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.
