Unifying Concepts

Diagnostic Criteria for Chronic Rhinosinusitis (CRS)

Chronic rhinosinusitis is defined by the presence of at least two out of four cardinal symptoms (i.e., facial pain/pressure, hyposmia/anosmia, nasal drainage, and nasal obstruction) for at least 12 consecutive weeks, in addition to objective evidence. Objective evidence of chronic rhinosinusitis may be obtained on physical examination (anterior rhinoscopy, endoscopy) or radiography, preferably from sinus computed tomography.

Chronic and recurrent rhinosinusitis definitions

Chronic rhinosinusitis (CRS): Twelve (12) weeks or longer of two or more of the following signs and symptoms:

  • Mucopurulent drainage (anterior, posterior, or both)
  • Nasal obstruction (congestion)
  • Facial pain-pressure-fullness, or
  • Decreased sense of smell

AND inflammation is documented by one or more of the following findings:

  • Purulent (not clear) mucus or edema in the middle meatus or ethmoid region
  • Polyps in nasal cavity or the middle meatus, and/or
  • Radiographic imaging showing inflammation of the paranasal sinuses

Recurrent acute rhinosinusitis: Four (4) or more episodes per year of Acute bacterial rhinosinusitis (ABRS) without signs or symptoms of rhinosinusitis between episodes.



  1. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1-S39. [Medline]
  2. Rosenfeld RM. Clinical practice guideline on adult sinusitis. Otolaryngol Head Neck Surg. 2007 Sep;137(3):365-77. [Medline]
  3. Sedaghat AR. Chronic Rhinosinusitis. Am Fam Physician. 2017;96(8):500–506. [Medline]

Created Mar 19, 2020.

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