In addition, the presentation of cavernous sinus thrombosis can be similar to the presentation of other causes of headache. [cureus.com]

Anatomy of the sinuses Ethmoid and maxillary sinuses are formed in utero and are present at birth. Frontal sinuses are not present until age 5-6 years. [meddean.luc.edu]

Patients should be advised of the need to re-present if any red flag symptoms should arise (Box 2). Box 2. [racgp.org.au]

Patients presenting with these symptoms should be closely monitored. [ajmc.com]

• Pain

  […] maxillary pain, frontal sinus pain, fever, sinus tenderness on exam, and purulent pharyngeal discharge have not been shown to be useful in acute bacterial rhinosinusitis diagnosis.7 TABLE Clinical prediction rule for acute bacterial rhinosinusitis Symptoms [mdedge.com]

  […] a feeling of fullness in the ears Fever Fatigue Facial pain Painful teeth Painful chewing Good to know: Bacterial sinusitis can follow a cold or the flu, and often the symptoms occur just when it seems as if the initial infection is clearing up. [ada.com]

  The symptoms may include: Face pain or pressure that’s worse when leaning forward Postnasal drip Nasal congestion Pain in your upper jaw Toothache in your upper jaw Yellow or greenish discharge from your nose Fever Cough Ear pressure or fullness Headache [cedars-sinai.org]

  Causes of facial pain Migraine Trigeminal neuralgia Cluster headache Paroxysmal hemicrania Atypical facial pain Tension headache Chronic oro-facial pain Dental infection Mid-facial segment pain Post-herpetic neuralgia Primary care approach to CRS Treatment [racgp.org.au]

  […] or pressure Pain is a common symptom in sinusitis. [medicalnewstoday.com]

• Fever

  Allergic rhinitis: Also known as hay fever, allergic rhinitis is a swelling of the nose’s lining and can be seasonal or year-round. Symptoms can include a runny nose, fatigue, itchy eyes, and sneezing. [khealth.ai]

  […] the guideline, a sinus infection is likely to be caused by bacteria rather than a virus if any of the three following conditions is present: Symptoms last for at least 10 days without any evidence of clinical improvement Symptoms are severe, including fever [clinicaladvisor.com]

  – Fever is usually mild or absent. Sinusitis is likely if symptoms persist for longer than 10 to 14 days or worsen after 5 to 7 days or are severe (severe pain, high fever, deterioration of the general condition). [medicalguidelines.msf.org]

  Sinus pressure while bending forward to changing head position Clinical Features of Bacterial Sinusitis Symptoms persist >10 days Daytime cough Worsening or bimodal course Fever >102.2F (39C) Purulent nasal discharge >3d Pain in maxillary teeth Hx of [wikem.org]

  You might have symptoms such as face pain and fever. You might have yellow or greenish discharge from your nose. Your healthcare provider might or might not use an antibiotic to help treat you. Other treatments may help make you feel better. [cedars-sinai.org]

• Fatigue

  Symptoms include drainage, constant clearing of the throat, sore throat, head and facial pressure, bad breath and fatigue. If you have asthma, a sinus infection can make your asthma difficult to control. [kallergy.com]

  Symptoms can include a runny nose, fatigue, itchy eyes, and sneezing. How Are Bacterial and Viral Sinusitis Diagnosed? Although most cases are viral, it’s important to appropriately identify whether your sinus infection is viral or bacterial. [khealth.ai]

  He also endorses ten days of fatigue, rhinorrhea and cough, which he reports are getting worse. For the last four days, he has also had facial pain and thicker nasal drainage. [step2.medbullets.com]

  She had body aches, chills, and extreme fatigue. “Do I maybe need antibiotics?” she asked. Most sinus infections don’t require antibiotics Ah, sinus infections. [health.harvard.edu]

  You can also have headaches, tooth pain, coughing from the post nasal drip, fever, fatigue, a bad smell in your nose or a bad taste in your mouth and bad breath. [acaai.org]

• Weakness

  The specialist will check for underlying factors such as allergies, asthma, structural defects, or a weakness of the immune system. [acaai.org]

  IDSA guidelines on drug choice and duration suggest using a macrolide (erythromycin, azithromycin, or clarithromycin) or doxycycline, based on strong and weak levels of evidence, respectively. [acpinternist.org]

  […] factors can increase your risk of getting a sinus infection: A previous cold Seasonal allergies Smoking and exposure to secondhand smoke Structural problems within the sinuses (such as growths on the lining of the nose or sinuses, known as nasal polyps) A weak [cdc.gov]

  About 30% of patients can develop complications like persistent oculomotor weakness, blindness and hemiparesis. Timely diagnosis and prompt management is crucial for good outcome. [cureus.com]

