Alabama Nasal & Sinus Center

Alabama Nasal & Sinus Center

Sinusitis Guidelines

Sinusitis Guidelines

Though not topping the headlines of your local newspaper or headlining the prime time shows on Fox News or CNN, the American Academy of Otolaryngology – Head and Neck Surgery just made news in the world of ear, nose, and throat specialists.  The Academy released its long awaited update to the clinical practice guideline for adult rhinosinusitis.  (Gasp!! Ooo! Ahhh!)  The 14 developed recommendations address diagnostic accuracy for adult rhinosinusitis, the appropriate use of ancillary tests to confirm diagnosis and guide management (including radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function), and the judicious use of systemic and topical therapy. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia.  An updated guideline is needed as a result of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.

We ENT doctors get all geeked out on this stuff.  It’s what we do!  The full text of the guideline document is a hearty thirty-nine pages with essentially no pictures.  I read the whole thing.  Again, it’s what I do.  I would not suggest you, the non-professional try that at home, unless you are suffering from insomnia.  But, there are some things in there that will affect how we practice and thus will become important to you if you are or have been a patient who suffers acute sinusitis.  To begin, we should define some terms for everyone. 


Acute rhinosinusitis:  Up to 4 weeks of purulent (pus-like) nasal drainage (anterior, posterior, or both) accompanied by nasal obstruction, facial pain, or both.

Acute bacterial rhinosinusitis:  Acute rhinosinusitis that is caused by, or is presumed to be caused by, bacterial infection. A clinician should diagnose acute bacterial rhinosinusitis when

  • Purulent nasal discharge is cloudy or colored, in contrast to the clear secretions that typically accompany viral upper respiratory infection, and it may be reported by the patient or observed on physical examination.
  • Nasal obstructionmay be reported by the patient as nasal obstruction, congestion, blockage, or stuffiness, or it may be diagnosed by physical examination.
  • Facial pain/pressure/fullness may involve the anterior face or periorbital region, or it may manifest with headache that is localized or diffuse.

 a. symptoms or signs of acute rhinosinusitis fail to improve within 10 days or more beyond the onset of upper respiratory symptoms


b. symptoms or signs of acute rhinosinusitis worsen within 10 d after an initial improvement (double worsening).  


Well, that's probably enough for now.  Stay tuned for more definitions and explanation of our treatment rationale.  The take home message for today is that acute sinusitis can last up to four weeks and that antibiotics are not considered primary therapy until symptoms have been present for at least ten days.  Whoa!  That may seem like a long time when your head feels like it's going to blow up.  Again, stay tuned.  We'll talk more about this in future posts or when you come see us.  Call 205-980-2091 to schedule an appointment now. 

Point-of-Care CT Imaging
Sinusitis Guidelines 2