From the Guidelines
Viral rhinosinusitis should be managed with supportive therapies that improve quality of life, such as analgesics, nasal saline, and decongestants, without the use of antibiotics, as they are ineffective for viral illness and do not provide direct symptom relief. The primary goal of treatment is to relieve symptoms, as the disease is self-limited and typically resolves within 10 to 14 days 1.
Key Considerations
- Nasal purulence alone does not indicate a bacterial infection, and discolored nasal discharge is a sign of inflammation, not a specific indicator of infection 1.
- Management of viral rhinosinusitis is primarily directed toward relief of symptoms, and palliative medications such as analgesics, anti-inflammatory agents, nasal saline, decongestants, antihistamines, mucolytics, cough suppressants, and topical or oral corticosteroids may be used alone or in varying combinations for symptom relief 1.
Treatment Options
- Analgesics or antipyretic drugs, such as acetaminophen or ibuprofen, may be given for pain or fever 1.
- Nasal saline may be palliative and cleansing with low risk of adverse reactions, and a Cochrane review reported minor improvements in nasal symptom scores with the use of nasal saline in both physiologic and hypertonic concentrations 1.
- Oral decongestants may provide symptomatic relief and should be considered barring any medical contraindications, such as hypertension or anxiety 1.
- Topical intranasal steroids may have a role in managing viral rhinosinusitis, although the magnitude of effect is small, and the choice of whether or not the modest clinical benefit of therapy justifies the cost is a decision that should be based largely on patient preference 1.
From the Research
Definition and Causes of Viral Rhinosinusitis
- Viral rhinosinusitis is a common inflammatory condition of the paranasal sinuses and nasal cavity, often caused by viral infections associated with the common cold 2.
- The condition is characterized by symptoms such as facial pain and pressure, nasal obstruction, congestion, postnasal drainage, and mucopurulence 3.
- Viral infection is often the inciting event, and the ensuing inflammation obstructs the narrow ostiomeatal complex, causing symptoms 3.
Diagnosis and Management of Viral Rhinosinusitis
- The diagnosis of viral rhinosinusitis is typically made on clinical grounds alone, and radiographic imaging is not recommended for uncomplicated cases 2, 4.
- Symptomatic treatment with analgesics, decongestants, and saline nasal irrigation is appropriate for patients with nonsevere symptoms 2.
- Supportive care, including the use of saline irrigation, nasal steroids or antihistamines, and decongestants, may help reduce the severity of symptoms 5.
- Antibiotics should only be considered for patients with symptoms or signs of acute bacterial rhinosinusitis, such as severe symptoms, significant worsening after 3 to 5 days, or 7 or more days of symptoms 5, 4.
Complications and Referral
- Complications of rhinosinusitis are rare but may include orbital cellulitis, meningitis, and abscess 5, 2.
- Computed tomography and referral to an otolaryngologist should be considered for patients with recurrent rhinosinusitis or concern about complications 5, 4.
- The management of viral rhinosinusitis should be aimed at controlling symptoms and preventing complications, rather than treating the underlying viral infection 6.