Acute Rhinosinusitis

- Executive Summary

1- Definition: Acute rhinosinusitis (ARS) is considered when symptoms and signs are present less than 4 weeks. (Strong recommendation)

2- Diagnosis of acute ARS through symptoms/signs and duration:

     -Symptoms must include most of the followings (All can be included in CPODS)

    C: Congestion, P: Pain, O: Obstruction,D: Drainage/Discharge,S: Smell affection

(Strong recommendation)

3- A thorough physical examination that includes inspection , palpation of the maxillary and frontal sinus, as well as anterior rhinoscopy (evidence of inflammation, mucosal oedema, and discharge). (Conditional recommendation)

4- Objective evidence of ARS on nasal endoscopy, antral puncture, or radiographic imaging (X-ray, ultrasonography, or CT) is not required for the diagnosis in uncomplicated cases. (Strong recommendation against)

5- ESR and CRP are inflammatory markers found to be elevated during ARS, but they are not routinely used for diagnosis because of their limited specificity. It can be used in COVID-19 . (Conditional recommendation)

6- Differentiate viral from bacterial ARS: -Duration is thought to be a key   factor differentiating ABRS from AVR, with persistence of symptoms beyond 7-10 days or worsening of symptoms after 5 days being indicators of development of post-viral ABRS.

     -Clinical factors associated with symptoms and signs ABRS include:

      Timing of the disease, worsening of the disease, purulent nasal discharge on rhinoscopy, localized unilateral pain, severe pain over the teeth and maxilla, and fever > 38˚C. (conditional recommendation)

7- Consider initial watchful waiting in uncomplicated   cases with assurance of follow up. (conditional recommendation)

8- Institution of antibiotic therapy if:

    A. No improvement after 4-7 days or worsening at any time,

    B. Mitigating circumstances with drug resistance e.g., severe   symptoms and immunocompromised states

    C. Concern for impending complications

    D. Suspected odontogenic source

    E. Prior antibiotics (1 month), prior hospitalization (5 days) and comorbidities.

(Conditional recommendation)

 9- If a decision is made to treat ABRS with an antibiotic, the clinician should prescribe amoxicillin with clavulanate (conditional recommendation)

10- First time non-responders can be based on lack of clinical improvement following treatment within 5 days in adults and 3 days in children. -Use second line antimicrobial agents. (Conditional recommendation)

11- In patients with ABRS suspected to have suppurative complications, axial, coronal and sagittal views with contrast-enhanced computed tomography (CT) is rec­ommended. (Conditional recommendation)

12- Recurrent acute rhinosinusitis RARS is diagnosed when At least 4 attacks of ABRS/year are documented (Conditional recommendation)

     -Consider Nasal endoscopy and/or CT imaging are an option during at least one episode of suspected RARS (Conditional recommendation)

     -Endoscopic sinus surgery (ESS) is recommended for pa­tients with RARS. (Conditional recommendation)