Treatment of acute and chronic rhinosinusitis

Rhinosinusitis is a common health complaint that is often seen by primary care physicians and otolaryngologists in the United States. The complicated anatomy of the paranasal sinuses, as well as the multiple etiologies, contributes to the complexity that one often faces in trying to ameliorate or eradicate this disease in affected individuals. A full understanding of the fundamentals of rhinosinusitis, as well as the treatment options available for the different types, is important. It is very important for the physician to take an organized, step-by-step approach to the management of each patient with this complicated disease. As most cases of rhinosinusitis presenting to the generalist's office will be of viral origin, antibiotics should not be given unless the patient has purulent rhinorrhea or worsening symptoms lasting more than 5 days, or total symptoms lasting longer than 10 days. When medical treatment fails or is incomplete, adjunctive surgical treatment becomes an option. Generally, the symptoms that are most helped by surgery include persistent headaches, nasal obstruction, and recurrent or persistent purulent rhinorrhea unresponsive to medical management. Appropriate and timely referral for specialty care will result in the definitive management of recalcitrant rhinosinusitis when medical management alone fails or in cases where a complication or malignancy is suspected. This article reviews the current understanding of the anatomy, pathophysiology, classification, diagnosis, and potential complications of rhinosinusitis. It also describes the current approach to the treatment of both acute and chronic rhinosinusitis.