Table 18.

Rhinosinusitis consensus research definitions and clinical trial guidelines

	Type of rhinosinusitis
	Acute (presumed bacterial) rhinosinusitis	CRS without nasal polyposis	CRS with nasal polyposis	AFRS
Criteria for diagnosis
Pattern of symptoms	•Symptoms present for a minimum of 10 d up until a maximum of 28 d •Severe disease* (presence of purulence for 3–4 d with high fever) •Worsening disease (symptoms that initially regress but worsen within first 10 d)	Symptoms present for ≥12 wk
Symptoms for diagnosis	Requires: •Anterior and/or posterior purulent drainage plus •Nasal obstruction or •Facial pain-pressure-fullness	Requires ≥2 of the following symptoms: •Anterior and/or posterior mucopurulent drainage •Nasal obstruction •Facial pain-pressure-fullness	Requires ≥2 of the following symptoms: •Anterior and/or posterior mucopurulent drainage •Nasal obstruction •Decreased sense of smell	Requires ≥1 of the following symptoms: •Anterior and/or posterior nasal drainage •Nasal obstruction •Decreased sense of smell •Facial pain-pressure-fullness
Objective documentation	Requires either • Nasal airway examination for purulent drainage: 1 beyond vestibule by either anterior rhinoscopy or endoscopy, or 2 posterior pharyngeal drainage, or •Radiographic evidence of acute rhinosinusitis	Requires both •Endoscopy to exclude presence of polyps in middle meatus and document presence of inflammation, such as discolored mucus or edema of middle meatus or ethmoid area, and •Evidence of rhinosinusitis on imaging by CT	Requires both •Endoscopy to confirm presence of bilateral polyps in middle meatus and •Imaging by CT with confirmation of bilateral mucosal disease	Requires •Endoscopy to document presence of allergic mucin (pathology showing fungal hyphae with degranulating eosinophils) and inflammation, such as edema of middle meatus or ethmoid area or nasal polyps •Evidence of rhinosinusitis by CT or MRI •Evidence of fungal-specific IgE (skin test or in vitro blood test) •No histologic evidence of invasive fungal disease
				Other possible, but not required, documentation measures: •Fungal culture •Total serum IgE level •Imaging by more than one technique (CT or MRI) highly suggestive of AFRS

^*Patients who have intracranial extension, have orbital cellulitis, or require hospitalization are considered to have severe disease but should be excluded from clinical trials of uncomplicated acute (presumed bacterial) rhinosinusitis.