Acute sinusitis and rhinosinusitis in adults: Clinical manifestations and diagnosis
- Peter H Hwang, MD
Peter H Hwang, MD
- Chief, Division of Rhinology
- Department of Otolaryngology - Head & Neck Surgery
- Stanford University School of Medicine
- Zara M Patel, MD
Zara M Patel, MD
- Assistant Professor
- Division of Rhinology
- Department of Otolaryngology - Head and Neck Surgery
- Stanford University School of Medicine
- Section Editors
- Daniel G Deschler, MD, FACS
Daniel G Deschler, MD, FACS
- Section Editor — Otorhinolaryngology
- Professor of Otology and Laryngology
- Harvard Medical School
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
Sinusitis and rhinosinusitis refer to inflammation in the nasal cavity and paranasal sinuses. Acute rhinosinusitis (ARS) lasts less than four weeks. The most common etiology of ARS is a viral infection associated with the common cold. Distinguishing acute viral rhinosinusitis related to colds and influenza-like illnesses from bacterial infection is a frequent challenge to the primary care clinician. This topic will address the clinical manifestations and diagnosis of acute viral and bacterial rhinosinusitis. The treatment of acute viral and bacterial ARS is discussed separately. (See "Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment".)
Acute invasive fungal sinusitis, nosocomial bacterial sinusitis, and chronic rhinosinusitis are discussed separately. (See "Fungal rhinosinusitis", section on 'Invasive fungal sinusitis' and "Chronic rhinosinusitis: Clinical manifestations, pathophysiology, and diagnosis" and "Chronic rhinosinusitis: Management" and "Complications of the endotracheal tube following initial placement: Prevention and management in adult intensive care unit patients", section on 'Sinusitis'.)
DEFINITION AND CLASSIFICATION
Acute rhinosinusitis (ARS) is defined as symptomatic inflammation of the nasal cavity and paranasal sinuses (figure 1) lasting less than four weeks. The term "rhinosinusitis" is preferred to "sinusitis" since inflammation of the sinuses rarely occurs without concurrent inflammation of the nasal mucosa .
●Acute rhinosinusitis – Symptoms for less than four weeks
- Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: Establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg 2004; 131:S1.
- Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 2015; 152:S1.
- Statistics by country for sinusitis. http://www.rightdiagnosis.com/s/sinusitis/stats-country.htm (Accessed on March 27, 2012).
- Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: national health interview survey, 2012. Vital Health Stat 10 2014; :1.
- Wilson JF. In the clinic. Acute sinusitis. Ann Intern Med 2010; 153:ITC31.
- Rosenfeld RM. CLINICAL PRACTICE. Acute Sinusitis in Adults. N Engl J Med 2016; 375:962.
- Gwaltney JM Jr. Acute community-acquired sinusitis. Clin Infect Dis 1996; 23:1209.
- Mogensen C, Tos M. Quantitative histology of the maxillary sinus. Rhinology 1977; 15:129.
- Fokkens W, Lund V, Mullol J, European Position Paper on Rhinosinusitis and Nasal Polyps Group. EP3OS 2007: European position paper on rhinosinusitis and nasal polyps 2007. A summary for otorhinolaryngologists. Rhinology 2007; 45:97.
- Scheid DC, Hamm RM. Acute bacterial rhinosinusitis in adults: part I. Evaluation. Am Fam Physician 2004; 70:1685.
- Evans FO Jr, Sydnor JB, Moore WE, et al. Sinusitis of the maxillary antrum. N Engl J Med 1975; 293:735.
- Meltzer EO, Hamilos DL. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clin Proc 2011; 86:427.
- Young J, De Sutter A, Merenstein D, et al. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet 2008; 371:908.
- Chow AW, Benninger MS, Brook I, et al. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clin Infect Dis 2012.
- Berg O, Carenfelt C. Analysis of symptoms and clinical signs in the maxillary sinus empyema. Acta Otolaryngol 1988; 105:343.
- Axelsson A, Runze U. Symptoms and signs of acute maxillary sinusitis. ORL J Otorhinolaryngol Relat Spec 1976; 38:298.
- Axelsson A, Runze U. Comparison of subjective and radiological findings during the course of acute maxillary sinusitis. Ann Otol Rhinol Laryngol 1983; 92:75.
