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Rhinosinusitis — Clinical Guidelines

Overview

Rhinosinusitis, characterized by symptomatic inflammation of the paranasal sinuses and nasal cavity, affects both pediatric and adult populations, leading to significant healthcare utilization 4 1.

Diagnosis

Clinical diagnosis primarily based on symptoms such as facial pain/pressure, nasal congestion, and purulent discharge 4.

Imaging (CT scans) is generally not required for uncomplicated cases 4.

Diagnostic tools like SNOT-22 and NOSE-scale can provide additional symptom assessment 2.

Management

First-line treatment: Symptomatic relief with saline irrigation, decongestants, and analgesics 4.

Antibiotics: Not routinely necessary for uncomplicated cases; reserved for severe or worsening symptoms 4. When indicated, amoxicillin (5-10 days) is recommended as first-line 4.

Avoid overuse: Minimize unnecessary diagnostic imaging and antibiotic prescriptions to prevent resistance 5.

Special Populations

Pediatrics: Preventive strategies should be holistic, integrating medical and policy support 1.

Immunocompromised patients: Tailored management approaches are needed due to varied outcomes influenced by patient and treatment factors 9.

Key Recommendations

Avoid unnecessary antibiotic use for uncomplicated rhinosinusitis to prevent resistance (Evidence: Strong 4 5).

Utilize clinical criteria strictly for diagnosis to minimize inappropriate antibiotic prescriptions (Evidence: Moderate 4).

Consider patient education and counseling as part of management to improve outcomes (Evidence: Moderate 8).

Evaluate and manage rhinosinusitis in immunosuppressed patients with specialized care plans (Evidence: Weak 9).

Monitor and limit diagnostic imaging to reduce unnecessary exposure and healthcare costs (Evidence: Moderate 5).

References

1 De Bernardi F, Zeroli C, Coecke S, Landi M, Gallo S, Castelnuovo P et al.. Empower your child's health: tailored strategies to prevent rhinosinusitis. Jornal de pediatria 2025. link 2 van Hof KS, Herkendaal AF, Ten Koppel PGJ, Baatenburg de Jong RJ, Sewnaik A, Offerman MPJ. Patients' and Physicians' Perspectives on Using an ePRO Structure at the Otorhinolaryngology Outpatient Clinic. The Laryngoscope 2025. link 3 Kudo A. Liver, Stroke, Rhinosinusitis. Advances in experimental medicine and biology 2019. link 4 Wyler B, Mallon WK. Sinusitis Update. Emergency medicine clinics of North America 2019. link 5 Jaume F, Quintó L, Alobid I, Mullol J. Overuse of diagnostic tools and medications in acute rhinosinusitis in Spain: a population-based study (the PROSINUS study). BMJ open 2018. link 6 Yan J, Shen J, Li Y, Tang F, Chen N. Survey about the use of clarithromycin in an ENT outpatient department of a tertiary hospital. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2017. link 7 Poetker DM, Smith TL. What rhinologists and allergists should know about the medico-legal implications of antibiotic use: a review of the literature. International forum of allergy & rhinology 2015. link 8 Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M et al.. Clinical practice guideline (update): adult sinusitis. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2015. link 9 Dao AM, Rereddy SK, Wise SK, DelGaudio JM, Patel ZM. Management of non-invasive rhinosinusitis in the immunosuppressed patient population. The Laryngoscope 2015. link 10 Parhar HS, Thamboo A, Habib AR, Chang B, Gan EC, Javer AR. The interrater and intrarater reliability of the Philpott-Javer staging system based on level of training. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2014. link 11 Folbe AJ, Svider PF, Setzen M, Zuliani G, Lin HS, Eloy JA. Scientific inquiry into rhinosinusitis: who is receiving funding from the National Institutes of Health?. The Laryngoscope 2014. link 12 Niles JK, Webber MP, Liu X, Zeig-Owens R, Hall CB, Cohen HW et al.. The upper respiratory pyramid: early factors and later treatment utilization in World Trade Center exposed firefighters. American journal of industrial medicine 2014. link 13 Gelardi M, Marchisio P, Caimmi D, Incorvaia C, Albertario G, Bianchini S et al.. Pathophysiology, favoring factors, and associated disorders in otorhinosinusology. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology 2012. link 14 Newton JR, Santangeli L, Shakeel M, Ram B. Use of complementary and alternative medicine by patients attending a rhinology outpatient clinic. American journal of rhinology & allergy 2009. link 15 Chester AC. Symptoms of rhinosinusitis in patients with unexplained chronic fatigue or bodily pain: a pilot study. Archives of internal medicine 2003. link 16 Werning JW, Preston TW, Khuder S. Physician specialty is associated with differences in the evaluation and management of acute bacterial rhinosinusitis. Archives of otolaryngology--head & neck surgery 2002. link 17 Senior BA, Glaze C, Benninger MS. Use of the Rhinosinusitis Disability Index (RSDI) in rhinologic disease. American journal of rhinology 2001. link 18 Blumenthal HJ. Headaches and sinus disease. Headache 2001. link 19 Krouse JH, Krouse HJ. Patient use of traditional and complementary therapies in treating rhinosinusitis before consulting an otolaryngologist. The Laryngoscope 1999. link 20 Friedman WH, Katsantonis GP, Rosenblum BN, Cooper MH, Slavin R. Sphenoethmoidectomy: the case for ethmoid marsupialization. The Laryngoscope 1986. link

Rhinosinusitis