Acute rhinosinusitis: Pathogenesis, diagnosis and treatment

Abstract

Acute rhinosinusitis (ARS) is an inflammation of the mucous membranes of the nasal cavity and paranasal sinuses with symptoms lasting up to 12 weeks. In more than 98% cases, ARS begins as a viral infection with common cold symptoms, usually caused by rhinoviruses or more severe acute viral rhinosinusitis usually caused by coronaviruses, influenza and parainfluenza virus. Worsening of symptoms after 5 days or persistence of symptoms after 10 days indicate the diagnosis of acute postviral rhinosinusitis, which indicates the presence of bacterial superinfection on the basis of previous viral infection. In about 0,5-2% of cases, complications of ARS with bacterial infection occur, so we have a clinical history of acute bacterial rhinosinusitis (ABRS). The most common causes of ABRS are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Diagnosis and treatment of uncomplicated ARS are the responsibility of primary care physicians. Failure in treatment indicates a potential complication of the disease, when the patient needs to be referred by an otorhinolaryngology specialist. The first line of the antimicrobial treatment of ARS is the use of amoxicillin. Inadequate response to firstline antimicrobial therapy within the 72 hours indicates the need for some broad-spectrum antibiotics. Complementary therapy consists of the use of saline solutions for rinsing the nasal cavity, decongestants in the form of drops, sprays or tablets, herbal drugs, as well as intranasal corticosteroids in the form of sprays.