Unifying Concepts

Clinical Criteria for the Diagnosis of Acute Bacterial Sinusitis

Acute bacterial sinusitis in children is diagnosed on the basis of the history, with the use of the criteria. Imaging studies (plain-film radiography, computed tomography [CT], magnetic resonance imaging [MRI], and ultrasonography) show signs of sinus inflammation but are not recommended in patients with uncomplicated infection, given the low specificity of these studies.

Clinical Criteria for the Diagnosis of Acute Bacterial Sinusitis
Persistent symptoms

  • Nasal congestion, rhinorrhea, or cough
  • >/=10 Days’ duration without improvement

Severe symptoms

  • Temperature >/=38.5°C for 3–4 days
  • Purulent rhinorrhea for 3–4 days

Worsening symptoms

  • Return of symptoms after initial resolution
  • New or recurrent fever, increase in rhinorrhea, or increase in cough



  1. DeMuri GP, Wald ER. Clinical practice. Acute bacterial sinusitis in children. N Engl J Med. 2012 Sep 20;367(12):1128-34. [Medline]
  2. DeMuri GP, Wald ER. Acute sinusitis: clinical manifestations and treatment approaches. Pediatr Ann. 2010 Jan;39(1):34-40. [Medline]


Created: Sep 21, 2012

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