Summary
Definition
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
- cough
- myalgia
- sore throat
- hyposmia
- edematous turbinate
- fever
Risk factors
- viral upper respiratory tract infection
- allergic rhinitis
- GERD
Diagnostic investigations
1st investigations to order
- clinical diagnosis
Investigations to consider
- nasal endoscopy
- sinus culture
- CT sinuses (with contrast)
- x-ray sinuses
- MRI
- lateral neck x-ray
Treatment algorithm
suspected acute viral sinusitis
suspected acute bacterial sinusitis
suspected acute invasive fungal rhinosinusitis
recurrent episodes
Contributors
Authors
Gordon H. Sun, MD, MSc

Chief Medical Information Officer
Chief of Otolaryngology
Rancho Los Amigos National Rehabilitation Center
Downey
CA
Disclosures
GHS is a consultant with MAXIMUS, Inc. for independent medical reviews.
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
Benjamin S. Bleier, MD
Instructor of Otology and Laryngology
Harvard Medical School
Massachusetts Eye and Ear Infirmary
Department of Otolaryngology - Head and Neck Surgery
Boston
MA
Disclosures
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
Amsterdam
The Netherlands
Disclosures
CG declares that he has no competing interests.
Differentials
- Allergic rhinitis
- Nonallergic rhinitis
- Migraine
More DifferentialsGuidelines
- ACR appropriateness criteria: sinonasal disease
- European position paper on rhinosinusitis and nasal polyps 2020
More GuidelinesPatient leaflets
Sinusitis
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