• Malaise

  Acute sinusitis usually follows a cold and presents with nasal obstruction, facial pain, dental pain, purulent rhinorrhoea, sinus tenderness and in some cases fever and malaise. [nps.org.au]

  Symptoms include nasal obstruction and congestion, purulent rhinorrhea, and facial pain or pressure; sometimes malaise, headache, and/or fever are present. [msdmanuals.com]

  […] pathogens via nasal mucosa Bronchial asthma Analgesic (NSAIDs, aspirin) intolerance References:[1][5][6] Pathophysiology Clinical features Condition Sinusitis Rhinitis Additional features Acute viral rhinosinusitis Fever (∼ 50% of cases), headaches, general malaise [amboss.com]

  Individuals with acute bacterial rhinosinusitis often have nasal mucous membranes edema, mucopurulent nasal discharge, persistent postnasal drip, fever, and malaise. [antimicrobe.org]

  […] discharge that is a common symptom of a sinus infection.[16] Chronic[edit] Symptoms may include any combination of: nasal congestion, facial pain, headache, night-time coughing, an increase in previously minor or controlled asthma symptoms, general malaise [en.wikipedia.org]

• Nasal Discharge

  Although unreliable, the best clinical predictor of acute bacterial sinusitis is the combination of unilateral nasal discharge and unilateral pain (positive likelihood ratio [LR+], 4.5; negative likelihood ratio [LR–], 0.25) (strength of recommendation [mdedge.com]

  discharge and facial pain enduring for at least three to four consecutive days at the beginning of illness Symptoms or signs worsen, as characterized by new fever or headache developing or nasal discharge increasing, typically after a viral upper respiratory [clinicaladvisor.com]

  Colds typically start with clear, watery nasal discharge. After a day or 2, it is normal for the nasal discharge to become thicker and white, yellow, or green. After several days, the discharge becomes clear again and dries. [healthychildren.org]

  Symptoms Signs Nasal discharge (purulence is of little significance) Inflamed nasal mucosa Nasal obstruction Pus exuding from the middle meatus Maxillary toothache Maxillary transillumination (over 9yo) Unilateral facial pain Associated middle ear changes [rch.org.au]

  Nasal discharge Nasal discharge is prominent in sinusitis as the mucous membrane of the nose and sinuses are attached. The drainage may be cloudy or colored green or yellow, blood-tinged, thick, and foul-smelling. [medicalnewstoday.com]

• Common Cold

  Illness that starts as the common cold and pain on bending forward were not predictors of acute bacterial rhinosinusitis (SOR: B).2,3,4 Evidence summary In one series, 87% of patients with the common cold had an abnormal computed tomography (CT) scan [mdedge.com]

  The common cold is a type of URI. Others types of URI’s, besides the common cold, include: Laryngitis: Inflammation of the larynx, which is an organ that contains our vocal cords. [khealth.ai]

  The first few weeks of the common cold aren’t fun, but the acute sinusitis that can pop up afterwards doesn’t help either. Sinus congestion and the common cold, unfortunately, go hand in hand. [mayoclinichealthsystem.org]

  It may be a short-term, acute inflammation caused by bacterial infection such as the common cold. [allergy.org.au]

  In the case of the common cold, the lining of the nose is erythematous and oedematous and there are clear or pale yellow nasal secretions (Fig. 3). [nps.org.au]

• Aspiration

  aspiration (sensitivity 79%, specificity 83%, positive predictive value [PPV], 80%). [mdedge.com]

  The information obtained from studies of putative ACABS without aspirate culture results is always open to question. [academic.oup.com]

  As the maxillary sinuses are the most accessible to aspiration and also the most commonly involved sinus in acute sinusitis, they were the most commonly aspirated sinuses. [nps.org.au]

  Pseudomonas aeruginosa is the most frequent isolate in sinus aspirates from patients with cystic fibrosis. [meddean.luc.edu]

• Sneezing

  If you have sinusitis, cover your mouth and nose when you cough or sneeze, and wash your hands to avoid making anyone sick. [webmd.com]

  Triggered by a host of outdoor and indoor allergens such as pollen, dust mites, and pet dander, it can cause symptoms of runny nose, nasal congestion, sneezing, postnasal drip, cough, and more. [allergytampa.com]

  Viral sinusitis The symptoms of viral sinusitis tend to be cold-like, including runny nose, sore throat, sneezing, nasal congestion, and coughing. Mucus may be clear, or slightly colored. Antibiotics are not effective against a viral infection. [medicalnewstoday.com]

