Table 19.

Rhinosinusitis consensus definitions for patient care

	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 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 nasal airway examination of the decongested nose 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 Sinus CT imaging is not essential but should be strongly considered (see text for further discussion). Rarely, incidental imaging findings can be used to make the diagnosis of CRS independent of symptoms and physical examination.†	Requires nasal airway examination of decongested nose to confirm presence of bilateral polyps in middle meatus Sinus CT imaging is not essential but should be strongly considered (see text for further discussion). Rarely, incidental imaging findings can be used to make diagnosis of CRS independent of symptoms and physical examination.†	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 fungal-specific IgE (skin test or in vitro blood test) •No histologic evidence of invasive fungal disease
				Sinus CT imaging is not essential but is highly recommended because of tendency for bony erosions and extension of disease into adjacent anatomic areas.
				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.

^†However, imaging studies alone might not be able to determine the presence or absence of polyps.