Acute and Chronic Sinusitis: Diagnosis, Antibiotics, and Treatment | Omicron Clinic<\/title>\n<meta name=\"description\" content=\"Sinusitis is an inflammation of the paranasal sinuses. Viral vs. bacterial sinusitis, antibiotics if double worsening or 10 days, nasal corticosteroids, chronic sinusitis, and surgery in Quebec.\">\n<meta name=\"keywords\" content=\"sinusite, sinusite traitement, sinusite antibiotiques, sinusite bact\u00e9rienne virale, sinusite chronique, rhinosinusite, sinusite amoxicilline, sinusite cortico\u00efdes nasaux, sinusite douleur faciale, sinusite Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap');\n\n.co-wrap * {\n font-family: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 1100px;\n margin: 0 auto;\n padding: 30px 0 60px;\n margin-top: 10px;\n}\n.co-label {\n font-family: 'Cinzel', serif;\n font-size: 14px;\n font-weight: bold;\n letter-spacing: 1px;\n text-transform: uppercase;\n color: #4D6577;\n margin-bottom: 14px;\n display: block;\n}\n.co-wrap h1 {\n font-size: 32px;\n font-weight: 500;\n color: #323C52;\n margin: 0 0 22px;\n line-height: 1.2;\n letter-spacing: 0.5px;\n}\n.co-intro {\n font-size: 16px;\n font-weight: 400;\n line-height: 1.75;\n color: #4D6577;\n margin-bottom: 36px;\n padding-bottom: 32px;\n border-bottom: 1px solid rgba(77,101,119,.2);\n}\n.co-wrap h2 {\n font-size: 20px;\n font-weight: 600;\n color: #323C52;\n margin: 32px 0 12px;\n letter-spacing: 0.3px;\n}\n.co-wrap p {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.7;\n margin-bottom: 14px;\n}\n.co-list {\n list-style: none;\n padding: 0;\n margin: 12px 0 24px;\n}\n.co-list li {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n padding: 10px 14px 10px 38px;\n margin-bottom: 8px;\n border-radius: 6px;\n position: relative;\n background: rgba(77,101,119,.06);\n border-left: 3px solid #4D6577;\n}\n.co-list li::before {\n content: \"\u2713\";\n position: absolute;\n left: 12px;\n font-weight: 700;\n color: #4D6577;\n}\n.co-table {\n width: 100%;\n border-collapse: collapse;\n margin: 14px 0 22px;\n font-size: 14px;\n border-radius: 8px;\n overflow: hidden;\n}\n.co-table thead tr {\n background: #323C52;\n color: #fff;\n}\n.co-table thead th {\n padding: 11px 16px;\n text-align: left;\n font-weight: 600;\n font-size: 13px;\n}\n.co-table tbody tr:nth-child(even) {\n background: rgba(77,101,119,.06);\n}\n.co-table tbody tr:nth-child(odd) {\n background: #fff;\n}\n.co-table td {\n padding: 10px 16px;\n color: #4D6577;\n border-bottom: 1px solid rgba(77,101,119,.12);\n font-size: 14px;\n vertical-align: top;\n}\n.co-table td:first-child {\n font-weight: 600;\n color: #323C52;\n}\n.co-infobox {\n display: flex;\n gap: 12px;\n background: rgba(77,101,119,.06);\n border-radius: 8px;\n border-left: 4px solid #4D6577;\n padding: 14px 18px;\n margin: 18px 0 28px;\n font-size: 14px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.65;\n}\n.co-infobox .ico {\n font-size: 18px;\n flex-shrink: 0;\n}\n.co-urgence {\n background: #fff8f8;\n border-left: 5px solid #c0392b;\n border-radius: 6px;\n padding: 20px 26px;\n margin: 24px 0 32px;\n}\n.co-urgence .co-urgence-titre {\n font-size: 13px;\n font-weight: 700;\n color: #c0392b;\n letter-spacing: 1.5px;\n text-transform: uppercase;\n margin-bottom: 10px;\n}\n.co-urgence p {\n color: #5a2020;\n font-size: 14px;\n margin: 0 0 10px;\n line-height: 1.7;\n}\n.co-urgence p:last-child {\n margin-bottom: 0;\n}\n.co-disclaimer {\n font-size: 13px;\n color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">ENT & Family Medicine & Infectious Diseases<\/span>\n <h1>Sinusitis (rhinosinusitis)<\/h1>\n\n <div class=\"co-intro\">\n Sinusitis\u2014now referred to as rhinosinusitis in international medical terminology to reflect the nearly constant and simultaneous involvement of the nasal mucosa and paranasal sinuses (since the nasal and sinus mucosa are anatomically and inflammatorily continuous)\u2014is the inflammation of the mucous membrane lining the sinus cavities (maxillary, ethmoid, frontal, and sphenoid), most often triggered by a viral infection of the upper respiratory tract (rhinovirus, seasonal coronaviruses, influenza, RSV) in the context of the common cold, with obstruction of the sinus ostium, accumulation of secretions, and a predisposition to secondary bacterial superinfection in a minority of cases. Acute rhinosinusitis is one of the most common conditions in primary care\u2014accounting for nearly 20 million annual medical visits in the United States\u2014and one of the leading causes of antibiotic prescriptions in Western countries, despite the fact that 90 to 98% of acute rhinosinusitis cases are viral in origin and do not require antibiotics. Canadian clinical guidelines (CMAJ + IDSA) emphasize the distinction between viral rhinosinusitis (symptomatic treatment only\u2014duration 7\u201310 days) and acute bacterial rhinosinusitis (antibiotics only if 3 specific criteria are met: see below) to reduce inappropriate antibiotic prescribing and preserve their effectiveness. Chronic rhinosinusitis (CRS\u2014duration > 12 weeks) is a distinct condition, often associated with allergic rhinitis + nasal polyposis + mucociliary dysfunction + or a deviated septum, requiring a different therapeutic approach focused on intranasal corticosteroids + nasal irrigation + and sometimes endoscopic sinus surgery.\n <\/div>\n\n <h2>Diagnostic Criteria and Viral vs. Bacterial Distinction<\/h2>\n <ul class=\"co-list\">\n <li><strong>Acute viral rhinosinusitis (common cold)<\/strong> Symptoms < 10 days + ongoing improvement + 4 cardinal symptoms: nasal congestion + rhinorrhea (clear or colored) + facial (sinus) pressure or pain + reduced sense of smell + color of secretions (yellow + green) is NOT a criterion for bacteremia \u2192 treatment: symptomatic only<\/li>\n <li><strong>Acute bacterial rhinosinusitis \u2014 IDSA criteria (3 scenarios):<\/strong><\/li>\n <li><strong>Scenario 1 \u2014 Persistent symptoms \u2265 10 days with no improvement:<\/strong> Rhinorrhea + congestion + facial pressure lasting > 10 days without improvement \u2192 viral sinusitis does not last > 10 days<\/li>\n <li><strong>Scenario 2 \u2014 Worsening following initial improvement (double worsening):<\/strong> Symptoms improving after D5\u2013D7 then worsening with fever + increased nasal discharge + facial pain \u2192 bacterial superinfection on initial viral rhinosinusitis<\/li>\n <li><strong>Scenario 3 \u2014 Sudden severe symptoms:<\/strong> Fever \u2265 39\u00b0C + intense unilateral facial pain + unilateral dental pain \u2192 probable bacterial rhinosinusitis from onset<\/li>\n <\/ul>\n\n <h2>Bacteria responsible for acute bacterial rhinosinusitis<\/h2>\n <ul class=\"co-list\">\n <li><strong><em>Streptococcus pneumoniae<\/em> Pneumococcus<\/strong> 30\u201340 % \u2192 primary cause + increasing penicillin resistance (PSPN + PSPI) \u2192 standard-dose amoxicillin remains effective if MIC \u2264 2 \u00b5g\/mL<\/li>\n <li><strong><em>Haemophilus influenzae<\/em> non-typable<\/strong> 20\u201330% of % strains \u2192 beta-lactamase production in 30\u201340% of % strains \u2192 amoxicillin-clavulanate if beta-lactamase is suspected<\/li>\n <li><strong><em>Moraxella catarrhalis<\/em> :<\/strong> 10\u201320 % \u2192 nearly constant beta-lactamase production (90 %) \u2192 amoxicillin-clavulanate<\/li>\n <li><strong>Anaerobes (odontogenic dental sinusitis):<\/strong> Bacteroides + Fusobacterium + Prevotella \u2192 maxillary sinusitis associated with recent tooth extraction + or apical abscess + treatment: amoxicillin-clavulanate + or metronidazole<\/li>\n <\/ul>\n\n <h2>Acute rhinosinusitis treatment<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Situation<\/th>\n <th>Recommended treatment<\/th>\n <th>Duration and remarks<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Viral rhinosinusitis (< 10 days + no worsening)<\/td>\n <td>Symptomatic treatment only: nasal irrigation with NaCl (normal saline or hypertonic saline) + topical nasal decongestants (oxymetazoline 0.1% 1\u20133 times daily for up to 3\u20135 days) + acetaminophen or NSAIDs for pain + intranasal corticosteroids (fluticasone + mometasone) if underlying allergic rhinitis + NO antibiotics<\/td>\n <td>Spontaneous resolution within 7\u201310 days for the vast majority; 2\u20133% progress to bacterial sinusitis; antibiotics do not shorten the duration of symptoms in viral sinusitis<\/td>\n <\/tr>\n <tr>\n <td>Mild to moderate bacterial rhinosinusitis (1 of 3 IDSA criteria)<\/td>\n <td>Amoxicillin 500\u2013875 mg x 2\u20133\/day x 5\u20137 days (adult) or amoxicillin 40\u201345 mg\/kg\/day x 5\u20137 days (child) or armed waiting 2\u20133 days