Viral Rhinosinusitis

Viral rhinosinusitis is the common cold with sinus involvement, caused by rhinoviruses, coronaviruses, adenovirus, parainfluenza and influenza virus. Symptoms peak at 3 to 5 days and resolve within 10 days.

• It is the commonest infection of the upper airway and is self limiting.
• Adults have 2 to 4 episodes yearly and children 6 to 8.
• Spread is by droplets and by hand contact with contaminated surfaces.

Nasal obstruction, clear then mucoid or yellow discharge, sneezing, sore throat, cough, mild headache, facial pressure, low grade fever and malaise.

• Coloured discharge alone does not indicate bacterial infection.
• Differential diagnosis: allergic rhinitis, influenza, COVID-19, acute bacterial sinusitis, streptococcal pharyngitis, nasal foreign body, vasomotor rhinitis, medication induced rhinitis.
• Complications: acute otitis media, bacterial sinusitis, exacerbation of asthma or COPD, bronchitis, pneumonia.

Diagnosis is clinical, with symptoms of less than 10 days and no worsening.

• No imaging or blood tests are needed.
• Test for influenza or COVID-19 only when the result will change management or in a high risk patient.
• Reconsider the diagnosis if symptoms persist beyond 10 days or worsen after day 5.

Treatment is symptomatic; antibiotics do not help and cause harm.

• Supportive: rest, fluids, saline nasal drops or irrigation, steam inhalation, honey 5 mL at night for cough in children over 1 year, hand washing and cough hygiene.
• Pharmacological: paracetamol 1 g every 6 hours (children 15 mg/kg) or ibuprofen 400 mg every 8 hours (children 5 to 10 mg/kg); ipratropium 0.06 percent nasal spray 2 sprays per nostril three times daily for watery discharge; oxymetazoline 0.05 percent for up to 3 days only in adults; chlorphenamine 4 mg every 6 hours at night for sneezing and rhinorrhoea in adults.
• Procedures: none.
• Special groups: pregnancy, paracetamol and saline, avoid decongestant tablets; infants under 1 year, saline drops and suction, no decongestants or cough preparations; hypertension and heart disease, avoid pseudoephedrine; asthma, avoid aspirin and NSAIDs if sensitive.
• Red flags: symptoms beyond 10 days, fever above 39 degrees Celsius for more than 3 days, periorbital swelling, severe unilateral pain, stiff neck, breathlessness.
• Follow-up: review only if worsening, with reconsideration of bacterial sinusitis or pneumonia.