rhinosinusitis guidelines

Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. An increased emphasis on evidence-based recommendations over the past decade has significantly improved the overall quality of most published guidelines, but present significant difficulties in developing guidelines where the evidence base for long-standing, traditional remedies is often weak or anecdotal, or in emerging entities such as chronic rhinosinusitis (CRS) where controversy remains and evidence is sparse. In developing these guidelines, standard evidence-based development techniques have been combined with the Delphi voting process in order to offer the reader the opinion of a multi-disciplinary expert group in areas where evidence is weak.

These guidelines were developed for all adult Canadians over 18 years of age and do not apply to the pediatric population. The guidelines are intended to provide guidance on the following clinical questions about acute and chronic sinusitis in adults:

  • Is it a cold, allergy, or sinusitis?
  • How is a patient with acute or chronic sinusitis identified?
  • What is the appropriate investigation of the patient with suspected acute or chronic sinusitis?
  • Are antibiotics required for the management of all cases of acute bacterial sinusitis?
  • When should a patient with suspected acute or chronic rhinosinusitis be referred?
  • How are complications detected in a patient with sinusitis?
  • What is the optimal management of sinusitis?
  • What are the evidence-based recommendations for appropriate selection of nonmedical and medical therapies for the management of acute and chronic sinusitis?
  • How are patients with chronic sinusitis managed over the long term?

To facilitate the use of these guidelines as a teaching tool, summaries and tables of take home points are presented within the text.

DISCLAIMER: These guidelines are designed to offer evidence-based strategies in the management of acute and chronic rhinosinusitis. They are, however, not intended to replace clinical judgment or establish a protocol for all individuals with suspected rhinosinusitis. Different presentations, associated comorbidities, or availability of resources may require adaptation of these guidelines, thus there may be other appropriate approaches to diagnosing and managing these conditions.

Click on the links below to download the PDF files
JOHNS Publication
AACI publication
Executive Summary
Chronic algorithm
Acute algorithm