Although sinusitis in one of the most common diagnoses in the acute care setting, controversy remains about how to diagnose and treat it. This is particularly evident when you compare practice patterns to the medical literature. Although less than 2% of acute sinusitis cases are likely bacterial, as many as 92% of patients receive antibiotics. Part of this disparity may be due to patients’ expectations. An understanding of the currently accepted methods of diagnosis and treatment as well as tools to assist providers in decreasing patients’ expectations for antibiotics may help providers narrow this gap. This article reviews current diagnostic and treatment patterns and methods to modify patient expectations with the goal of applying the information to the urgent care setting.