The American Academy of Otolaryngology—Head and Neck Surgery Foundation has published an updated “Clinical Practice Guideline: Adult Sinusitis” as a supplement to Otolaryngology–Head and Neck Surgery. The guideline recommendations address diagnostic accuracy for adult rhinosinusitis, the appropriate use of ancillary tests to confirm diagnosis and guide management (including radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function), and the judicious use of systemic and topical therapy. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia.
The treatment recommendations include:
Symptoms of viral sinusitis can be treated symptomatically by relieving pain, and administration of nasal steroid sprays, and/or nasal saline rinse (irrigation).
Acute bacterial sinus can be watchful waited without antibiotics or be treated with an antibiotic. If a decision is made to treat acute bacterial sinus infection with an antibiotic, amoxicillin will likely be prescribed. A combination of amoxicillin with clavulanate for 5 to 10 days may also be prescribed as a different treatment. If after 7 days the patient feel worse or does not improve (whether receiving antibiotic treatment or not) he/she should see their healthcare provider. The healthcare provider will review the diagnosis and exclude other causes. The provider may also decide to start or change antibiotics. To relieve symptoms, the healthcare provider may recommend over-the-counter treatments. These include pain relievers, nasal steroid sprays, decongestants, mucus thinners, cough suppressants, and nasal saline rinse.