Epidemiology and management of rhinosinusitis

Acute and chronic rhinosinusitis are different diseases with different aetiology and they require different treatment. In this thesis we evaluated the prevalence of acute and chronic rhinosinusitis in the general population and in primary care. We investigated which factors are related to rhinosinusitis and whether general practitioners (GPs) distinguish between acute and chronic rhinosinusitis. We evaluated their management of rhinosinusitis (especially with regard to antibiotics). Furthermore we discuss the complications that can occur as a result of acute rhinosinusitis and whether these complications could have been prevented by prescribing antibiotics.
In the general population we found a prevalence of 18% for acute rhinosinusitis and 16% for chronic rhinosinusitis. Ninety-six percent of GPs say they differentiate between acute and chronic rhinosinusitis, but they use different definitions (54% of these definitions correspond to the European guideline, EPOS). For mild and moderate symptoms of acute rhinosinusitis, 21% and 34% of the GPs, respectively, consider prescribing antibiotics (while there is no indication according to the guideline). The prescription of antibiotics for acute rhinosinusitis does not prevent the occurrence of complications.
We think it would help if, in addition to the current guideline on acute rhinosinusitis, a separate guideline on chronic rhinosinusitis for GPs is developed to help distinguishing acute and chronic rhinosinusitis. Until that time, we advise GPs to use the European guideline for the diagnosis and treatment of rhinosinusitis. In comparison to doctors abroad, Dutch GPs are reluctant to prescribe antibiotics, but this can be further reduced.