INTRODUCTION
The terms rhinitis and sinusitis have been superseded by rhinosinusitis, which represents the understanding that the two conditions usually coexist. Rhinosinusitis can be subdivided into acute and chronic. Acute rhinosinusitis (ARS) presents an enormous burden in primary care. It is estimated that around 1–2% of visits to a GP in Europe are for symptoms of ARS.1
ARS is seen across a wide spectrum of ages, but is less common in the paediatric group due to the relative immature development of the sinuses in children (maxillary and ethmoidal sinuses develop during gestation, whereas the frontal and sphenoid sinuses begin to develop at the age of 3 years but are not fully developed until late adolescence). A consequence of patients presenting to primary care is the associated high pharmacy costs. Ashworth et al found that a prescription for antibiotics was given in 92% of patients with symptoms of ARS.2
This article provides a summary of the current best evidence for the management of ARS in primary care and highlights the recent guidelines provided by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS2012).3
AETIOLOGY AND PATHOPHYSIOLOGY
The paranasal sinuses are lined by pseudostratified ciliated columnar epithelia containing basal cells, columnar cells, and mucus-secreting goblet cells. Secretions aid humidification, olfaction, and filtration. Cilia are crucial to mucus clearance. The cilia can be damaged by smoking, chronic nasal disease, or genetic predisposition such as primary cilia dyskinesia. When the clearance of mucus from the paranasal sinuses to the meati of the nose is interrupted, mucus trapping can occur with increased risk of infection.
Viral causes of the common cold include respiratory syncytial virus (RSV), rhinovirus, parainfluenza, and influenza with rhinovirus being the most common. The commonest organisms in acute bacterial rhinosinusitis (ABRS) include Streptococcus pneumonia (41%) and Haemophilus influenza (35%). Other causes include …