Most upper respiratory tract infections are viral and treatment of a viral URTI is symptomatic. Today, with the emergence of
antimicrobial resitance, antibiotics must be thought of as contra-indicated. Acute bacterial sinusitis may complicate a viral URTI.
All special investigations for diagnosing acute sinusitis are unhelpful. Treatment of pain and fever are usually the only nonspecific
measures that help. Antimicrobial treatment has become a mainstay of acute sinusitis but there are studies suggesting
that antibiotics do not alter the course of the disease. Since hearing loss is a risk of untreated and severe acute otitis media,
this conditionis usually treated with antibiotics. However, a recent Cochrane Review has concluded that the number of patients
needed to treat with antibiotics for a benefit is 15. The picture of itching, sneezing and profuse rhinorrhoea are classic of early
allergic rhinitis but with time, and especially in perennial allergic rhinitis, nasal obstruction is a prominent symptom. It is the
pathology which gives rise to both the classic facial appearance of patients (especially children) with perennial allergic rhinitis
and the many complications. The most effective therapy of allergic rhino-sinusitis (as the disease should correctly be called)involves the topical nasal steroids.