Overview of the Treatment and Management of Rhinosinusitis
Rhinosinusitis has three cardinal symptoms: purulent nasal discharge, nasal obstruction, and facial pain-pressure-fullness. Purulent nasal discharge is cloudy or colored in appearance; nasal obstruction is defined by the patient as obstruction, congestion, blockage, or stuffiness; and facial pain-pressure-fullness involves the anterior face and periorbital region or manifests with headache that can be localized or diffuse. Secondary symptoms can include fever, cough, fatigue, hyposmia, anosmia, maxillary dental pain, and ear fullness or pressure. The 2012 IDSA guidelines help distinguish between viral and bacterial rhinosinusitis by defining three clinical presentations that may be present in bacterial but not viral infections: persistent and nonimproving symptoms, severe symptoms, or a worsening (i.e., "double sickening").
Some risk factors that predispose patients to rhinosinusitis include anatomical abnormalities, nasal allergic reactions, dental infections, mucosal abnormalities (i.e., cystic fibrosis), chemical irritants, and immunodeficiency. Some conditions that present similarly to rhinosinusitis warrant urgent referral due to possible complications, including intracranial and orbital infections. Symptoms that indicate urgent referral are diplopia, blindness, change in mental status, and periorbital edema.
Symptoms
Rhinosinusitis has three cardinal symptoms: purulent nasal discharge, nasal obstruction, and facial pain-pressure-fullness. Purulent nasal discharge is cloudy or colored in appearance; nasal obstruction is defined by the patient as obstruction, congestion, blockage, or stuffiness; and facial pain-pressure-fullness involves the anterior face and periorbital region or manifests with headache that can be localized or diffuse. Secondary symptoms can include fever, cough, fatigue, hyposmia, anosmia, maxillary dental pain, and ear fullness or pressure. The 2012 IDSA guidelines help distinguish between viral and bacterial rhinosinusitis by defining three clinical presentations that may be present in bacterial but not viral infections: persistent and nonimproving symptoms, severe symptoms, or a worsening (i.e., "double sickening").
Some risk factors that predispose patients to rhinosinusitis include anatomical abnormalities, nasal allergic reactions, dental infections, mucosal abnormalities (i.e., cystic fibrosis), chemical irritants, and immunodeficiency. Some conditions that present similarly to rhinosinusitis warrant urgent referral due to possible complications, including intracranial and orbital infections. Symptoms that indicate urgent referral are diplopia, blindness, change in mental status, and periorbital edema.