• Clinical diagnosis: Most common method; acute rhinosinusitis signs and symptoms (as above) that have not resolved after 10 days or that worsen within 10 days after initial improvement. Sputum color is unreliable for diagnosis of bacterial infection because neutrophil presence causes color and can be found in viral sinusitis.

• Radiographic studies: Useful for assessing presence of abscess or intracranial complication.

• Paranasal sinus puncture: "Gold standard"; not performed routinely but can be useful in complicated or chronic cases.

• Laboratory studies/nasopharyngeal cultures: Not recommended for routine diagnosis.

Table 72-3 Risk Factors for ABRS

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