Acute bacterial rhinosinusitis is the mucosal inflammation of the nose and paransal sinuses caused by bacteria lasting >10 days for up to 4 weeks or symptoms worsening for 5-7 days and is <12 weeks with complete resolution of symptoms.
It is often preceded by a viral upper respiratory tract infection.
Signs and symptoms are nonspecific and typically difficult to differentiate from viral upper respiratory tract infection.
There is fever with nasal obstruction/congestion or anterior and/or posterior purulent drainage, with or without facial pressure/pain/fullness and reduction/loss of smell.
Streptococcus pneumoniae and unencapsulated strains of Haemophilus influenzae cause half of acute rhinosinusitis cases.

Differential Diagnosis

  • Acute viral rhinosinusitis
    • Has similar signs and symptoms (nasal discharge and congestion, cough) as ABRS but symptom improvement is usually seen within 10 days
  • Acute invasive fungal rhinosinusitis
    • Has similar symptoms with ARS but in acute invasive fungal rhinosinusitis, the symptoms rapidly progress and the infection has already extended outside the sinuses at presentation
    • Patients with uncontrolled diabetes and those who are immunocompromised are the ones who usually develop acute invasive fungal rhinosinusitis
  • Common cold
    • The symptoms of common cold and viral or post-viral ARS may overlap (eg sneezing, anterior or posterior rhinorrhea), but the common cold generally does not have facial pain
    • Associated with sore throat or cough
  • Other conditions that cause rhinitis, facial pain, headache or dental pain
    • Allergic rhinitis and nonallergic vasomotor rhinitis may present with rhinorrhea and nasal congestion, but can be distinguished from ARS in the presence of nasal congestion, rhinorrhea, sneezing and nasal itching
    • Facial pain or pressure, headache or purulent nasal drainage are absent in allergic rhinitis
    • Facial pain is present in patients with neuralgias, cancer pain, temporomandibular joint disorder or carotidynia and these patients do not present with the other symptoms of ARS
    • Patients with dental pain should be directly asked for prior dental procedures as they may have referred pain without an actual infection within the sinuses
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