- Williams JW Jr, Simel DL, Roberts L, Samsa GP. Clinical evaluation for sinusitis. Making the diagnosis by history and physical examination. Ann Intern Med 1992; 117:705.
- Fokkens W, Lund V, Bachert C, et al. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy 2005; 60:583.
- Gwaltney JM Jr, Hendley JO, Simon G, Jordan WS Jr. Rhinovirus infections in an industrial population. II. Characteristics of illness and antibody response. JAMA 1967; 202:494.
- Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012; 54:e72.
- Gwaltney JM Jr, Scheld WM, Sande MA, Sydnor A. The microbial etiology and antimicrobial therapy of adults with acute community-acquired sinusitis: a fifteen-year experience at the University of Virginia and review of other selected studies. J Allergy Clin Immunol 1992; 90:457.
- Hadley JA, Mösges R, Desrosiers M, et al. Moxifloxacin five-day therapy versus placebo in acute bacterial rhinosinusitis. Laryngoscope 2010; 120:1057.
- Bird J, Biggs TC, Thomas M, Salib RJ. Adult acute rhinosinusitis. BMJ 2013; 346:f2687.
- Low DE, Desrosiers M, McSherry J, et al. A practical guide for the diagnosis and treatment of acute sinusitis. CMAJ 1997; 156 Suppl 6:S1.
- Havas TE, Motbey JA, Gullane PJ. Prevalence of incidental abnormalities on computed tomographic scans of the paranasal sinuses. Arch Otolaryngol Head Neck Surg 1988; 114:856.
- Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991; 101:56.
- Gwaltney JM Jr, Phillips CD, Miller RD, Riker DK. Computed tomographic study of the common cold. N Engl J Med 1994; 330:25.
- Berger G, Steinberg DM, Popovtzer A, Ophir D. Endoscopy versus radiography for the diagnosis of acute bacterial rhinosinusitis. Eur Arch Otorhinolaryngol 2005; 262:416.
- Lau J, Zucker D, Engels EA, et al. Diagnosis and treatment of acute bacterial rhinosinusitis. Evid Rep Technol Assess (Summ) 1999; :1.
- Fokkens WJ, Hoffmans R, Thomas M. Avoid prescribing antibiotics in acute rhinosinusitis. BMJ 2014; 349:g5703.
- Fokkens WJ, Lund VJ, Mullol J, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl 2012; :3 p preceding table of contents, 1.
- Desrosiers M, Evans GA, Keith PK, et al. Canadian clinical practice guidelines for acute and chronic rhinosinusitis. J Otolaryngol Head Neck Surg 2011; 40 Suppl 2:S99.
- Benninger MS, Appelbaum PC, Denneny JC, et al. Maxillary sinus puncture and culture in the diagnosis of acute rhinosinusitis: the case for pursuing alternative culture methods. Otolaryngol Head Neck Surg 2002; 127:7.
- Benninger MS, Payne SC, Ferguson BJ, et al. Endoscopically directed middle meatal cultures versus maxillary sinus taps in acute bacterial maxillary rhinosinusitis: a meta-analysis. Otolaryngol Head Neck Surg 2006; 134:3.
- Talbot GH, Kennedy DW, Scheld WM, et al. Rigid nasal endoscopy versus sinus puncture and aspiration for microbiologic documentation of acute bacterial maxillary sinusitis. Clin Infect Dis 2001; 33:1668.
- Gold SM, Tami TA. Role of middle meatus aspiration culture in the diagnosis of chronic sinusitis. Laryngoscope 1997; 107:1586.
- Vogan JC, Bolger WE, Keyes AS. Endoscopically guided sinonasal cultures: a direct comparison with maxillary sinus aspirate cultures. Otolaryngol Head Neck Surg 2000; 122:370.
- DEFINITION AND CLASSIFICATION
- PATHOPHYSIOLOGY AND MICROBIOLOGY
- Acute viral rhinosinusitis
- Acute bacterial rhinosinusitis
- CLINICAL FEATURES
- Physical findings
- Radiologic features
- DIAGNOSIS AND EVALUATION
- Uncomplicated acute rhinosinusitis
- - Acute viral rhinosinusitis
- - Acute bacterial rhinosinusitis
- - Supportive testing
- Complicated acute bacterial rhinosinusitis
- DIFFERENTIAL DIAGNOSIS
- Acute invasive fungal rhinosinusitis
- The common cold
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS