Rhinosinusitis

Rhinosinusitis is inflammation of the nasal mucosa and paranasal sinuses. Oedema narrows the osteomeatal complex, the drainage pathway for several sinuses. Once that pathway is blocked, mucociliary transport slows, secretions become trapped, and pressure, obstruction, and nasal discharge develop. The symptoms are therefore consequences of impaired drainage as well as inflammation. Acute rhinosinusitis lasts up to 4 weeks. Chronic rhinosinusitis (CRS) requires symptoms for at least 12 weeks. Recurrent acute rhinosinusitis means four or more separate acute episodes in a year with symptom-free intervals between them; persistent symptoms between episodes suggest CRS rather than recurrence. Most acute episodes are viral. Bacterial infection complicates approximately 2% to 10% of cases, so discoloured mucus alone does not justify an antibiotic. A patient on day 4 of a typical upper-respiratory illness with congestion, pressure, and coloured discharge usually needs symptom relief and a safety-net plan, not antibacterial treatment. Unnecessary antibiotics expose the patient to adverse effects and promote antimicrobial resistance without treating the cause.