Acute viral rhinosinusitis

Acute viral rhinosinusitis should be diagnosed in patients with typical symptoms of rhinosinusitis for less than 10 days and in whom symptoms are not worsening (Strong recommendation)

Do not obtain radiographic imaging for acute rhinosinusitis unless a complication or alternative diagnosis is suspected (Recommendation)

Symptomatic relief may be prescribed (Option)

Acute bacterial rhinosinusitis

Management should include pain assessment (Strong recommendation)

Symptomatic relief may be prescribed (Option)

Observation without antibiotic treatment is an option for some patients with mild, uncomplicated illness (Option)

If antibiotic treatment is initiated, amoxicillin should be the first-line therapy (Recommendation)

If the patient does not improve with initial management within seven days of diagnosis, reassess the diagnosis and management options; initiate or change antibiotic therapy (Recommendation)

Chronic and recurrent acute rhinosinusitis

Chronic and recurrent acute rhinosinusitis should be distinguished from other illnesses (Recommendation)

Patients should be assessed for factors that modify management such as allergic rhinitis, cystic fibrosis, immunocompromised state, ciliary dyskinesia, anatomic variations (Recommendation)

Diagnosis should be corroborated and/or underlying causes should be identified (Recommendation)

Nasal endoscopy may be performed during evaluation or diagnosis (Option)

Computed tomography of the paranasal sinuses should be performed during evaluation or diagnosis (Recommendation)

Allergy or immune testing may be performed during evaluation (Option)

Patients should be educated about preventive measures (Recommendation)