Acute Bacterial Rhinosinusitis

What is acute bacterial rhinosinusitis?

Acute bacterial rhinosinusitis (ABRS) is an infection of both your nasal cavity and sinuses. It is caused by bacteria. The nasal cavity is the large air-filled space behind your nose. The sinuses are a group of spaces formed by the bones of your face. They connect with your nasal cavity. ABRS causes the tissue lining these spaces to become inflamed. Mucus may not drain normally. This leads to face pain and other common symptoms.

It’s more common for rhinosinusitis to be caused by a virus. But ABRS is caused by bacteria. An acute infection means that you’ve had symptoms for less than 4 weeks.

ABRS isn’t as common as acute viral rhinosinusitis. Women get it more often than men. Middle-aged and older adults also get it more often.

What causes acute bacterial rhinosinusitis?

ABRS is caused by bacteria that infect the lining of your nasal cavity and sinuses. It’s most often caused by the bacteria Streptococcus pneumonia. Or it may be caused by the bacteria Haemophilus influenzae. This can happen when the lining is already inflamed. This is often caused by a virus. The bacterial infection comes later. It often starts in the nasal cavity and spreads into your sinuses.

Other factors can cause inflammation and make a bacterial infection more likely, such as:

  • Allergies
  • Blockage in the nose
  • Swimming
  • Tooth infection
  • Cocaine use in the nose

What are the symptoms of acute bacterial rhinosinusitis?

The symptoms of ABRS can look like other health conditions. Symptoms may be different for each person. The symptoms may include:

  • Face pain or pressure that’s worse when leaning forward
  • Postnasal drip
  • Nasal congestion
  • Pain in your upper jaw
  • Toothache in your upper jaw
  • Yellow or greenish discharge from your nose
  • Fever
  • Cough
  • Ear pressure or fullness
  • Headache
  • Decreased smell

Most people don’t have all of these symptoms. With an acute infection, these symptoms have lasted less than 4 weeks.

How is acute bacterial rhinosinusitis diagnosed?

Your healthcare provider will ask about your health history. He or she will ask about your symptoms and how long you’ve had them. You may have a physical exam. This is to look for signs of a respiratory infection.

It’s hard to tell the difference between viral and bacterial rhinosinusitis. Both have similar symptoms. You may be more likely to have ABRS if you’ve had:

  • Symptoms for more than 10 days with no improvement
  • A fever of 100.4°F (38.0°C) or higher
  • Yellow or greenish nasal discharge
  • Pain in the areas around your nose
  • Symptoms that suddenly get much worse after they seemed to be getting better

In most cases, your provider will not need to do more tests. They are often not needed, unless you have signs of complications. You might also need testing if you’ve had several episodes of ABRS. These tests might include:

  • Endoscopy of the nasal cavity and sinuses, with and without a culture. This is done to identify the particular bacteria. And to be sure that there are no blockages, such as a foreign body, polyps, or a tumor.
  • CT scan. This provides more information about your nasal cavity, sinuses, and related structures.

How is acute bacterial rhinosinusitis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatments for ABRS can include:

  • Antibiotics to kill the infecting bacteria
  • Pain medicines
  • Rinsing the nasal passages with saline to make them feel better

Researchers don’t know if some of these treatments work for ABRS.

Your healthcare provider may not give you antibiotics at first. It is hard to tell if you have a bacterial infection. So other treatments may be recommended. Antibiotics don’t help rhinosinusitis that is caused by a virus. Healthcare providers don’t like to give antibiotics if they’re not needed. Many people get better without antibiotics.

If your symptoms don’t get better in several days, you might need antibiotics. If your healthcare provider finds that you have a bacterial infection at your first visit, you might get antibiotics right away.

What are possible complications of acute bacterial rhinosinusitis?

In rare cases, ABRS may cause complications such as:

  • Infection of the tissue around the brain and spinal cord (meningitis)
  • Infection of the tissue around the eye (orbital cellulitis)
  • Infection of the sinus bones (osteitis)

Your healthcare provider will keep track of your symptoms to make sure you don’t have these complications. If you do, you might need antibiotics given through an IV (intravenous) line. In very rare cases, you might need surgery as well.

When should I call my healthcare provider?

Call your healthcare provider if your symptoms don't get better after several days of treatment. Also call right away if you have any symptoms of possible complications such as:

  • Swelling around your eyes

Call 911 if you have:

  • Abnormal vision
  • Confusion or loss of alertness

Key points about acute bacterial rhinosinusitis

  • Acute bacterial rhinosinusitis (ABRS) is an infection of both your nasal cavity and sinuses. It is caused by bacteria.
  • ABRS sets in when your nasal cavity and sinuses first become inflamed from another cause, often a viral infection.
  • You might have symptoms such as face pain and fever.
  • You might have yellow or greenish discharge from your nose.
  • Your healthcare provider might or might not use an antibiotic to help treat you. Other treatments may help make you feel better.
  • ABRS rarely causes serious complications.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Medical Reviewer: Ashutosh Kacker MD
Medical Reviewer: Ronald Karlin MD
Medical Reviewer: Daphne Pierce-Smith RN MSN CCRC
© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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