Is it important to distinguish acute bacterial rhinosinusitis (sinus infection) from acute viral or noninfectious rhinosinusitis, and what are the clues for differentiation?

Updated: Mar 01, 2018
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Michael Stuart Bronze, MD  more...
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A consensus statement published in 2007 in Otolaryngology-Head and Neck Surgery made strong recommendations that clinicians should distinguish between acute rhinosinusitis caused by bacterial causes and those episodes caused by viral upper respiratory infections and noninfectious conditions. [29]

The panel suggests that the diagnosis of acute bacterial sinusitis be entertained when (1) symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or (2) symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement. A history of purulent secretions and facial or dental pain are specific symptoms that may point to a bacterial etiology. In a patient in intensive care, acute sinusitis should be suspected in the presence of sepsis of unknown origin.

The consensus statement is in accordance with the AAAAI 2005 practice parameter for diagnosis and management of sinusitis, which states that upper respiratory tract infections persisting after 10-14 days are suspicious for acute bacterial sinusitis. The likelihood of bacterial disease increases if the infection history includes persistent purulent rhinorrhea, postnasal drainage, and facial pain. [2]

The 2007 guidelines [29] were updated in 2015 [30] based on evidence from 42 new systematic reviews. They included a new algorithm to clarify action statement relationships and expanded opportunities for watchful waiting (without antibiotic therapy) as initial therapy for acute bacterial rhinosinusitis. They strongly recommended that clinicians (1) distinguish presumed acute bacterial rhinosinusitis from acute sinusitis caused by viral upper respiratory infections and noninfectious conditions and (2) confirm a clinical diagnosis of chronic sinusitis with objective documentation of sinonasal inflammation, which may be accomplished using anterior rhinoscopy, nasal endoscopy, or computed tomography.

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