Limited use of topical decongestants such as oxymetazoline has shown benefit in treating viral rhinosinusitis. Oral decongestants (phenylephrine, pseudoephedrine) and antihistamines have not been shown to be superior to a placebo in randomized trials and may worsen inflammation by drying mucous membranes.

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Table 1. Conversation Guide for Acute Sinusitis

So, the next time you diagnose a patient with acute sinusitis, skip the CT and antibiotics and offer a prescription for evidence-based symptomatic therapy instead (see Table 1). Opting for a cost-effective approach to sinusitis can not only improve quality of care and reduce costs, it can actually relieve your patient’s sinus discomfort.

References

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2. Nazri M, Bux SI, Tengku-Kamalden TF, Ng K-H, Sun Z. Incidental detection of sinus mucosal abnormalities on CT and MRI imaging of the head. Quant Imaging Med Surg. 2013 Apr;3(2):82–8.
3. Gwaltney JM, Phillips CD, Miller RD, Riker DK. Computed Tomographic Study of the Common Cold. N Engl J Med [Internet]. 1994 Jan 6 [cited 2015 May 13];330(1):25–30. Accessed: Aug. 23, 2016.
4. Basu S, Georgalas C, Kumar BN, Desai S. Correlation between symptoms and radiological findings in patients with chronic rhinosinusitis: an evaluation study using the Sinonasal Assessment Questionnaire and Lund-Mackay grading system. Eur Arch Otorhinolaryngol. 2005 Sep;262(9):751–4.
5. Sharp AL, Klau MH, Keschner D, Macy E, Tang T, Shen E, Munoz-Plaza C, Kanter M, Silver MA, Gould MK. Low-value care for acute sinusitis encounters: who‘s choosing wisely? Am J Manag Care. 2015 Jul;21(7):479-85.
6. Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev. 2013;6:CD000247.
7. Ahovuo-Saloranta A, Rautakorpi U-M, Borisenko OV, Liira H, Williams JW, Mäkelä M. Antibiotics for acute maxillary sinusitis in adults. Cochrane Database Syst Rev. 2014;2:CD000243.
8. Fairlie T, Shapiro DJ, Hersh AL, Hicks LA. National trends in visit rates and antibiotic prescribing for adults with acute sinusitis. Arch Intern Med [Internet]. 2012 Oct 22 [cited 2015 May 12];172(19):1513–4. Accessed: Aug. 23, 2016.