QUESTION: Is there any difference between the effect of therapeutic ultrasound and antibiotics (amoxicillin) on pain and congestion for acute bacterial rhinosinusitis in the short-term? Is there any difference in patient satisfaction, preferred future intervention, side-effects and relapses in the long-term? DESIGN: A randomised trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS: 48 patients (6 dropouts) with clinically diagnosed acute bacterial rhinosinusitis in primary care. INTERVENTION: The experimental group received 4 consecutive days of ultrasound and the control group received a 10-day course of antibiotics. OUTCOME MEASURES: Pain and congestion around the nose and in the forehead and teeth were measured on a 0 to 10 numeric rating scale at baseline, day 4, and day 21. Satisfaction, preferred future intervention, side-effects, and relapses were measured one year later. RESULTS: By day 4, pain around the nose had decreased by 1.5 points out of 10 (95% CI 0.6 to 2.5) more in the experimental group than the control group. There were no other differences in decrease in pain and congestion between the groups at day 4 or 21. At one year follow-up, the experimental group were more likely to prefer ultrasound than the control group were to prefer antibiotics to manage a future episode (RR 2.75, 95% CI 1.19 to 7.91). There were no other differences between the groups in terms of satisfaction with intervention, number of side-effects, or number of relapses. CONCLUSION: The results of this study suggest that therapeutic ultrasound is a viable alternative to antibiotics in the management of acute bacterial rhinosinusitis. TRIAL REGISTRATION: NCT00934830.

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