with symptomatic treatment if symptoms are mild (Canadian guidelines \u00abwait-and-see\u00bb option)<\/td>\n <td>Spontaneous recovery rate of 60\u201370% for % even without antibiotics \u2192 the decision must weigh the benefits against the risk of resistance + prefer narrow-spectrum amoxicillin as first-line treatment<\/td>\n <\/tr>\n <tr>\n <td>Severe bacterial rhinosinusitis (fever \u2265 39\u00b0C + intense pain) or amoxicillin failure at 72 hours<\/td>\n <td>Amoxicillin-clavulanate 875\/125 mg \u00d7 2\/day \u00d7 7\u201310 days (adult) OR levofloxacin 500 mg \u00d7 1\/day \u00d7 5 days (non-anaphylactic penicillin allergy) OR ceftriaxone 1 g IM\/IV for very severe forms<\/td>\n <td>Covers H. influenzae + M. catarrhalis beta-lactamases + true penicillin allergy: aztreonam (parenteral) + or respiratory quinolone<\/td>\n <\/tr>\n <tr>\n <td>Acute Rhinosinusitis in Children (Bacteriological Criteria Met)<\/td>\n <td>Amoxicillin 45-90 mg\/kg\/day \u00d7 10 days (high dose if resistant pneumococcus or daycare + or recent antibiotic therapy < 3 months)<\/td>\n <td>Duration 10 days in children (vs 5\u20137 days in adults) + amoxicillin-clavulanate if beta-lactamase suspected<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Chronic rhinosinusitis (CRS)<\/h2>\n <ul class=\"co-list\">\n <li><strong>Definition:<\/strong> Symptoms of rhinosinusitis \u2265 12 weeks despite adequate medical treatment + confirmed by nasal endoscopy + or sinus CT scan (mucosal thickening + opacification)<\/li>\n <li><strong>Shapes<\/strong> CRS with nasal polyps (CRSwNP) - bilateral nasal polyps + often associated with the Yenner triad (asthma + aspirin sensitivity + polyps) + type 2 (eosinophilic) + or CRS without nasal polyps (CRSsNP) - neutrophilic + often linked to septal deviation + recurrent infections<\/li>\n <li><strong>Medical treatment:<\/strong> Daily intranasal corticosteroid spray (fluticasone + mometasone + budesonide) for at least 3\u20136 months \u2192 reduction in polyp size + improved sinus drainage + hypertonic nasal rinses (2% NaCl \u2014 squeeze bottle) \u00d7 2\/day \u2192 clearance of secretions + improvement in mucus + oral corticosteroids (prednisone 0.5 mg\/kg\/day \u00d7 2 weeks) during acute polyposis flare-ups<\/li>\n <li><strong>Biotherapies (Severe refractory RSCaPN type 2):<\/strong> dupilumab (Dupixent\u00ae \u2014 anti-IL-4\/IL-13) 300 mg SC every 2 weeks \u2192 Health Canada approved for severe type 2 eosinophilic chronic rhinosinusitis refractory to corticosteroid therapy + significant reduction in polyp volume + improved sense of smell + mepolizumab (anti-IL-5) + omalizumab (anti-IgE if associated allergic asthma)<\/li>\n <li><strong>Functional Endoscopic Sinus Surgery (FESS):<\/strong> if medical treatment has failed for \u2265 3 months + or complications are present + or there is extensive polyposis + under general anesthesia + results: 75\u201385% improvement in long-term symptoms + surgery does not cure chronic sinusitis but significantly improves quality of life + sinus patency + and response to postoperative medical treatments<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>The green or yellow color of nasal discharge does NOT indicate bacterial sinusitis requiring antibiotics. This coloration simply reflects the presence of neutrophils mobilized against the virus\u2014it's part of the normal progression of viral rhinosinusitis between days 3 and 7. The true criteria for a bacterial superinfection are duration (> 10 days with no improvement) OR biphasic worsening after initial improvement OR severe symptoms from the outset (fever \u2265 39\u00b0C + intense unilateral pain).<\/span>\n <\/div>\n\n <h2>Complications \u2014 urgencies to recognize<\/h2>\n <ul class=\"co-list\">\n <li><strong>Orbital cellulitis (preseptal or postseptal):<\/strong> Ethmoidal sinusitis extension \u2192 periorbital edema + erythema + pain \u2192 if postseptal: proptosis + limited eye movements + diplopia + vision loss \u2192 ophthalmological and ENT emergency + CT scan of orbits + sinuses + IV antibiotics + surgical drainage if abscess<\/li>\n <li><strong>Intracranial abscess (subdural empyema + epidural abscess + brain abscess):<\/strong> severe headaches + fever + focal neurological signs + nuchal rigidity \u2192 urgent brain MRI + neurosurgery + intensive care<\/li>\n <li><strong>Secondary bacterial meningitis:<\/strong> extension of sphenoidal or ethmoidal sinusitis + stiff neck + severe headaches \u2192 lumbar puncture + urgent ceftriaxone<\/li>\n <li><strong>Frontal osteomyelitis (Pott's tumor)<\/strong> Frontal sinus extension \u2192 painful + fluctuant frontal swelling + frontal CT scan + prolonged antibiotics + surgery<\/li>\n <li><strong>Isolated sphenoid sinusitis<\/strong> often unknown \u2192 very intense retro-orbital and occipital headaches + without obvious rhinorrhea + risk of intracranial extension + urgent CT or MRI<\/li>\n <\/ul>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Urgent medical consultation<\/div>\n <p>Consult a doctor for sinusitis accompanied by swelling or redness around the eyes, difficulty opening the eye, blurred vision, severe headaches, neck stiffness, confusion, or a very high fever (\u2265 39.5\u00b0C) unresponsive to antipyretics\u2014these signs suggest an orbital or intracranial complication of sinusitis, a medical and surgical emergency. For sinusitis evaluation, antibiotic prescription if bacterial criteria are met, nasal washes, and intranasal corticosteroids, Clinique Omicron offers medical consultations at its service points in Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron's doctors and nurse practitioners (NPs) diagnose and differentiate viral rhinosinusitis (symptomatic treatment) from bacterial rhinosinusitis (IDSA criteria \u2014 antibiotics if indicated), prescribe amoxicillin or amoxicillin-clavulanate based on severity and risk factors, recommend nasal rinses and intranasal corticosteroids, recognize orbital and intracranial complications requiring urgent referral, and manage chronic rhinosinusitis with referral to an ENT for FESS if necessary. Consultations are available at several service locations in Quebec and via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is for informational purposes only and is not a substitute for medical advice from a doctor or an ENT. The vast majority of acute sinusitis cases are viral and resolve spontaneously without antibiotics in 7 to 10 days \u2014 antibiotics are only indicated if the criteria for bacterial sinusitis are met according to Canadian guidelines. The color of nasal discharge is not a criterion for prescribing antibiotics.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Sinusite aigu\u00eb et chronique : diagnostic, antibiotiques et traitement | Clinique Omicron ORL & M\u00e9decine de famille & Infectiologie Sinusite (rhinosinusite) La sinusite \u2014 d\u00e9sign\u00e9e aujourd’hui rhinosinusite dans la nomenclature m\u00e9dicale internationale pour refl\u00e9ter l’implication quasi-constante et simultan\u00e9e de la muqueuse nasale et des sinus paranasaux (car les muqueuses nasale et sinusale sont en continuit\u00e9… <a href=\"https:\/\/cliniqueomicron.ca\/en\/sinusite\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Acute and Chronic Sinusitis: Diagnosis, Antibiotics, and Treatment | Omicron Clinic<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Sinusite : sympt\u00f4mes, causes et traitement | Omicron","_metasync_otto_description":"Sinusite Sinusite est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0 la Clinique...","_metasync_otto_keywords":"","_metasync_otto_og_title":"Sinusite | Clinique Omicron Qu\u00e9bec","_metasync_otto_og_description":"Sinusite Sinusite est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0 la Clinique...","_metasync_otto_twitter_title":"Sinusite | Clinique Omicron","_metasync_otto_twitter_description":"Sinusite Sinusite est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0 la Clinique...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Sinusite aigu\u00eb et chronique : diagnostic, antibiotiques et traitement | Clinique Omicron","_aioseo_description":"La sinusite est virale dans 90-98% des cas et ne n\u00e9cessite pas d'antibiotiques. 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\n\t\t\t\t\t\n\n\n\n\nAcute and Chronic Sinusitis: Diagnosis, Antibiotics, and Treatment | Omicron Clinic<\/title>\n<meta name=\"description\" content=\"Sinusitis is an inflammation of the paranasal sinuses. Viral vs. bacterial sinusitis, antibiotics if double worsening or 10 days, nasal corticosteroids, chronic sinusitis, and surgery in Quebec.