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Acute sinusitis

Last reviewed: 6 Nov 2023
Last updated: 17 Feb 2022



History and exam

Key diagnostic factors

  • symptoms <10 days (acute viral sinusitis)
  • symptoms >10 days but <4 weeks (acute bacterial sinusitis)
  • symptoms that worsen after an initial improvement (acute bacterial sinusitis)
  • purulent nasal discharge
  • nasal obstruction
  • facial pain/pressure
  • severe symptoms at onset (acute bacterial sinusitis)
  • dental pain
More key diagnostic factors

Other diagnostic factors

  • cough
  • myalgia
  • sore throat
  • hyposmia
  • edematous turbinate
  • fever
Other diagnostic factors

Risk factors

  • viral upper respiratory tract infection
  • allergic rhinitis
  • GERD
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • nasal endoscopy
  • sinus culture
  • CT sinuses (with contrast)
  • x-ray sinuses
  • MRI
  • lateral neck x-ray
More investigations to consider

Treatment algorithm


suspected acute viral sinusitis

suspected acute bacterial sinusitis

suspected acute invasive fungal rhinosinusitis


recurrent episodes



Gordon H. Sun, MD, MSc
Gordon H. Sun

Chief Medical Information Officer

Chief of Otolaryngology

Rancho Los Amigos National Rehabilitation Center




GHS is a consultant with MAXIMUS, Inc. for independent medical reviews.


Dr Gordon H. Sun would like to gratefully acknowledge Dr Melissa A. Pynnonen and Dr Joseph K. Han, previous contributors to this topic.


MAP and JKH declare that they have no competing interests.

Peer reviewers

Benjamin S. Bleier, MD

Instructor of Otology and Laryngology

Harvard Medical School

Massachusetts Eye and Ear Infirmary

Department of Otolaryngology - Head and Neck Surgery




BSB is a co-founder and equity shareholder in Luxxeal, Inc.

Christos Georgalas, MD, PhD, DLO, FRCS (ORL-HNS)

Assistant Professor/Consultant

Academic Medical Center


The Netherlands


CG declares that he has no competing interests.

  • Acute sinusitis images
  • Differentials

    • Allergic rhinitis
    • Nonallergic rhinitis
    • Migraine
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: sinonasal disease
    • European position paper on rhinosinusitis and nasal polyps 2020
    More Guidelines
  • Patient leaflets


    More Patient leaflets
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