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Clinical Practice Guideline: Adult Sinusitis

Clinical Practice Guideline: Adult Sinusitis

The guideline was published as a supplement in the April 2015 issue of Otolaryngology—Head and Neck Surgery.

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 judicious use of systemic and topical therapy, and promote appropriate use of ancillary tests to confirm diagnosis and guide management, which include 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. The guideline is intended for all clinicians who are likely to diagnose and manage adults with rhinosinusitis and applies to any setting in which an adult with rhinosinusitis would be identified, monitored, or managed. This guideline, however, does not apply to patients younger than 18 years or to patients of any age with complicated rhinosinusitis.

Leadership: Richard M. Rosenfeld MD, MPH (Chair), Jay F. Piccirillo MD, (Assistant Chair), Sujana S. Chandrasekhar, MD (Methodologist)

Guideline Development Group: Itzhak Brook, MD, MSc; Kaparaboyna Ashok Kumar, MD, FRCS; Maggie Kramper, RN, FNP; Richard R. Orlandi, MD; James N. Palmer, MD; Zara M. Patel, MD; Anju Peters, MD; Sandra A. Walsh, and Maureen D. Corrigan.


Society of Otorhinolaryngology-Head and Neck Nurses, Inc . Oct 2011 (original 2007 Guideline)


For Physicians
    1. Implications for Otolaryngologists
    2. Implications for Non-Otolaryngologists
For Patients

In 2012 the ABIM Foundation launched Choosing Wisely® with a goal of advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures.

Choosing Wisely centers around conversations between providers and patients informed by the evidence-based recommendations.

Access the AAO-HNSF Choosing Wisely List of 10 Things Providers and Patients Should Question

Imaging of the paranasal sinuses, including plain film radiography, computed tomography (CT) and magnetic resonance imaging (MRI) is unnecessary in patients who meet the clinical diagnostic criteria for uncomplicated acute rhinosinusitis. Acute rhinosinusitis is defined as up to four weeks of purulent nasal drainage (anterior, posterior or both) accompanied by nasal obstruction, facial pain-pressure-fullness or both. Imaging is costly and exposes patients to radiation. Imaging may be appropriate in patients with a complication of acute rhinosinusitis, patients with comorbidities that predispose them to complications and patients in whom an alternative diagnosis is suspected.

Computerized tomography scanning is expensive, exposes the patient to ionizing radiation and offers no additi onal information that would improve initial management. Multiple CT scans within 90 days may be appropriate in patients with complicated sinusitis or where an alternative diagnosis is suspected.