\">\n<meta name=\"keywords\" content=\"sinusite, sinusite traitement, sinusite antibiotiques, sinusite bact\u00e9rienne virale, sinusite chronique, rhinosinusite, sinusite amoxicilline, sinusite cortico\u00efdes nasaux, sinusite douleur faciale, sinusite Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap');\n\n.co-wrap * {\n font-family: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 1100px;\n margin: 0 auto;\n padding: 30px 0 60px;\n margin-top: 10px;\n}\n.co-label {\n font-family: 'Cinzel', serif;\n font-size: 14px;\n font-weight: bold;\n letter-spacing: 1px;\n text-transform: uppercase;\n color: #4D6577;\n margin-bottom: 14px;\n display: block;\n}\n.co-wrap h1 {\n font-size: 32px;\n font-weight: 500;\n color: #323C52;\n margin: 0 0 22px;\n line-height: 1.2;\n letter-spacing: 0.5px;\n}\n.co-intro {\n font-size: 16px;\n font-weight: 400;\n line-height: 1.75;\n color: #4D6577;\n margin-bottom: 36px;\n padding-bottom: 32px;\n border-bottom: 1px solid rgba(77,101,119,.2);\n}\n.co-wrap h2 {\n font-size: 20px;\n font-weight: 600;\n color: #323C52;\n margin: 32px 0 12px;\n letter-spacing: 0.3px;\n}\n.co-wrap p {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.7;\n margin-bottom: 14px;\n}\n.co-list {\n list-style: none;\n padding: 0;\n margin: 12px 0 24px;\n}\n.co-list li {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n padding: 10px 14px 10px 38px;\n margin-bottom: 8px;\n border-radius: 6px;\n position: relative;\n background: rgba(77,101,119,.06);\n border-left: 3px solid #4D6577;\n}\n.co-list li::before {\n content: \"\u2713\";\n position: absolute;\n left: 12px;\n font-weight: 700;\n color: #4D6577;\n}\n.co-table {\n width: 100%;\n border-collapse: collapse;\n margin: 14px 0 22px;\n font-size: 14px;\n border-radius: 8px;\n overflow: hidden;\n}\n.co-table thead tr {\n background: #323C52;\n color: #fff;\n}\n.co-table thead th {\n padding: 11px 16px;\n text-align: left;\n font-weight: 600;\n font-size: 13px;\n}\n.co-table tbody tr:nth-child(even) {\n background: rgba(77,101,119,.06);\n}\n.co-table tbody tr:nth-child(odd) {\n background: #fff;\n}\n.co-table td {\n padding: 10px 16px;\n color: #4D6577;\n border-bottom: 1px solid rgba(77,101,119,.12);\n font-size: 14px;\n vertical-align: top;\n}\n.co-table td:first-child {\n font-weight: 600;\n color: #323C52;\n}\n.co-infobox {\n display: flex;\n gap: 12px;\n background: rgba(77,101,119,.06);\n border-radius: 8px;\n border-left: 4px solid #4D6577;\n padding: 14px 18px;\n margin: 18px 0 28px;\n font-size: 14px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.65;\n}\n.co-infobox .ico {\n font-size: 18px;\n flex-shrink: 0;\n}\n.co-urgence {\n background: #fff8f8;\n border-left: 5px solid #c0392b;\n border-radius: 6px;\n padding: 20px 26px;\n margin: 24px 0 32px;\n}\n.co-urgence .co-urgence-titre {\n font-size: 13px;\n font-weight: 700;\n color: #c0392b;\n letter-spacing: 1.5px;\n text-transform: uppercase;\n margin-bottom: 10px;\n}\n.co-urgence p {\n color: #5a2020;\n font-size: 14px;\n margin: 0 0 10px;\n line-height: 1.7;\n}\n.co-urgence p:last-child {\n margin-bottom: 0;\n}\n.co-disclaimer {\n font-size: 13px;\n color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">ENT & Family Medicine & Infectious Diseases<\/span>\n <h1>Sinusitis (rhinosinusitis)<\/h1>\n\n <div class=\"co-intro\">\n Sinusitis\u2014now referred to as rhinosinusitis in international medical terminology to reflect the nearly constant and simultaneous involvement of the nasal mucosa and paranasal sinuses (since the nasal and sinus mucosa are anatomically and inflammatorily continuous)\u2014is the inflammation of the mucous membrane lining the sinus cavities (maxillary, ethmoid, frontal, and sphenoid), most often triggered by a viral infection of the upper respiratory tract (rhinovirus, seasonal coronaviruses, influenza, RSV) in the context of the common cold, with obstruction of the sinus ostium, accumulation of secretions, and a predisposition to secondary bacterial superinfection in a minority of cases. Acute rhinosinusitis is one of the most common conditions in primary care\u2014accounting for nearly 20 million annual medical visits in the United States\u2014and one of the leading causes of antibiotic prescriptions in Western countries, despite the fact that 90 to 98% of acute rhinosinusitis cases are viral in origin and do not require