From the Guidelines
Viral rhinosinusitis is characterized by symptoms such as cough, sneezing, rhinorrhea, sore throat, and nasal congestion, which typically peak within 3 days and resolve within 10 to 14 days 1. The symptoms of viral rhinosinusitis can be similar to those of bacterial infection, but clinical emphasis on duration, illness pattern, and severity of symptoms can help to differentiate between the two 1. Some key symptoms include:
- Cough
- Sneezing
- Rhinorrhea
- Sore throat
- Nasal congestion
- Facial pressure or pain
- Decreased sense of smell
- Postnasal drip
- Headache
- Fatigue
- Low-grade fever It's essential to note that nasal purulence alone does not indicate a bacterial infection, and discolored nasal discharge is a sign of inflammation, not specifically of infection 1. Management of viral rhinosinusitis is primarily directed toward relief of symptoms, and antibiotics are not recommended since they are ineffective for viral illness and do not provide direct symptom relief 1. Instead, 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. For example, analgesics or antipyretic drugs like acetaminophen or ibuprofen may be given for pain or fever, and nasal saline may be palliative and cleansing with low risk of adverse reactions 1. Topical intranasal steroids may also have a role in managing viral rhinosinusitis, although the magnitude of effect is small, and the decision to use them should be based on patient preference 1.
From the Research
Signs and Symptoms of Viral Rhinosinusitis
The signs and symptoms of viral rhinosinusitis can be understood through various studies, including 2, 3, and 4.
- The primary symptoms of rhinosinusitis include:
- Nasal obstruction
- Nasal discharge
- Facial pain
- Loss of sense of smell
- Secondary symptoms may also be present, such as:
- Cough
- Sneezing
- Sore throat
- Voice changes
- Epiphora
- Fever
- Psychological effects and fatigue As noted in 4, sneezing is a common symptom of acute rhinosinusitis with allergy, but its incidence in chronic rhinosinusitis is not well understood and requires further research.
Duration and Diagnosis of Rhinosinusitis
The duration of symptoms can help distinguish between acute, subacute, and chronic rhinosinusitis, as mentioned in 2.
- Acute rhinosinusitis typically lasts 10-30 days
- Subacute rhinosinusitis lasts 30-90 days
- Chronic rhinosinusitis lasts more than 90 days The diagnosis of rhinosinusitis should be based on anamnestic and clinical criteria, as stated in 2 and 3.
Treatment and Management of Rhinosinusitis
Treatment options for rhinosinusitis, including viral rhinosinusitis, may involve supportive care, such as saline irrigation, nasal steroids or antihistamines, and decongestants, as mentioned in 3 and 5.
- Antibiotics may be recommended for bacterial rhinosinusitis, but not for viral rhinosinusitis
- Novel treatments, such as biologics and advanced corticosteroid delivery devices, may be used for chronic rhinosinusitis, as discussed in 5