Diagnosis and management of acute rhinosinusitis

Acute rhinosinusitis (ARS) is a highly prevalent condition with substantial public health implications. The disease is associated with a high degree of disability, impairment of quality of life, and school and workplace absenteeism. Acute rhinosinusitis is most often precipitated by a viral upper respiratory infection or an episode of allergic rhinitis. Typical signs and symptoms include nasal congestion, purulent nasal discharge, headache, cough, and facial pain or tenderness. Diagnosis is usually based on patient history and physical examination. Specialist consultation is indicated for intractable or complicated disease, signified by signs or symptoms suggestive of orbital, intraosseous, or intracranial extension of sinus disease. Most cases of ARS in the ambulatory setting are viral. In the absence of severe or rapidly worsening symptoms, antibiotic prescription should be delayed until an appropriate surveillance period has elapsed. Symptomatic therapy is the most efficient approach for uncomplicated ARS. There is a paucity of data supporting use of commonly used symptomatic therapies, with the exception of intranasal corticosteroids, which have demonstrated rapid improvement of the symptoms of ARS and return to normal functioning when used as monotherapy or as an adjunct to antibiotics.