Evidence-Based Evaluation and Treatment of Acute Rhinosinusitis in Adults

November 2026 Postscript #1

Test Your Knowledge

A 46-year-old man presents with 12 days of nasal congestion, cough, and facial pressure. His symptoms initially improved around day 6, but 3 days later he developed increasing unilateral maxillary pain, worsening nasal discharge, and recurrent congestion. He has no significant medical history, medication allergies, or recent antibiotic use.

His vital signs are temperature, 100.2°F; heart rate, 86 beats/min; blood pressure, 126/78 mm Hg; respiratory rate, 16 breaths/min; and SpO₂, 98% on room air. Examination shows nasal congestion and mild right maxillary tenderness without facial swelling, orbital abnormalities, or neurologic findings.

Which finding most strongly supports a diagnosis of acute bacterial rhinosinusitis in this patient?

1. Green nasal discharge
2. Facial tenderness
3. Temperature >100˚F
4. Worsening after initial improvement