Rhinosinusitis - Acute, Bacterial Differential Diagnosis

Differential Diagnosis

Rhinosinusitis - Acute, Bacterial_Diffential Diganosis

• Acute viral rhinosinusitis (AVRS)/common cold: Symptoms include sneezing, anterior or posterior rhinorrhea, and congestion, but it generally does not present with facial pain or mucopurulent discharge. This is associated with a sore throat or cough. Improvement is usually seen in <10 days but may persist for >10 days in cases of post-viral rhinosinusitis (PVRS)
• Other conditions that can cause rhinitis, facial pain, headache or dental pain: Allergic rhinitis and non-allergic vasomotor rhinitis may present with rhinorrhea and nasal congestion but can be distinguished from acute rhinosinusitis in the presence of nasal congestion, rhinorrhea, sneezing, and nasal itching. Facial pain or pressure, headache, or purulent nasal drainage are absent in allergic rhinitis. Facial pain is present in patients with neuralgias, cancer pain, temporomandibular joint disorder, or carotidynia, but these patients do not present with the other symptoms of acute rhinosinusitis. Migraine is a non-sinus diagnosis that may mimic acute bacterial rhinosinusitis with headache or facial pain. Patients with dental pain should be directly asked about prior dental procedures and assessed for orodontal disease since these may cause referred pain without an actual infection within the sinuses. Acute invasive fungal rhinosinusitis has similar symptoms to acute rhinosinusitis but with rapidly progressive symptoms and infection extending outside the sinuses at presentation, usually seen in patients with uncontrolled diabetes and those who are immunocompromised
• Consider immunodeficiency states and bacterial resistance