antibiotics. Canadian clinical guidelines (CMAJ + IDSA) emphasize the distinction between viral rhinosinusitis (symptomatic treatment only\u2014duration 7\u201310 days) and acute bacterial rhinosinusitis (antibiotics only if 3 specific criteria are met: see below) to reduce inappropriate antibiotic prescribing and preserve their effectiveness. Chronic rhinosinusitis (CRS\u2014duration > 12 weeks) is a distinct condition, often associated with allergic rhinitis + nasal polyposis + mucociliary dysfunction + or a deviated septum, requiring a different therapeutic approach focused on intranasal corticosteroids + nasal irrigation + and sometimes endoscopic sinus surgery.\n <\/div>\n\n <h2>Diagnostic Criteria and Viral vs. Bacterial Distinction<\/h2>\n <ul class=\"co-list\">\n <li><strong>Acute viral rhinosinusitis (common cold)<\/strong> Symptoms < 10 days + ongoing improvement + 4 cardinal symptoms: nasal congestion + rhinorrhea (clear or colored) + facial (sinus) pressure or pain + reduced sense of smell + color of secretions (yellow + green) is NOT a criterion for bacteremia \u2192 treatment: symptomatic only<\/li>\n <li><strong>Acute bacterial rhinosinusitis \u2014 IDSA criteria (3 scenarios):<\/strong><\/li>\n <li><strong>Scenario 1 \u2014 Persistent symptoms \u2265 10 days with no improvement:<\/strong> Rhinorrhea + congestion + facial pressure lasting > 10 days without improvement \u2192 viral sinusitis does not last > 10 days<\/li>\n <li><strong>Scenario 2 \u2014 Worsening following initial improvement (double worsening):<\/strong> Symptoms improving after D5\u2013D7 then worsening with fever + increased nasal discharge + facial pain \u2192 bacterial superinfection on initial viral rhinosinusitis<\/li>\n <li><strong>Scenario 3 \u2014 Sudden severe symptoms:<\/strong> Fever \u2265 39\u00b0C + intense unilateral facial pain + unilateral dental pain \u2192 probable bacterial rhinosinusitis from onset<\/li>\n <\/ul>\n\n <h2>Bacteria responsible for acute bacterial rhinosinusitis<\/h2>\n <ul class=\"co-list\">\n <li><strong><em>Streptococcus pneumoniae<\/em> Pneumococcus<\/strong> 30\u201340 % \u2192 primary cause + increasing penicillin resistance (PSPN + PSPI) \u2192 standard-dose amoxicillin remains effective if MIC \u2264 2 \u00b5g\/mL<\/li>\n <li><strong><em>Haemophilus influenzae<\/em> non-typable<\/strong> 20\u201330% of % strains \u2192 beta-lactamase production in 30\u201340% of % strains \u2192 amoxicillin-clavulanate if beta-lactamase is suspected<\/li>\n <li><strong><em>Moraxella catarrhalis<\/em> :<\/strong> 10\u201320 % \u2192 nearly constant beta-lactamase production (90 %) \u2192 amoxicillin-clavulanate<\/li>\n <li><strong>Anaerobes (odontogenic dental sinusitis):<\/strong> Bacteroides + Fusobacterium + Prevotella \u2192 maxillary sinusitis associated with recent tooth extraction + or apical abscess + treatment: amoxicillin-clavulanate + or metronidazole<\/li>\n <\/ul>\n\n <h2>Acute rhinosinusitis treatment<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Situation<\/th>\n <th>Recommended treatment<\/th>\n <th>Duration and remarks<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Viral rhinosinusitis (< 10 days + no worsening)<\/td>\n <td>Symptomatic treatment only: nasal irrigation with NaCl (normal saline or hypertonic saline) + topical nasal decongestants (oxymetazoline 0.1% 1\u20133 times daily for up to 3\u20135 days) + acetaminophen or NSAIDs for pain + intranasal corticosteroids (fluticasone + mometasone) if underlying allergic rhinitis + NO antibiotics<\/td>\n <td>Spontaneous resolution within 7\u201310 days for the vast majority; 2\u20133% progress to bacterial sinusitis; antibiotics do not shorten the duration of symptoms in viral sinusitis<\/td>\n <\/tr>\n <tr>\n <td>Mild to moderate bacterial rhinosinusitis (1 of 3 IDSA criteria)<\/td>\n <td>Amoxicillin 500\u2013875 mg x 2\u20133\/day x 5\u20137 days (adult) or amoxicillin 40\u201345 mg\/kg\/day x 5\u20137 days (child) or armed waiting 2\u20133 days with symptomatic treatment if symptoms are mild (Canadian guidelines \u00abwait-and-see\u00bb option)<\/td>\n <td>Spontaneous recovery rate of 60\u201370% for % even without antibiotics \u2192 the decision must weigh the benefits against the risk of resistance + prefer narrow-spectrum amoxicillin as first-line treatment<\/td>\n <\/tr>\n <tr>\n <td>Severe bacterial rhinosinusitis (fever \u2265 39\u00b0C + intense pain) or amoxicillin failure at 72 hours<\/td>\n <td>Amoxicillin-clavulanate 875\/125 mg \u00d7 2\/day \u00d7 7\u201310 days (adult) OR levofloxacin 500 mg \u00d7 1\/day \u00d7 5 days (non-anaphylactic penicillin allergy) OR ceftriaxone 1 g IM\/IV for very severe forms<\/td>\n <td>Covers H. influenzae + M. catarrhalis beta-lactamases + true penicillin allergy: aztreonam (parenteral) + or respiratory quinolone<\/td>\n <\/tr>\n <tr>\n <td>Acute Rhinosinusitis in Children (Bacteriological Criteria Met)<\/td>\n <td>Amoxicillin 45-90 mg\/kg\/day \u00d7 10 days (high dose if resistant pneumococcus or daycare + or recent antibiotic therapy < 3 months)<\/td>\n <td>Duration 10 days in children (vs 5\u20137 days in adults) + amoxicillin-clavulanate if beta-lactamase suspected<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Chronic rhinosinusitis (CRS)<\/h2>\n <ul class=\"co-list\">\n <li><strong>Definition:<\/strong> Symptoms of rhinosinusitis \u2265 12 weeks despite adequate medical treatment + confirmed by nasal endoscopy + or sinus CT scan (mucosal thickening + opacification)<\/li>\n <li><strong>Shapes<\/strong> CRS with nasal polyps (CRSwNP) - bilateral nasal polyps + often associated with the Yenner triad (asthma + aspirin sensitivity + polyps) + type 2 (eosinophilic) + or CRS without nasal polyps (CRSsNP) - neutrophilic + often linked to septal deviation + recurrent infections<\/li>\n <li><strong>Medical treatment:<\/strong> Daily intranasal corticosteroid spray (fluticasone + mometasone + budesonide) for at least 3\u20136 months \u2192 reduction in polyp size + improved sinus drainage + hypertonic nasal rinses (2% NaCl \u2014 squeeze bottle) \u00d7 2\/day \u2192 clearance of secretions + improvement in mucus + oral corticosteroids (prednisone 0.5 mg\/kg\/day \u00d7 2 weeks) during acute polyposis flare-ups<\/li>\n <li><strong>Biotherapies (Severe refractory RSCaPN type 2):<\/strong> dupilumab (Dupixent\u00ae \u2014 anti-IL-4\/IL-13) 300 mg SC every 2 weeks \u2192 Health Canada approved for severe type 2 eosinophilic chronic rhinosinusitis refractory to corticosteroid therapy + significant reduction in polyp volume + improved sense of smell + mepolizumab (anti-IL-5) + omalizumab (anti-IgE if associated allergic asthma)<\/li>\n <li><strong>Functional Endoscopic Sinus Surgery (FESS):<\/strong> if medical treatment has failed for \u2265 3 months + or complications are present + or there is extensive polyposis + under general anesthesia + results: 75\u201385% improvement in long-term symptoms + surgery does not cure chronic sinusitis but significantly improves quality of life + sinus patency + and response to postoperative medical treatments<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>The green or yellow color of nasal discharge does NOT indicate bacterial sinusitis requiring antibiotics. This coloration simply reflects the presence of neutrophils mobilized against the virus\u2014it's part of the normal progression of viral rhinosinusitis between days 3 and 7. The true criteria for a bacterial superinfection are duration (> 10 days with no improvement) OR biphasic worsening after initial improvement OR severe symptoms from the outset (fever \u2265 39\u00b0C + intense unilateral pain).<\/span>\n <\/div>\n\n <h2>Complications \u2014 urgencies to recognize<\/h2>\n <ul class=\"co-list\">\n <li><strong>Orbital cellulitis (preseptal or postseptal):<\/strong> Ethmoidal sinusitis extension \u2192 periorbital edema + erythema + pain \u2192 if postseptal: proptosis + limited eye movements + diplopia + vision loss \u2192 ophthalmological and ENT emergency + CT scan of orbits + sinuses + IV antibiotics + surgical drainage if abscess<\/li>\n <li><strong>Intracranial abscess (subdural empyema + epidural abscess + brain abscess):<\/strong> severe headaches + fever + focal neurological signs + nuchal rigidity \u2192 urgent brain MRI + neurosurgery + intensive care<\/li>\n <li><strong>Secondary bacterial meningitis:<\/strong> extension of sphenoidal or ethmoidal sinusitis + stiff neck + severe headaches \u2192 lumbar puncture + urgent ceftriaxone<\/li>\n <li><strong>Frontal osteomyelitis (Pott's tumor)<\/strong> Frontal sinus extension \u2192 painful + fluctuant frontal swelling + frontal CT scan + prolonged