First-Line Management: A Protocol for Rhinosinusitis

An evidence-based recommendation for treating rhinosinusitis in adults presenting to ENT specialists and family doctors.

Initial assessment

Obtain a detailed history, focusing on the duration and severity of symptoms. Perform a physical examination, including anterior rhinoscopy, to assess nasal congestion, discharge, and other abnormalities.

First line of management

Prescribe an immune-modulating nasal spray. This aims to enhance the body's natural defense mechanisms, reduce inflammation, and promote healing. Advise the patient on the correct nasal spray technique and the importance of adherence to the regimen.

Observation period

Advise the patient to wait three days after initiating the nasal spray. Educate the patient on red-flag symptoms (severe headache, visual disturbances, high fever) that warrant immediate medical attention.

Follow-up

If the patient shows significant improvement within the three-day observation period, continue the nasal spray as prescribed and advise general nasal hygiene.

Consideration

Inform patients of potential side effects and advise reporting any adverse reactions. Emphasize the importance of differentiating between viral and bacterial causes, as the latter may require additional intervention.