Clinical practice guideline: adult sinusitis
Richard M Rosenfeld1, David Andes, Neil Bhattacharyya
1Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital, Brooklyn, NY 11201-5514, USA. richrosenfeld@msn.com
Summary
This guideline offers evidence-based strategies for managing adult rhinosinusitis, emphasizing accurate diagnosis and appropriate treatment. It advises distinguishing bacterial from viral infections and judicious use of antibiotics and imaging for better patient outcomes.
Area of Science:
- Otolaryngology-Head and Neck Surgery
- Infectious Disease
- Allergy and Immunology
Background:
- Rhinosinusitis, inflammation of the paranasal sinuses and nasal cavity, affects millions of adults annually in the US.
- Accurate diagnosis and appropriate management are crucial to reduce complications and inappropriate treatment, such as overuse of antibiotics and imaging.
Purpose of the Study:
- To provide evidence-based recommendations for the diagnosis and management of uncomplicated adult rhinosinusitis.
- To improve diagnostic accuracy, reduce unnecessary antibiotic prescriptions, and optimize the use of diagnostic imaging and ancillary tests.
Main Methods:
- Development of a clinical practice guideline by a multidisciplinary expert panel.
- Review and synthesis of evidence to formulate strong recommendations and options for managing acute and chronic rhinosinusitis.
Main Results:
- Strong recommendations for diagnosing acute bacterial rhinosinusitis (ABRS) based on symptom duration or worsening.
- Amoxicillin recommended as first-line antibiotic for ABRS; radiographic imaging discouraged unless complications are suspected.
- Guidance provided for distinguishing chronic rhinosinusitis (CRS) and recurrent ABRS, including assessment for modifying factors and use of CT scans and nasal endoscopy.
Conclusions:
- The guideline provides an evidence-based framework to assist clinicians in decision-making for adult rhinosinusitis management.
- It emphasizes clinical judgment and is not intended to replace individualized patient care or establish a universal protocol.
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