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Curr Opin Otolaryngol Head Neck Surg. 2008 Jun;16(3):226-30. doi: 10.1097/MOO.0b013e3282fdcc9a.

Review of current guidelines related to the diagnosis and treatment of rhinosinusitis.

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  • 1Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL 60611, USA.



Rhinosinusitis is one of the most common medical complaints, affecting nearly 31 million US citizens annually. Multiple medical professionals including emergency medicine, internal medicine, allergy, and otolaryngology treat rhinosinusitis, resulting in high-practice variability. This review will discuss recommendations of the 2007 American Academy of Otolaryngology - Head and Neck Surgery's multispecialty panel on evidence based clinical practice guidelines for diagnosis and treatment of rhinosinusitis.


The task force for recommendations defines rhinosinusitis as follows: acute bacterial, viral, chronic, or recurrent acute rhinosinusitis. For acute rhinosinusitis three symptoms are required: purulent nasal discharge with nasal obstruction and/or facial pain-pressure-fullness lasting between 10 days and 4 weeks. For viral rhinosinusitis, imaging is not recommended and treatment is symptomatic. For acute bacterial rhinosinusitis in an otherwise healthy patient, symptomatic relief is recommended including pain control. Amoxicillin is the first-line antibiotic of choice if needed. Radiographic imaging should be considered if an infectious complication is suspected. Chronic rhinosinusitis is likely when symptoms persist for greater than 12 weeks, with computed tomography being the gold standard for diagnostic testing. Nasal endoscopy and allergy/immune testing are also considered.


Accurate diagnosis of rhinosinusitis with recommended treatments should standardize management. However, these recommendations are guidelines and the clinician's judgment is highly important.

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