| Major consideration | Clinical feature | Viral rhinosinusitis | Bacterial rhinosinusitis |
| Viral URI | Fever | - Typically absent
- When present, fever occurs early (in first 24 hours), is low grade, and resolves within the first 2 days
| - In severe presentation, temperature may be ≥39°C (102.2°F) for >3 days
- In worsening presentation, fever may develop or recur on day 6 to 7 of illness after initial improvement
|
| Nasal discharge | - Peaks on days 3 to 6 then steadily improves
| - Fails to improve substantially or worsens over time
|
| Cough | - Peaks on days 3 to 6 then steadily improves
| - Fails to improve substantially or worsens over time
|
| Ill appearance | | - May occur (in severe presentation)
|
| Severe headache | | - May be a sign of severe illness or complication
|
| Clinical course | - Symptoms peak in severity on days 3 to 6 and then improve
| - Symptoms are present for ≥10 days without improvement
|
| Other considerations | Associated clinical features |
| Allergic rhinitis | - May be associated with allergic facies:
- Infraorbital edema
- Accented lines or folds below the lower eyelids
- Transverse nasal crease
- May be associated with cobblestoning of posterior pharynx
|
| Nasal foreign body | - Foul odor
- Serosanguineous nasal drainage
- May be directly observed
|
| Infected adenoids | - Downward displacement of soft palate (adenoids usually not seen)
- Mouth breathing
- Halitosis
- Snoring
|
| Gastroesophageal reflux | - May be associated with persistent nasal discharge, wheezing, and cough
|
| Pertussis (particularly catarrhal stage) | - Nasal symptoms usually precede cough
- Cough is paroxysmal
- Cough may be followed by inspiratory whoop
- Cough may be associated with posttussive emesis
|
