What are the AAO-HNSF clinical practice guidelines on adult sinusitis?

Updated: Jan 29, 2020
  • Author: Tejas Raval, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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A 2015 update of the clinical practice guideline for adult sinusitis, from the American Academy of Otolaryngology-Head and Neck Surgery Foundation, strongly recommends that clinicians differentiate acute bacterial rhinosinusitis from acute rhinosinusitis resulting from viral upper respiratory infections or from noninfectious causes and that a clinical diagnosis of chronic rhinosinusitis be confirmed by objectively documenting sinonasal inflammation. The guideline also recommends that clinicians do the following [15] :

  • Either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated acute bacterial rhinosinusitis

  • Prescribe amoxicillin with or without clavulanate as first-line therapy for 5-10 days (if a decision is made to treat acute bacterial rhinosinusitis with an antibiotic)

  • Reassess the patient to confirm acute bacterial rhinosinusitis, 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

  • Distinguish chronic rhinosinusitis and recurrent acute rhinosinusitis from isolated episodes of acute bacterial rhinosinusitis and other causes of sinonasal symptoms

  • Assess the patient with chronic rhinosinusitis or recurrent acute rhinosinusitis for multiple chronic conditions that would modify management, such as asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia

  • Confirm the presence or absence of nasal polyps in a patient with chronic rhinosinusitis

  • Recommend saline nasal irrigation, topical intranasal corticosteroids, or both for symptom relief of chronic rhinosinusitis

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