Acute Rhinosinusitis Pathway (Adults)

Any alarm symptom?

Periorbital oedema or erythemaDisplaced globeDouble visionOphthalmoplegiaReduced visual acuitySevere headacheFrontal swellingSigns of sepsisSigns of meningitisNeurological signs

Symptoms for 12 weeks or more, with no symptom-free interval

Features of bacterial rhinosinusitis (0 of 5)

Discoloured mucusSevere local painFever above 38 °CRaised CRP or ESRDouble sickening

Course of this episode

Choose the course of this episode.

Notes

For adults with acute rhinosinusitis: sudden onset of nasal blockage, obstruction or congestion, or of nasal discharge (anterior or posterior), with or without facial pain or pressure and reduced or lost smell.

Sudden onset means symptoms lasting under 12 weeks, with a symptom-free interval if the episodes recur.

Double sickening is a worsening after an initial milder phase of illness.

Sources

National Antimicrobial Guideline 2024, 4th edition, C4: Acute Rhinosinusitis. Ministry of Health Malaysia.
Fokkens WJ, Lund VJ, Hopkins C, et al. Executive summary of EPOS 2020 including integrated care pathways. Rhinology. 2020;58(2):82–111.