Rewriting the Rules of Rhinosinusitis

Otolaryngologists’ understanding of rhinosinusitis has evolved significantly over the past decade. The latest American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guidelines—one focused on medical management of adult sinusitis, the other on surgical management of chronic rhinosinusitis—reflect that evolution. Together, they codify the current scientific consensus on how to best diagnose and treat sinus disease in adults.

Published in the summer of 2025, the new guidelines will influence how otolaryngologists, primary care providers, and others manage adult sinusitis—and hopefully lead to improved clinical outcomes and a decreased disease burden for millions of Americans.

The 2025 Adult Sinusitis Update replaces the 2015 practice guideline; the surgical management guideline is the first surgical-specific guideline for chronic rhinosinusitis (Otol Head Neck Surg. 2025;173(S1):S1–S56; Otol Head Neck Surg. 2025;172(S2):S1–S47).

“Over the last 10 years, we’ve learned a lot about the disease process underlying chronic sinusitis. Whereas in the past, we really focused on patency of the sinuses, bacterial colonization, and infection, there is now an understanding that chronic sinusitis is an inflammatory regional disease,” said Justin Turner, MD, PhD, chair of the department of otolaryngology at the University of Alabama–Birmingham Marnix E. Heersink School of Medicine.

The 2025 guidelines reflect this refined pathophysiologic view of sinus disease and encourage a more individualized, targeted approach to management.

“We now know that the vast majority of chronic rhinosinusitis in western populations— maybe 70% to 80%—is primarily inflammatory,” said Benjamin Bleier, MD, associate professor of otolaryngology–head and neck surgery at Harvard Medical School and Claire and John Bertucci Chair in Otolaryngology–Head and Neck Surgery at Massachusetts Eye and Ear. “The general movement in otolaryngology is toward personalized medicine and away from one-size-fits-all maximal treatment.”

Dr. Bleier, left, says movement in otolaryngology is toward personalized medicine and away from one-size-fits-all maximal treatment.

For rhinologists and other physicians who specialize in the treatment of adult sinusitis, little in the guidelines will feel new or revolutionary. Because clinical practice guidelines are built upon scientific research and expert consensus, they reinforce best practices. Many adults with sinusitis (or sinusitis symptoms) are not initially seen by otolaryngologists, however, and approximately half of patients who are referred to an otolaryngology practice for sinusitis may not meet diagnostic criteria for sinusitis (Ann Otol Rhinol Laryngol. 2024;133:476-448). This gap underscores all otolaryngologists’ responsibility to implement and disseminate the updated guidelines across the broader clinical community.