Evidence-Based Evaluation and Treatment of Acute Rhinosinusitis in Adults

Why is distinguishing viral from bacterial rhinosinusitis challenging?

Nasal and sinus symptoms overlap across several conditions. The issue reviews how the illness course and clinical context inform that distinction.

How does watchful waiting fit into urgent care management?

Watchful waiting and delayed prescribing are reviewed as approaches to selected uncomplicated presentations. The discussion includes patient preferences, communication, and follow-up considerations.

What does the issue cover about antibiotics and symptom relief?

The review addresses antibiotic selection alongside commonly used prescription, over-the-counter, and home treatments. It emphasizes the balance between expected benefit, medication risks, and stewardship.

Which presentations raise concern beyond routine rhinosinusitis?

The issue examines orbital and intracranial complications, immunocompromised patients, and odontogenic disease. These presentations can involve different risks, care needs, and warrant higher level of evaluation.

Can respiratory testing simplify sinusitis decisions?

The review discusses potential roles and limitations of point-of-care biomarkers and multiplex respiratory tests. It also explores why test results must be interpreted within the clinical context.

CASE 1 — Familiar Sinus Symptoms and Treatment Expectations: A healthy 45-year-old woman presents with several days of sore throat, rhinorrhea, congestion, and cough, describing a pattern previously treated with azithromycin and a steroid pack. The case explores how prior prescribing shapes expectations and how clinicians discuss the current illness and treatment options.

CASE 2 — Worsening After Initial Improvement: A healthy 35-year-old man reports a prolonged cold that briefly improved before worsening with increasing facial pain and pressure. The case highlights the importance of illness trajectory when weighing viral and bacterial explanations and management choices.

CASE 3 — Severe Unilateral Symptoms in a Medically Complex Patient: A 73-year-old woman with diabetes and adalimumab use presents acutely ill with fever, unilateral cheek pain, facial redness, and swelling. The case focuses on recognizing when patient risk and examination findings challenge the assumption of routine outpatient sinusitis care.

• An anatomical illustration of sinus infection and a summary of causes of acute sinus symptoms.
• A reference describing rhinosinusitis timing and illness patterns, plus a summary of risk factors for bacterial disease.
• Antibiotic selection covering factors favoring broader coverage, shorter treatment options, and allergy considerations.
• Communication strategies for discussing symptom relief, antibiotic expectations, and delayed prescribing with patients.
• Pediatric references covering presentation patterns, pathogens, and antibiotic treatment considerations.
• Clinical pathways for urgent care evaluation and management of adult and pediatric rhinosinusitis.
• A coding case and medical decision-making reference illustrating documentation and evaluation and management service selection.

• Repeating previous antibiotic prescriptions without reassessing the current illness.
• Using systemic corticosteroids routinely for sinus symptoms.
• Overlooking a suppurative complication after a positive viral test.
• Missing immunosuppressive medications in the treatment history.
• Assuming a negative multiplex respiratory panel establishes bacterial disease.