  Common symptoms of an allergic reaction include nasal stuffiness, runny nose, sneezing and itchy watery eyes. Chronic sinusitis is sometimes associated with asthma. [entuk.org]

• Rhinorrhea

  […] clinical predictor of acute bacterial sinusitis is the combination of unilateral nasal discharge and unilateral pain (positive likelihood ratio [LR+], 4.5; negative likelihood ratio [LR–], 0.25) (strength of recommendation [SOR]: B).1 History of purulent rhinorrhea [mdedge.com]

  Related Articles Acute bacterial sinusitis is diagnosed in children with persistent rhinorrhea and cough, severe symptoms, or worsening of symptoms after initial improvement. [nejm.org]

  He also endorses ten days of fatigue, rhinorrhea and cough, which he reports are getting worse. For the last four days, he has also had facial pain and thicker nasal drainage. [step2.medbullets.com]

  Cerebrospinal fluid rhinorrhea D. Ciliary dyskinesia syndrome Nasal polyps are benign growths which can cause unilateral or bilateral nasal obstruction, loss of smell and/or rhinorrhea. [cancertherapyadvisor.com]

  The nasal mucous membrane is red and turgescent; yellow or green purulent rhinorrhea may be present. [msdmanuals.com]

• Toothache

  Symptoms Signs Nasal discharge (purulence is of little significance) Inflamed nasal mucosa Nasal obstruction Pus exuding from the middle meatus Maxillary toothache Maxillary transillumination (over 9yo) Unilateral facial pain Associated middle ear changes [rch.org.au]

  […] sensitivity and specificity unknown),5 x-ray3 (sensitivity 41%–90%, specificity 61%–85%),5 and ultrasound4 (sensitivity 76%, specificity 76%).7 Williams found 5 independent predictors of x-ray findings consistent with sinusitis in 247 male veterans: maxillary toothache [mdedge.com]

  Symptoms and signs suggesting bacterial, as opposed to viral sinusitis include purulent nasal discharge in combination with facial pain and maxillary toothache, facial swelling and tenderness. [ti.ubc.ca]

  Symptoms of sinusitis include: pain, swelling and tenderness around your cheeks, eyes or forehead a blocked nose a reduced sense of smell green or yellow mucus from your nose a sinus headache a high temperature toothache bad breath Signs of sinusitis [nhs.uk]

  The symptoms may include: Face pain or pressure that’s worse when leaning forward Postnasal drip Nasal congestion Pain in your upper jaw Toothache in your upper jaw Yellow or greenish discharge from your nose Fever Cough Ear pressure or fullness Headache [cedars-sinai.org]

• Dental Caries

  She has no obvious dental caries or pain on tapping of her teeth. Her lungs are clear. The rest of her exam is normal. A diagnosis of acute bacterial sinusitis is made on the basis of history and physical exam. [hawaii.edu]

• Suggestibility

  The IDSA guideline also suggests that a five- to seven-day course of antibiotics is long enough to treat the infection in adults without encouraging antibiotic resistance. Children, however, should undergo antibiotic treatment for 10 to 14 days. [clinicaladvisor.com]

  If symptoms start to worsen beyond those first couple days, that is a “very important sign” that may suggest a bacterial infection, Dr. Mejicano said. [acpinternist.org]

  They may suggest you use the nasal spray for up to three months. Your doctor may suggest a three-to-four week course of antibiotics to treat the infection and reduce the risk of it returning. [bupa.co.uk]

  Alarm signs There might be pus seen in the ostia or the cavity of the nose (suggesting bacterial infection). There might be a high fever. [ncbi.nlm.nih.gov]

  The pediatric study by Ueda et al. [26] suggested that bacterial sinusitis should be suspected in children whose respiratory symptoms persist for ⩾10 days, a delineation that has come to be referred to as the “10-day mark.” [academic.oup.com]

• Sinus Pain

  Treating Related Symptoms of Bacterial Sinusitis Headache or sinus pain. To treat headache or sinus pain, try placing a warm washcloth on your child's face for a few minutes at a time. [healthychildren.org]

  […] maxillary pain, frontal sinus pain, fever, sinus tenderness on exam, and purulent pharyngeal discharge have not been shown to be useful in acute bacterial rhinosinusitis diagnosis.7 TABLE Clinical prediction rule for acute bacterial rhinosinusitis Symptoms [mdedge.com]

  […] chronic sinus infection lasts more than 12 weeks and may reoccur A sinus infection, whether chronic or acute, normally consists of the following symptoms: Facial pain or pressure Pain is a common symptom in sinusitis. [medicalnewstoday.com]

  Pain relievers like acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) can help relieve sinus pain. Sleep with your head elevated. This encourages your sinuses to drain. [healthline.com]