antibiotics + surgery<\/li>\n <li><strong>Isolated sphenoid sinusitis<\/strong> often unknown \u2192 very intense retro-orbital and occipital headaches + without obvious rhinorrhea + risk of intracranial extension + urgent CT or MRI<\/li>\n <\/ul>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Urgent medical consultation<\/div>\n <p>Consult a doctor for sinusitis accompanied by swelling or redness around the eyes, difficulty opening the eye, blurred vision, severe headaches, neck stiffness, confusion, or a very high fever (\u2265 39.5\u00b0C) unresponsive to antipyretics\u2014these signs suggest an orbital or intracranial complication of sinusitis, a medical and surgical emergency. For sinusitis evaluation, antibiotic prescription if bacterial criteria are met, nasal washes, and intranasal corticosteroids, Clinique Omicron offers medical consultations at its service points in Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron's doctors and nurse practitioners (NPs) diagnose and differentiate viral rhinosinusitis (symptomatic treatment) from bacterial rhinosinusitis (IDSA criteria \u2014 antibiotics if indicated), prescribe amoxicillin or amoxicillin-clavulanate based on severity and risk factors, recommend nasal rinses and intranasal corticosteroids, recognize orbital and intracranial complications requiring urgent referral, and manage chronic rhinosinusitis with referral to an ENT for FESS if necessary. Consultations are available at several service locations in Quebec and via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is for informational purposes only and is not a substitute for medical advice from a doctor or an ENT. The vast majority of acute sinusitis cases are viral and resolve spontaneously without antibiotics in 7 to 10 days \u2014 antibiotics are only indicated if the criteria for bacterial sinusitis are met according to Canadian guidelines. The color of nasal discharge is not a criterion for prescribing antibiotics.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Sinusite aigu\u00eb et chronique : diagnostic, antibiotiques et traitement | Clinique Omicron ORL & M\u00e9decine de famille & Infectiologie Sinusite (rhinosinusite) La sinusite \u2014 d\u00e9sign\u00e9e aujourd’hui rhinosinusite dans la nomenclature m\u00e9dicale internationale pour refl\u00e9ter l’implication quasi-constante et simultan\u00e9e de la muqueuse nasale et des sinus paranasaux (car les muqueuses nasale et sinusale sont en continuit\u00e9… <a href=\"https:\/\/cliniqueomicron.ca\/en\/sinusite\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Acute and Chronic Sinusitis: Diagnosis, Antibiotics, and Treatment | Omicron Clinic<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Sinusite : sympt\u00f4mes, causes et traitement | Omicron","_metasync_otto_description":"Sinusite Sinusite est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0 la Clinique...","_metasync_otto_keywords":"","_metasync_otto_og_title":"Sinusite | Clinique Omicron Qu\u00e9bec","_metasync_otto_og_description":"Sinusite Sinusite est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0 la Clinique...","_metasync_otto_twitter_title":"Sinusite | Clinique Omicron","_metasync_otto_twitter_description":"Sinusite Sinusite est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0 la Clinique...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Sinusite aigu\u00eb et chronique : diagnostic, antibiotiques et traitement | Clinique Omicron","_aioseo_description":"La sinusite est virale dans 90-98% des cas et ne n\u00e9cessite pas d'antibiotiques. Crit\u00e8res IDSA 10 jours double aggravation fi\u00e8vre 39\u00b0C, amoxicilline 5-7j, cortico\u00efdes nasaux lavages, RSC dupilumab FESS au Qu\u00e9bec.","_metasync_seo_title":"","_metasync_seo_desc":"","_metasync_breadcrumb_title":"","_metasync_primary_category":0,"_metasync_primary_product_cat":0,"_metasync_otto_disabled":"","_metasync_hreflang":"","_metasync_plugin_sync_ts":"{\"aioseo\":\"2026-05-04T21:55:25+00:00\"}","_metasync_robots_advanced":"","footnotes":""},"class_list":["post-24961","page","type-page","status-publish","hentry"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t<meta name=\"description\" content=\"Sinusite Sinusite est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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