Diagnosis and Management of Acute Rhinosinusitis

Abstract

In 1997 the Rhinosinusitis Task Force published the first definitions and guidelines for the diagnosis of rhinosinusitis in the otolaryngological literature. In general, rhinosinusitis was defined as a manifestation of an inflammatory response involving the mucous membranes of the sinonasal cavities with or without involvement of the underlying bone. As such, it manifests with symptoms and physical findings over a particular timeframe. To establish a consistent definition among all health care professionals treating patients, major and minor criteria incorporating these symptoms and physical findings were established (see Chapter 1, Table 1.1). A time factor was thought necessary to distinguish various forms of rhinosinusitis including acute, subacute, and chronic. Therefore, acute rhinosinusitis was defined by a sudden onset with symptoms lasting no more than 4 weeks, while subacute rhinosinusitis encompassed symptoms lasting for 4 to 12 weeks (thought to reflect acute rhinosinusitis that had not completely resolved itself). Finally, chronic rhinosinusitis was defined by symptoms lasting more than 12 weeks with either two or more major factors or one major and two minor factors [1]. Notable in these criteria is that fever and/or facial pressure/pain without other nasal factors do not by themselves constitute a diagnosis of rhinosinusitis. Additionally, in contrast to acute rhinosinusitis, fever is not a major factor in subacute rhinosinusitis as the symptoms overall are less severe in nature. Since the original attempt to clinically define rhinosinusitis in 1997, the guidelines have been enhanced to make them more useful. In the 2007 clinical practice guidelines, acute rhinosinusitis was further subdivided—based on symptom pattern—into acute bacterial rhinosinusitis (ABRS) and viral rhinosinusitis (VRS), which are further discussed under “Presenting Symptoms and Signs [2]. ” In the 2005 position paper by the European Academy of Allergology and Clinical Immunology, the definition of acute rhinosinusitis is symptom based. Acute rhinosinusitis is defined as the sudden onset of two or more of the following symptoms for less than 12 weeks: blockage/congestion, rhinorrhea/postnasal drip, facial pressure/pain, and reduction/loss of sense of smell. Symptom-free intervals must also exist if the problem is intermittent in nature. Acute viral rhinosinusitis is further defined as symptoms lasting less than 10 days, whereas a worsening of symptoms after 5 days or with persistence of symptoms after 10 days (but less than 12 weeks) constitutes acute nonviral rhinosinusitis [3].