There is no proved specific treatment for a cold, but supportive measures such as decongestants (pseudoephedrine, 30 mg every 4 hours, or 120 mg twice daily) may provide some relief of rhinorrhea and nasal obstruction. Nasal sprays such as oxymetazolone or phenylephrine are rapidly effective. They should not be used for more than a few days at a time, since chronic use leads to a rebound congestion that is often worse than the original symptoms. This chronic nasal stuffiness is known as rhinitis medicamentosa. Treatment requires complete cessation of the sprays. This triggers a period of severe nasal congestion that usually lasts 1–2 weeks. Topical intranasal corticosteroids (flunisolide, two sprays in each nostril twice daily) or a short tapering course of oral prednisone may help during the process of withdrawal.

Other than transient middle ear effusion, complications of viral rhinitis are unusual. Secondary bacterial infection may occur and is suggested by a change in color of the rhinorrhea from clear and watery to mucoid and yellow or green. In such cases, nasal cultures may help treatment. The most common pathogens are the same as those responsible for acute otitis media, ie, Streptococcus pneumoniae, other streptococci, Haemophilus influenzae, Staphylococcus aureus, and Moraxella catarrhalis.

Acute sinus infections are uncommon compared to viral rhinitis. Because sinusitis usually has followed an acute respiratory infection and because media advertisements often use the term "sinusitis" when "rhinitis" would be more accurate, it is understandable that patients and physicians alike sometimes confuse these entities. In addition to the symptoms of rhinitis, the diagnosis of sinusitis requires clinical signs and symptoms that indicate involvement of the affected sinus or sinuses such as pain and tenderness over the involved sinus.

Sinusitis occurs when an undrained collection of pus accumulates in a sinus. Diseases that swell the nasal mucous membrane, such as viral or allergic rhinitis, are usually the underlying cause. Edematous mucosa causes obstruction of a sinus drainage tract, resulting in the accumulation of mucous secretion in the sinus cavity that becomes secondarily infected by bacteria. The typical pathogens of bacterial sinusitis are the same as those that cause acute otitis media: S pneumoniae, other streptococci, H influenzae, and, less commonly, S aureus and Moraxella catarrhalis.

A. Symptoms and Signs: Because the maxillary sinus is the largest of the paranasal sinuses and its ostia into the nose is superiorly placed, thereby failing to take advantage of gravity, it is the most commonly affected sinus. Pain and pressure over the cheek are the usual symptoms. Pain may refer to the upper incisor and canine teeth via branches of the trigeminal nerve, which traverse the floor of the sinus. It is not uncommon for maxillary sinusitis to result from dental infection, and teeth that are tender should be carefully examined for signs of abscess. Discolored nasal discharge and poor response to decongestants may also suggest sinusitis. Other possible causes for facial pain, such as trigeminal neuralgia and optic neuritis, should be kept in mind as well.

Acute ethmoiditis in adults is usually accompanied by maxillary sinusitis. In such cases, the symptoms of maxillary sinusitis generally predominate. Ethmoidal infection presents with pain and pressure over the high lateral wall of the nose that may radiate to the orbit. Periorbital cellulitis may be present.

Sphenoid sinusitis is usually seen in the setting of pansinusitis. The patient may complain of a headache "in the middle of the head" and often points to the vertex. Sixth nerve palsy may occur as the abducens nerve courses just lateral to the sinus.

Acute frontal sinusitis usually causes pain and tenderness of the forehead. This is most easily elicited by palpation of the orbital roof just below the medial end of the eyebrow. Palpation here is more accurate than percussion of the supraorbital area or forehead.

B. Imaging: Although it is often possible to make the diagnosis of sinusitis on clinical grounds alone, radiologic confirmation allows a more definitive diagnosis and is an objective monitor of the course of infection. Transillumination may aid in diagnosis, but variations in soft tissue thickness and technique often make interpretation difficult. The authors have not found it particularly helpful in practice.

The standard set of conventional sinus films and the sinus best seen in each view are Caldwell (frontal), Waters (maxillary), lateral (sphenoid), and submentovertical (ethmoid). Opacification without bone destruction is a typical feature of sinusitis. An air-fluid level may be seen if the films are taken with the patient upright rather than supine. The frontal sinus may occasionally appear normal even in the face of clinically compelling evidence of sinusitis. Limited coronal CT scans have increasingly replaced sinus films for screening sinusitis. They are no more expensive than conventional films and are more sensitive to both inflammatory changes and bone destruction (which would lead one to suspect a tumor). In recurrent sinusitis, CT scanning may help delineate anatomic blockage of the osteomeatal complex and thus suggest a role for functional endoscopic sinus surgery. If, however, malignancy is suspected (eg, because of unilateral cranial neuropathy or a nasoantral mass), then MRI with gadolinium should be ordered. MRI will distinguish tumor from inflammation and inspissated mucus far better than CT.