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Clinical Practice Guideline (Update): Adult Sinusitis
Open accessAbstract
Objective: This update of a 2007 guideline from the American Academy of Otolaryngology—Head and Neck Surgery Foundation provides evidence‐based recommendations to manage adult rhinosinusitis, defined as symptomatic inflammation of the paranasal sinuses and nasal cavity. Changes from the prior guideline include a consumer added to the update group, evidence from 42 new systematic reviews, enhanced information on patient education and counseling, a new algorithm to clarify action statement relationships, expanded opportunities for watchful waiting (without antibiotic therapy) as initial therapy of acute bacterial rhinosinusitis (ABRS), and 3 new recommendations for managing chronic rhinosinusitis (CRS). Purpose: The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing adult rhinosinusitis and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy for adult rhinosinusitis, promote appropriate use of ancillary tests to confirm diagnosis and guide management, and promote judicious use of systemic and topical therapy, which includes radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia. Action statements: The update group made strong recommendations that clinicians (1) should distinguish presumed ABRS from acute rhinosinusitis (ARS) caused by viral upper respiratory infections and noninfectious conditions and (2) should confirm a clinical diagnosis of CRS with objective documentation of sinonasal inflammation, which may be accomplished using anterior rhinoscopy, nasal endoscopy, or computed tomography. The update group made recommendations that clinicians (1) should either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated ABRS; (2) should prescribe amoxicillin with or without clavulanate as first‐line therapy for 5 to 10 days (if a decision is made to treat ABRS with an antibiotic); (3) should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications if the patient worsens or fails to improve with the initial management option by 7 days after diagnosis or worsens during the initial management; (4) should distinguish CRS and recurrent ARS from isolated episodes of ABRS and other causes of sinonasal symptoms; (5) should assess the patient with CRS or recurrent ARS for multiple chronic conditions that would modify management, such as asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia; (6) should confirm the presence or absence of nasal polyps in a patient with CRS; and (7) should recommend saline nasal irrigation, topical intranasal corticosteroids, or both for symptom relief of CRS. The update group stated as options that clinicians may (1) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief of viral rhinosinusitis; (2) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation) for symptomatic relief of ABRS; and (3) obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent ARS. The update group made recommendations that clinicians (1) should not obtain radiographic imaging for patients who meet diagnostic criteria for ARS, unless a complication or alternative diagnosis is suspected, and (2) should not prescribe topical or systemic antifungal therapy for patients with CRS.
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The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“ARS is defined as the sudden onset of sinonasal symptoms with associated sinonasal inflammation that lasts less than 4 weeks.1,137,138,266,267”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Fever is not included in other guidelines, due to its low specificity and sensitivity.137”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“RARS is defined as at least 4 episodes of ARS per year, with disease-free intervals between episodes.1,137,138,266,268”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The development of acute, moderate to severe symptoms, and nasal purulence may be consistent with ARS or RARS rather than AR.1,137,138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Moderate to severe facial pain and/or fever would also be atypical for isolated AR and may indicate the presence of an episode of ARS or an acute exacerbation of CRS, differentiated by duration and chronicity of symptoms.1,137,138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Progressive worsening over a short period of time (ie, 5 days) is also suggestive of bacterial ARS.137,138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The timing of symptoms may also help delineate between rhinosinusitis and AR as ARS symptoms typically last days to weeks (but no more than 4 weeks), CRS symptoms persist daily for greater than 12 weeks.”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Symptoms include nasal congestion, nasal obstruction or nasal discharge, and facial pressure or pain, or anosmia/hyposmia.”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Facial pressure and pain is described as moderate to severe.137”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“A longer duration of illness suggests bacterial ARS.137,138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
The cited source says what the claim attributes to it.
In the citing paper
“CRS is divided into 2 main phenotypic groups: CRSwNP and CRSsNP.”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
The cited source says what the claim attributes to it.
In the citing paper
“CRS is an inflammatory condition of the sinonasal cavity persisting for more than 12 weeks with at least 2 symptoms of nasal obstruction and congestion, mucopurulent nasal drainage (anterior or posterior), facial pressure or pain, and anosmia/hyposmia.1,137,138,266,267”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
The cited source says what the claim attributes to it.
In the citing paper
“In addition, patients must have objective evidence of sinonasal inflammation on either nasal endoscopy (polyps, edema, mucopurulent rhinorrhea) or on CT scans of the sinuses.137,138,266,267”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
The cited source says what the claim attributes to it.
In the citing paper
“In general, viral ARS is present for less than 10 days.”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
The cited source says what the claim attributes to it.
In the citing paper
“A prolonged duration of symptoms (greater than 12 weeks) should raise suspicions for CRS and prompt further investigation.1,137,138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“In comparison, while AR symptoms are variable in duration, they tend to have seasonal or exposure-related fluctuations.1,137,138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Conversely, AR is typically not associated with purulent or unilateral nasal discharge.”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [137]
Experimental — accuracy not yet measured
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Metadata
- Authors
- Rosenfeld, R. M., Piccirillo, J. F., Chandrasekhar, S. S., Brook, I., Ashok Kumar, K., Kramper, M., Orlandi, R. R., Palmer, J. N., Patel, Z. M., Peters, A., Walsh, S. A., & Corrigan, M. D.
- Affiliations
- SUNY Downstate Health Sciences University (US)
- Washington University in St. Louis (US)
- New York Otology New York Head and Neck Institute New York New York USA
- Georgetown University (US)
- Department of Family Medicine University of Texas Health Sciences Center at San Antonio San Antonio Texas USA
- University of Utah (US)
- Hospital of the University of Pennsylvania (US)
- Emory University (US)
- Northwestern University (US)
- Consumers United for Evidence‐Based Healthcare Davis California USA
- American Academy of Otolaryngology — Head and Neck Surgery (US)
- Corresponding author
- Rosenfeld, Richard M.
- ORCID
- Venue
- Otolaryngology–Head and Neck Surgery
- Publisher
- Wiley
- Published
- 2015-04
- Volume
- 152
- Issue
- S2
- Pages
- S1-S39
- ISSN
- 0161-6439 (ISSN-L)
- 0194-5998
- 1097-6817
- OpenAlex
- W2149116105
- Cited by
- 1,159
- References
- 301
- Citations by year
- 2026: 35 · 2025: 98 · 2024: 118 · 2023: 120 · 2022: 122 · 2021: 106 · 2020: 138 · 2019: 116 · 2018: 99 · 2017: 91 · 2016: 91 · 2015: 21
- FWCI
- 90.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Otolaryngology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Otorhinolaryngology › Sinusitis and nasal conditions
- Health Sciences › Medicine › Infectious Diseases › Otolaryngology and Infectious Diseases
- Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
- Keywords
- sinusitis, acute bacterial rhinosinusitis, chronic rhinosinusitis, expectant management, antibiotic therapy, amoxicillin-clavulanic acid, nasal endoscopy, computed tomography, anterior rhinoscopy, viral upper respiratory tract infection, asthma, cystic fibrosis, immunocompromised patients, ciliary dyskinesia, patient education, quality improvement, diagnostic accuracy
- MeSH terms
- Academies and Institutes, Adult, Anti-Bacterial Agents, Humans, Otolaryngology, Rhinitis, Sinusitis, Societies, Medical, United States, Watchful Waiting
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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