ABSTRACT
Acute rhinosinusitis (ARS) is common, affecting 6–15% of the population each year. The vast majority of cases are viral, with bacterial infection estimated in less than 2% of cases. Inappropriate antibiotic use is a significant threat to public health in terms of increasing resistance, yet antibiotics are prescribed in over 80% of outpatient visits in the United States for ARS, and ARS is the fifth most common indication for antibiotic treatment. The management of complications of ARS will often require surgical intervention to address the complication itself, but will also require ongoing medical management to treat the underlying sinus infection. Chronic rhinosinusitis (CRS) is a heterogenous group of several phenotypes, and is likely to represent the end-point of multiple aetiologies, rather than a single disease process. Mucosal inflammation is the defining feature of CRS; it may be intrinsic, as in those with asthma and aspirin sensitivity, or occur as a result of local infection or environmental exposure.
