Rhinosinusitis is inflammation of the paranasal sinuses and nasal cavity. It can result from viral, bacterial, or fungal infections with viral being the most common. Infection extension beyond the sinuses and cavities can result in bacterial rhinosinusitis complications (i.e, periorbital edema, meningitis). Sinusitis affects 1 in 8 adults in the United States and accounts for more outpatient antibiotic prescriptions than any other diagnosis. Sinusitis can be further categorized as acute, subacute, chronic, and recurrent based on symptom duration. Whether viral or bacterial, most cases of uncomplicated acute rhinosinusitis self-resolve with supportive care alone but antibiotic therapy should be considered in certain cases of acute bacterial rhinosinusitis.
Cardinal symptoms of Acute Rhinosinusitis (ARS)
Note: ARS is a clinical diagnosis based on the presence of cardinal symptoms. Imaging is not needed. Distinguishing between a viral or bacterial infection is based more on duration and course of symptomatology. Color of nasal discharge alone has poor predictability for predicting the likelihood of a bacterial sinus infection.
Complications of bacterial sinusitis occur when infection spreads beyond the nasal sinuses into surrounding areas including the central nervous system, orbits, and adjacent tissue spaces
Note: Consider imaging with urgent referral to specialist or immediate emergency department evaluation if signs of systemic toxicity, peri-orbital involvement, meningeal symptoms, or concern for invasive fungal infection
Risk factors for Complications from ABRS
First determine if viral or bacterial etiology
If Acute Viral Rhinosinusitis offer supportive care
If Acute Bacterial Rhinosinusitis offer antibiotic therapy or period of ‘watchful waiting’ in conjunction with supportive care
When to initiate antibiotics
AAFP: Clinical Practice Guideline Update: Adult Sinusitis
Clinical Practice Guideline Update: Adult Sinusitis from American Academy of Otolaryngology–Head and Neck Surgery Foundation
Cochrane Systematic Review – Antibiotics for Acute Rhinosinusitis in Adults
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