
- purulent nasal discharge
- nasal obstruction
- facial pain/pressure
- severe symptoms at onset (acute bacterial rhinosinusitis)
- dental pain
Other diagnostic factors
- cough
- sore throat
- hyposmia
- edematous turbinate
- fever
Risk factors
- viral upper respiratory tract infection
- allergic rhinitis
Diagnostic tests
1st tests to order
- clinical diagnosis
Investigations to avoid
- x-ray paranasal sinuses
Tests to consider
- nasal endoscopy
- sinus culture
- CT sinuses
- MRI
- lateral neck x-ray
- allergy testing
Treatment algorithm
suspected acute viral rhinosinusitis
suspected acute bacterial rhinosinusitis
suspected acute invasive fungal rhinosinusitis
recurrent episodes
Contributors
Authors
Gordon H. Sun, MD, MBA, MSc
Director of Specialty Care
High Desert Regional Health Center
Lancaster
CA
Clinical Associate Professor of Otolaryngology-Head and Neck Surgery
Charles R. Drew University of Medicine and Science
Los Angeles
CA
Disclosures
GHS is a contractor for MAXIMUS, Inc.
Acknowledgements
Dr Gordon H. Sun would like to gratefully acknowledge Dr Melissa A. Pynnonen and Dr Joseph K. Han, previous contributors to this topic.
Disclosures
MAP and JKH declare that they have no competing interests.
Peer reviewers
Michael S. Benninger, MD
Professor of Otolaryngology Head and Neck Surgery
Cleveland Clinic
Lerner College of Medicine
Cleveland
OH
Disclosures
MSB declares that he has no competing interests.
Daniel Merenstein, MD
Director of Research Family Medicine
Georgetown University
Washington, DC
Disclosures
DM declares that he has no competing interests.
Amin R. Javer, MD, FRCSC, FARS
Clinical Professor
Division of Otolaryngology
University of British Columbia
Vancouver
Canada
Disclosures
ARJ is a consultant for iView Therapeutics, GSK, and Sanofi.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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.Full text Abstract
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. Abstract
Peters AT, Spector S, Hsu J, et al. Diagnosis and management of rhinosinusitis: a practice parameter update. Ann Allergy Asthma Immunol. 2014 Oct;113(4):347-85.Full text
Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020 Feb 20;58(suppl s29):1-464.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Allergic rhinitis
- Nonallergic rhinitis
- Migraine
More DifferentialsGuidelines
- Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases
- Diagnosis and management of sinusitis in adults and children: 2023 update
More GuidelinesPatient information
Sinusitis
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer