Widespread underdiagnosis and inadequate treatment of acute sinusitis may be inferred from the prevalence of chronic sinusitis in the United States. Thus the otolaryngologist's role in the management of sinusitis goes beyond treatment of referred patients. It also includes the responsibility to educate referring physicians in improved diagnostic methods and earlier, more effective forms of therapy. While antral puncture is the sine qua non for determining specific diagnosis, standard radiographs and sound clinical judgment may offer practical alternatives. Early, aggressive antibiotic therapy (with ampicillin, amoxicillin, amoxicillin-clavulanate potassium, or appropriate cephalosporins), plus oral decongestants for symptomatic relief, provides therapeutic efficacy for acute sinusitis and should be considered the initial step toward prevention of chronic sinusitis.