Adult rhinosinusitis: Diagnosis and management

Rhinosinusitis can be divided among four subtypes: acute, recurrent acute, subacute and chronic, based on patient history and a limited physical exami nation. In most instances, therapy is initiated based on this classificatio n. Antibiotic therapy, supplemented by hydration and decongestants, is indi cated for seven to 14 days in patients with acute, recurrent acute or subac ute bacterial rhinosinusitis. For patients with chronic disease, the same t reatment regimen is indicated for an additional four weeks or more, and a n asal steroid may also be prescribed if inhalant allergies are known or susp ected. Nasal endoscopy and computed tomography of the sinuses are reserved for circumstances that include a failure to respond to therapy as expected, spread of infection outside the sinuses, a question of diagnosis and when surgery is being considered. Laboratory tests are infrequently necessary an d are reserved for patients with suspected allergies, cystic fibrosis, immu ne deficiencies, mucociliary disorders and similar disease states. Findings on endoscopically guided microswab culture obtained from the middle meatus correlate 80 to 85 percent of the time with results from the more painful antral puncture technique and is performed in patients who fail to respond to the initial antibiotic selection. Surgery is indicated for extranasal sp read of infection, evidence of mucocele or pyocele, fungal sinusitis or obs tructive nasal polyposis, and is often performed in patients with recurrent or persistent infection not resolved by drug therapy.