Most acute rhinosinusitis begins when a viral upper respiratory infection (URI) extends into the paranasal sinuses, which may be followed by bacterial infection. About 20 million cases occur each year, which makes it one of the most common conditions that send people to the physician’s office. Its importance in health care relates not only to its prevalence but also to the potential for rare but serious sequelae: meningitis, brain abscess, orbital cellulitis, and orbital abscess.
A strong recommendation means that a treatment’s benefits clearly exceed the harms-or that the harms clearly exceed the benefits in the case of a strong negative recommendation-and that the quality of the supporting evidence is excellent. Clinicians should follow a strong recommendation unless there is a clear and compelling reason for an alternative.
A recommendation means that the benefits exceed the harms-or the reverse for a negative recommendation-but the quality of evidence is not as strong. Clinicians should generally follow a recommendation but should remain alert to new information and be sensitive to patient preferences.