Rhinosinusitis is one of the most common conditions for which patients seek medical care. Subtypes of
rhinosinusitis include acute, subacute, recurrent acute, and chronic. Acute
rhinosinusitis is further specified as bacterial or viral. Most cases of acute
rhinosinusitis are caused by
viral infections associated with the
common cold. Symptomatic treatment with
analgesics,
decongestants, and saline nasal irrigation is appropriate in patients who present with nonsevere symptoms (e.g., mild
pain, temperature less than 101°F [38.3°C]). Narrow-spectrum
antibiotics, such as
amoxicillin or
trimethoprim/sulfamethoxazole, are recommended in patients with symptoms or signs of acute
rhinosinusitis that do not improve after seven days, or that worsen at any time. Limited evidence supports the use of intranasal
corticosteroids in patients with acute
rhinosinusitis. Radiographic imaging is not recommended in the evaluation of uncomplicated acute
rhinosinusitis. Computed tomography of the sinuses should not be used for routine evaluation, although it may be used to define anatomic abnormalities and evaluate patients with suspected complications of acute bacterial
rhinosinusitis. Rare complications of acute bacterial
rhinosinusitis include orbital, intracranial, and bony involvement. If symptoms persist or progress after maximal medical
therapy, and if computed tomography shows evidence of sinus disease, referral to an otolaryngologist is warranted.