rhinosinusitis%20-%20acute,%20bacterial
RHINOSINUSITIS - ACUTE, BACTERIAL
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.

Otolaryngologist Referral

  • Reassure and educate the patient about the nature of URTI and ABRS and expected duration of illness
  • Encourage the patient to implement home self-care measures to provide relief of symptoms and prevent the occurrence of ABRS
  • Maintain adequate hydration by drinking 6-10 glasses of water/day to thin the mucus
  • Steamy baths: Inhaled steam (from a hot bath/shower) may loosen secretions
  • If necessary, increase humidity at home
  • Apply warm facial packs (eg warm wash cloth, hot water bottle) for 5-10 minutes ≥3 x/day to promote drainage of mucus and provide some localized relief
  • Adequate rest
  • Avoid irritants that affect sinuses eg cigarette smoke, extreme cool or dry air, pollution, swimming in contaminated water and barotrauma
  • Appropriate management of allergies and viral URTI (eg frequent handwashing)
  • There is little evidence on the efficacy of phytomedical preparations, immunomodulators and bacterial lysate preparations
  • There is no proven benefit to the use of mist, zinc salt lozenges, ascorbic acid, or echinacea
Treatment with Antibiotics
  • Educate the patient about worsening signs and symptoms that should prompt them to contact a physician 
  • It is important to counsel the patient on the use of the medications and its dosing schedule and the potential adverse effects
  • It is important to instruct the patient to complete the course of antibiotics
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