  How to Feel Better Below are some ways you help relive sinus pain and pressure: Put a warm compress over the nose and forehead to help relieve sinus pressure. Use a decongestant or saline nasal spray. [cdc.gov]

• Unilateral Facial Pain

  Symptoms Signs Nasal discharge (purulence is of little significance) Inflamed nasal mucosa Nasal obstruction Pus exuding from the middle meatus Maxillary toothache Maxillary transillumination (over 9yo) Unilateral facial pain Associated middle ear changes [rch.org.au]

  These included unilateral facial pain (OR, 1.9), maxillary toothache (OR, 1.9), unilateral tenderness of the maxillary sinus (OR, 2.5), and mucopurulent nasal discharge (OR, 1.6) [19]. [academic.oup.com]

  facial pain for at least 3-4 days May be associated with Maxillary Toothache Persistent Fever over 101 to 102 F Upper respiratory symptoms for 5 to 6 days that resolved and then recurred (double-Hump Sign) Delayed prescription may be considered (fill [fpnotebook.com]

• Headache

  Common Migraine headache Tension headache Cluster headache Killers Meningitis/encephalitis Retropharyngeal abscess Intracranial Hemorrhage (ICH) SAH / sentinel bleed Acute obstructive hydrocephalus Space occupying lesions CVA Carbon monoxide poisoning [wikem.org]

  His mother noted that her son complained of a headache, stuffy nose, facial pain, and feeling warm for the past ten days. The headache was exacerbated whenever he bent over. [step2.medbullets.com]

  Severe unilateral headache, bilateral frontal headache, or frontal swelling. Neurological signs or reduced conscious level. Specialist Management An ENT specialist will perform nasal endoscopy, to identify any abnormal anatomy or pathology. [teachmesurgery.com]

  Treating Related Symptoms of Bacterial Sinusitis Headache or sinus pain. To treat headache or sinus pain, try placing a warm washcloth on your child's face for a few minutes at a time. [healthychildren.org]

  In addition, the presentation of cavernous sinus thrombosis can be similar to the presentation of other causes of headache. [cureus.com]

The patient had an extensive workup outside the hospital including temporal artery biopsy, CT angiogram of the head and neck which were all reportedly negative. [cureus.com]

Objective/s This article provides an overview of acute and chronic sinusitis, and a guide to workup and management in a primary care setting. Complications and other indications for referral are discussed. [racgp.org.au]

See Workup for more detail. Management Treatment of acute sinusitis consists of providing adequate drainage of the involved sinus and appropriate systemic treatment of the likely bacterial pathogens. [emedicine.medscape.com]

A thorough diagnostic workup should be performed to rule out any underlying conditions, including allergies, asthma, immune system problems, gastroesophageal reflux disorder, and structural problems in the nasal passages. [mountsinai.org]

• Staphylococcus Aureus

  The initial antibiotics should cover methicillin-resistant Staphylococcus aureus (MRSA) with vancomycin which can be later switched to nafcillin or oxacillin if cultures reveal methicillin sensitive staphylococcus. [cureus.com]

  Staphylococcus aureus and anaerobes are seen in chronic sinusitis and are often the pathogens seen in intracranial extension of infection. [meddean.luc.edu]

  Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med. 2005;352(14):1436–44. [PubMed] [Google Scholar] 59. Barton M, Hawkes M, Moore D, Conly J, Nicolle L, Allen U, et al. [ncbi.nlm.nih.gov]

  In chronic sinusitis, results have been variable with alpha hemolytic streptococci, Staphylococcus aureus, anaerobes, and mixed colonies frequently recovered. [hawaii.edu]

  Other organisms involved include other streptococci, anaerobes, Moraxella catarrhalis and Staphylococcus aureus.5 Beta-lactamase production by Haemophilus influenzae has dramatically increased over the last 15 years and is found in up to 50% of organisms [nps.org.au]

Treatment Symptomatic relief is the primary goal in the treatment of viral rhinosinusitis. [ajmc.com]

Placebo recipients with unresolved infection would be offered treatment. [academic.oup.com]

These differences between treatments were not statistically significant. A low incidence of generally mild adverse clinical experiences occurred in both treatment groups. [jamanetwork.com]

In severe cases or cases that do not respond to treatment, a nasal endoscopy may be done to aid diagnosis and treatment. [ada.com]

Treatments for ABRS can include: Antibiotics to kill the infecting bacteria Pain medicines Rinsing the nasal passages with saline to make them feel better Researchers don’t know if some of these treatments work for ABRS. [cedars-sinai.org]

