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The paranasal sinuses are responsible for a considerable amount of human unhappiness, but 2012 yielded a consensus: Sinusitis is so seldom caused by acute bacterial infection that automatic prescription of antibiotics for patients complaining about their sinuses should be avoided.
In one study, a single practitioner systematically evaluated 125 consecutive patients who presented with classic sinusitis symptoms. Only 75 (60%) had evidence of sinusitis identified by computed tomography, only a few of those patients (18) had purulent secretions on nasal endoscopy and, for only a minority of them (5) were standard respiratory bacterial pathogens isolated in culture. These data imply that only a tiny fraction of individuals with standard-issue sy…