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Diagnosis and Management of Acute Rhinosinusitis

Sinusitis remains one of the most common reasons for seeking medical treatment in the United States. Each year 1 out of 7 adults will suffer from acute sinusitis, with over 30 million cases reported each year. Recognizing the symptoms of sinusitis and current best practice guidelines can help to alleviate symptoms and avoid complications.


A diagnosis of rhinosinusitis is probable if 2 or more major symptoms, or 1 major and 2 or more minor symptoms are present.


Major and Minor Symptoms


If symptoms are present for less than 10 days, the treatment goal is to alleviate symptoms, as most cases will resolve within one week. Early treatment recommendations:

  • avoid dehydrating substances such as drinks containing caffeine or alcohol
  • nasal saline rinses or irrigations
  • topical decongestants like Afrin or Neosynephrine (limit use to 4 days)
  • oral antihistamines/decongestants (Benadryl, Dayquil, Bromfed DM) particularly if copious watery mucus
  • mucoevacuants to thin secretions and facilitate drainage (guaifenesin)
  • topical steroids (like Fluticasone)
  • topical antihistamines (like Azelastine)
  • oral steroids may be considered if strong history of severe allergic or inflammatory disease

If symptoms persist beyond 10 days, or if there is an acute worsening after 5 days, treatment should include an antibiotic prescribed by your doctor.

  • Antibiotic course should be of 14 days duration to ensure complete response and avoid selection of resistant bacteria.
  • Antibiotic choice may be culture-directed if appropriate sinus culture is performed.
  • Persistence of purulent drainage beyond 5 days after starting antibiotic therapy should trigger a return visit to the doctor.
  • Any severe worsening of symptoms despite antibiotic therapy, such as facial or eye swelling, fever > 102, or cognitive changes is a medical emergency. Patients should seek immediate medical attention, as these symptoms may represent a vision-threatening or life-threatening complication of sinusitis.

We are here to help you

If you are suffering from a persistent sinus infection, our experts at Greenville Ear, Nose, and Throat Associates want to hear from you. We will perform a thorough evaluation and come up with a treatment plan specific for you.