Majority of cases of acute sinusitis in adults and children are of viral etiology.
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 is recommended.
Antibiotics are only recommended in select patient groups (e.g., immunocompromised or with severe disease) as 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 sinusitis (also commonly known as acute rhinosinusitis) 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. It can be caused by either a viral or a bacterial infection.
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
Other diagnostic factors
- sore throat
- edematous turbinate
- viral upper respiratory tract infection
- allergic rhinitis
1st investigations to order
- clinical diagnosis
Investigations to consider
- nasal endoscopy
- sinus culture
- CT sinuses (with contrast)
- x-ray sinuses
- lateral neck x-ray
suspected acute viral sinusitis
suspected acute bacterial sinusitis
suspected acute invasive fungal rhinosinusitis
Gordon H. Sun, MD, MSc
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.
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)
Academic Medical Center
CG declares that he has no competing interests.
- Allergic rhinitis
- Nonallergic rhinitis
- ACR appropriateness criteria: sinonasal disease
- European position paper on rhinosinusitis and nasal polyps 2020
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