Prevention, and Complications Prognosis Generally good in acute bacterial sinusitis can be fatal in diabetic or immunocompromised patients with invasive fungal disease Complications osteomyellitis mucocele meningitis epidural abcess cerebral abscess [step2.medbullets.com]

J Laryngol Otol. 2002, 116:667-676. 10.1258/002221502760237920 van der Poel NA, Mourits MP, de Win MML, Coutinho JM, Dikkers FG: Prognosis of septic cavernous sinus thrombosis remarkably improved: a case series of 12 patients and literature review. [cureus.com]

The black eschar of the palate (necrotic hard-palate lesions that respect the midline) is a hallmark of this disease unfortunately; if no treatment begins before this the patient’s prognosis is poor. [atsu.edu]

Lancet 335:1077-8, 1990 Stern RC, Boat TF, Wood RE, Matthews LW, Doershuk CF: Treatment and prognosis of nasal polyps in cystic fibrosis. [med.stanford.edu]

Predicting prognosis and effect of antibiotic treatment in rhinosinusitis. Ann Fam Med. 2006;4(6):486–93. [PMC free article] [PubMed] [Google Scholar] 20. Institute for Clinical Systems Improvement. Health care guideline: acute sinusitis in adults. [ncbi.nlm.nih.gov]

Table 2 Viral and bacterial etiology of acute sinusitis. Table 2 Viral and bacterial etiology of acute sinusitis. [academic.oup.com]

Sinusitis Summary Definition Epidemiology Etiology Pathophysiology Clinical features Subtypes and variants Nasal polyps Primary ciliary dyskinesia Diagnostics Treatment Complications [amboss.com]

Cefdinir versus levofloxacin in patients with acute rhinosinusitis of presumed bacterial etiology: a multicenter, randomized, double-blind study. Clinical Therapeutics, 26(12): 2026-2033, 2004. [ti.ubc.ca]

Etiology and antimicrobial treatment of acute sinusitis. Ann Otol Rhinol Laryngol Suppl. 1981;90(3 Pt 3):68–71. [PubMed] [Google Scholar] 13. Van Cauwenberge P, Verschraegen G, Van Renterghem L. [ncbi.nlm.nih.gov]

References: [4] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Abnormalities visible on the CT scan persisted in 20% of patients at 2 weeks, yet epidemiological studies have shown that acute bacterial rhinosinusitis develops in only 0.5% to 2% of upper respiratory infections in adults. [mdedge.com]

“Epidemiology and economic impact of rhinosinusitis”. Ann Otol Rhinol Laryngol Suppl. vol. 193. 2004. pp. 3-5. (This article describes the epidemiology of sinusitis and its economic impact in the United States.) [infectiousdiseaseadvisor.com]

Epidemiology and burden of nasal congestion. Stewart M, Ferguson B, Fromer L. Int J Gen Med. 2010 Apr 8;3:37-45. 28. De la rhinite allergique aux pathologies sinusiennes (sinusite/polypose) : les liens épidémiologiques et expérimentaux. P. Demoly. [passeportsante.net]

Sinusitis Summary Definition Epidemiology Etiology Pathophysiology Clinical features Subtypes and variants Nasal polyps Primary ciliary dyskinesia Diagnostics Treatment Complications [amboss.com]

(See Anatomy, Pathophysiology, and Etiology.) [emedicine.medscape.com]

By evaluating the respiratory tract as one continuous structure, it becomes easier to understand the underlying pathophysiology and treatment of sinus disease in CF. [med.stanford.edu]

Anatomic and pathophysiologic considerations". Otolaryngology–Head and Neck Surgery. 94 (2): 143–7. doi:10.1177/019459988609400202. PMID 3083326. S2CID 34575985. ^ Liang J, Lane AP (March 2013). "Topical Drug Delivery for Chronic Rhinosinusitis". [en.wikipedia.org]

Pathophysiology The ostiomeatal complex, the area at the confluence of drainage from the sinuses, is particularly vulnerable to inflammatory changes, swelling, and obstruction. [aafp.org]

Preventing Sinusitis As always, an ounce of prevention is worth a pound of cure. [entsc.com]

[…] care to prevent the spread of colds or the flu in the home and community can help prevent some cases of bacterial sinusitis. [ada.com]

How can sinusitis be prevented? As always, an ounce of prevention is worth a pound of cure. [ashfordclinic.com]

Can I Prevent Sinusitis? You can lower your risk of getting sinusitis by making some simple changes in your home environment. [kidshealth.org]

How Can I Prevent Sinusitis? There is little information about the prevention of acute or chronic sinusitis. But the following measures may help: Avoid contact with allergens or irritants that trigger your nasal allergies. [aafa.org]