Feature Article

Acute rhinosinusitis: tailoring treatment to presentation

Jason Roth



Acute rhinosinusitis is a common presentation in general practice. Determining whether the cause is viral or bacterial can be challenging. There is a plethora of medical treatments available but evidence suggests that not all are helpful. Surgery generally has no role in uncomplicated viral and bacterial disease but may provide benefit in certain situations, such as in the management of recurrent acute rhinosinusitis and complications.

Key Points

  • Management of acute rhinosinusitis (ARS) should be tailored to the presentation.
  • A viral episode of ARS is generally present for fewer than 10 days.
  • Bacteria are generally thought to be the chief pathogen in ARS if symptoms persist beyond 10 days or worsen after five days. A unilateral predominance or presence of severe pain is also suggestive of bacterial infection.
  • In children, inflammation of the adenoid pad can mimic or cause rhinosinusitis.
  • Important differential diagnoses of ARS include allergic rhinitis, dental disease, headache and facial pain syndromes.
  • Patients presenting with complications of rhinosinusitis require hospital admission and specialist consultation. Children should be assessed by an otolaryngologist before CT scans are ordered.
  • Antibiotics are not always needed in the treatment of ARS.
  • Topical corticosteroids are helpful for ARS.
  • Patients experiencing four or more episodes of ARS in a year may benefit from specialist review.

    Picture credit: © Jonathan Dimes