ABSTRACT
It is a widely held assertion that the diagnosis of bacterial rhinosinusitis is made too often (1). This is due to the inherent difficulty in making an accurate diagnosis. Many diagnostic challenges exist when evaluating patients with presumed rhinosinusitis. Since the sinuses cannot be observed directly, the diagnosis is dependent upon the history of present illness and is often aided by nonspecific symptoms and physical examination. Primary care physicians are at a particular disadvantage as they do not have ready access to nasal endoscopy or antral puncture with fluid analysis, which at times are helpful for establishing a diagnosis. Particularly challenging is differentiating between a self-limiting upper respiratory tract infection (URTI) or ‘‘common cold’’ and allergy from an acute bacterial rhinosinusitis (ABRS). The most common symptoms of rhinosinusitis include nasal congestion, purulent rhinorrhea, facial pressure or pain, and anosmia or hyposmia. These symptoms are not unique to rhinosinusitis and may be features of other inflammatory processes of the sinonasal tract. Frequently, a recent viral infection or underlying allergy precedes the development of ABRS, and thus makes the diagnosis of rhinosinusitis all the more difficult.
