10-Minute Consultation

Adult acute rhinosinusitis

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2687 (Published 10 May 2013)
Cite this as: BMJ 2013;346:f2687

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  1. J Bird, core trainee year 1, ENT1,
  2. TC Biggs, core trainee year 2, ENT1,
  3. M Thomas, professor of primary care research2,
  4. RJ Salib, senior lecturer in rhinology; consultant otorhinolaryngologist13
  1. 1Department of Otolaryngology/Head & Neck Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
  2. 2University of Southampton, Aldermoor Health Centre, Southampton
  3. 3Clinical Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton
  1. Correspondence to: J Bird jonathan.bird83{at}googlemail.com
  • Accepted 28 December 2012

A 35 year old woman presents to her general practitioner with a 10 day history of worsening nasal congestion, purulent nasal discharge, and frontal headaches.

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Rhinosinusitis (including nasal polyps) is an inflammatory condition of the nose and paranasal sinuses. Diagnosis requires at least two symptoms, one of which must be nasal discharge or obstruction, with the others comprising facial pain or smell disturbance.

Acute rhinosinusitis is defined as symptoms lasting less than 12 weeks with complete resolution and can be subdivided into

  • Acute viral rhinosinusitis (common cold)—Defined by duration of symptoms of less than 10 days.

  • Acute non-viral rhinosinusitis—Defined by an increase in symptoms after 5 days or persistent symptoms after 10 days.

  • Acute bacterial rhinosinusitis—Suggested by the presence of at least three symptoms or signs of

    • Discoloured discharge (with unilateral predominance) and purulent secretions

    • Severe local pain (with unilateral predominance)

    • Fever (>38°C)

    • Elevated erythrocyte sedimentation rate or C reactive protein

    • “Double sickening” (that is, a deterioration after an initial milder illness).

Chronic rhinosinusitis (with or without polyps) is defined as more than 12 weeks of symptoms without complete resolution.

The following points are important within the history in acute rhinosinusitis:

  • Nasal blockage, obstruction, or congestion—Is the blockage unilateral or bilateral? Acute rhinosinusitis is usually associated with bilateral symptoms. With unilateral symptoms, bear in mind the possibility (albeit rare) of an underlying malignancy.

  • Nasal discharge (anterior or posterior nasal drip)—Attempts should be made to assess and record the character, amount, and pattern of nasal discharge over time.

  • Facial pain or pressure—Facial pain without …

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