Thursday, February 2, 2012

Review of Acute Rhinosinusitis

Review of Acute Rhinosinusitis


Acute rhinosinusitis is a common ailment accounting for millions of

office visits annually, including that of Mrs D, a 51-year-old woman

presenting with 5 days of upper respiratory illness and facial pain.

Her case is used to review the diagnosis and treatment of acute rhinosinusitis.

Acute viral rhinosinusitis can be difficult to distinguish from acute

bacterial rhinosinusitis, especially during the first 10 days of symptoms.

Evidence-based clinical practice guidelines developed to guide

diagnosis and treatment of acute viral and bacterial rhinosinusitis

recommend that the diagnosis of acute rhinosinusitis be based on the

presence of "cardinal symptoms" of purulent rhinorrhea and either facial

pressure or nasal obstruction of less than 4 weeks' duration.

Antibiotic treatment generally can be withheld during the first 10 days

of symptoms for mild to moderate cases, given the likelihood of acute

viral rhinosinusitis or of spontaneously resolving acute bacterial rhinosinusitis.

After 10 days, the likelihood of acute bacterial rhinosinusitis

increases, and initiation of antibiotic therapy is supported by practice guidelines. Complications

of sinusitis, though rare, can be serious and require early recognition and treatment.


Antibiotics are not recommended during the first 10 days of symptoms due

to the fact that the main etiology of Acute Rhinosinusitis is viral, and therefore

symptomatic treatment is indicated. Nasodren®, which acts locally

within the nasal sinuses, facilitates natural secretion and drainage, thereby

reducing the signs and symptoms of the underlying inflammatory process

associated with Rhinosinusitis. Nasodren® can be used as monotherapy

or adjunctive therapy.
Peter H. Hwang, MD, Discussant

JAMA. 2009; 301(17): 1798-1807.

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