Sinusitis is considered to be one of the most frequently encountered ear, nose, and throat (ENT) infections in medical practice and the maxillary sinus is identified as the predominant site where this infection occurs [1] [2] [3]. Based on symptoms duration, maxillary sinusitis can be divided into acute, when inflammation of the mucosal lining of the maxillary sinus lasts less than 30 days, or chronic (> 3 months) [1] [2]. The pathogenesis and appearance of symptoms almost exclusively involve a preceding milder infection of the upper respiratory tract, primarily by viral pathogens (such as rhinoviruses, as well as influenza and parainfluenza viruses) [4] [5]. A number of studies, however, have confirmed that odontogenic infections are an important cause of maxillary sinusitis, accounting for up to 30-40% of cases [4] [6] [7]. In addition to viruses, various bacteria may be responsible for sinusitis. However, respiratory infection-induced sinusitis has a different spectrum of bacteria (Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, or Staphylococcal species) than sinusitis stemming from an odontogenic infection, which is caused by Bacteroides spp., Proteus spp., and coliform bacilli, but also streptococci [2] [3] [6]. Principal manifestations of maxillary sinusitis are a facial pain, mainly in the cheekbones, rhinorrhea, and nasal congestion [2] [3] [4]. Additional signs and symptoms are a foul breath, a postnasal drip, and toothache, which is not a definite indicator of an odontogenic source [4] [8].

• Fever

  Common causes of fever in tetraplegia include urinary tract infection, respiratory complications, bacteremia, impaired autoregulation, deep vein thrombosis, osteomyelitis, drug fever, and intra-abdominal abscess. [ncbi.nlm.nih.gov]

  Hay fever and other allergies. Risks The main risk factors include: Infection. Decreased sense of smell. Mucocele. Infection of the surrounding structures. Infections due to mucous obstruction. Osteomyelitis. [medanta.org]

  In case of fever, prescription of antibiotics is recommended only selectively. (b) Subacute maxillary sinusitis. [fulspecialista.hu]

  Symptoms of sinusitis can include fever, weakness, fatigue, cough, and congestion. There may also be mucus drainage in the back of the throat, called postnasal drip. [icdlist.com]

  Cough, nasal discharge, and fetid breath were the most common signs, but fever was present inconsistently. Facial pain or swelling and headache were prominent symptoms in older children. [nejm.org]

• Low Fever

  Childhood chronic maxillary sinusitis is most frequent between the ages of 7 and 12 and is often responsible for secondary illnesses (bronchitis and pneumonia, developmental anomalies, low fever of unclear origin, and diseases of the stomach, intestines [fulspecialista.hu]

• Fever of Unknown Origin

  We report 2 acute tetraplegic patients who presented with fever of unknown origin. After extensive work-up, they were diagnosed with occult maxillary sinusitis. [ncbi.nlm.nih.gov]

• Nasal Congestion

  Patients with tetraplegia, especially in the acute phase of spinal cord injury, often undergo nasotracheal intubation or nasogastric tube placement, which may result in mucosal irritation and nasal congestion. [ncbi.nlm.nih.gov]

  The common symptoms are facial pain or pressure, nasal congestion or discharge and reduced ability to smell. The pain is localized to blocked sinus. Other symptoms generally include: Headache. Bad breath. Fatigue. Cough. [medanta.org]

  In the current patient, retained gutta-percha in the maxillary sinus resulted in chronic inflammation and a persistent sinusitis-type picture with nasal congestion, pain and drainage. [f1000research.com]

  Principal manifestations of maxillary sinusitis are a facial pain, mainly in the cheekbones, rhinorrhea, and nasal congestion. [symptoma.com]

  Symptoms include sinus pain, pressure, nasal congestion, and drainage of fluids. Surgery is needed to open the affected sinus and remove the fungal debris. [msdmanuals.com]

• Bad Taste

  In our series the mean age was 53 years (range, 21-70 years), mean duration of symptoms was 2.6 years (range, 1 month to 15 years), rotten smell or bad taste was present in 10 of 21 (48%) patients, dental pain was present in 6 of 21 (29%) patients, and [ncbi.nlm.nih.gov]

• Epistaxis

  Nasal symptoms may include epistaxis, allergic rhinitis and postnasal drip. [oralhealthgroup.com]

  4: Some signs and symptoms that may be suspicions for maxillary sinus malignancy Figure 9: A non-healing upper right extraction site with a spindle cell squamous carcinoma arising from the maxillary sinus Figure 10: Left sided nasal obstruction with epistaxis [nature.com]

  This should include a thorough discussion of possible risks such as orbital injury, blindness, nasolacrimal duct injury, epiphora, epistaxis, cerebrospinal fluid leak, meningitis and brain abscess, and of course persistent rhinosinusitis. [medigoo.com]

  It causes non-specific symptoms like nasal congestion or epistaxis. Biopsy is necessary to make the diagnosis and because more than 10% of inverted papillomas harbor a squamous cell carcinoma. [radiologyassistant.nl]

  The nose should be examined for a deviated nasal septum, nasal polyps, and epistaxis. Foreign bodies and tumors can mimic symptoms of sinusitis and should be in the differential diagnosis, especially if the symptoms are unilateral. [clevelandclinicmeded.com]

• Pelvic Pain

  Resolution of the acute maxillary sinusitis after operative intervention and termination of the above-mentioned medication, resolution of pelvic pain after therapy with leuprolide after 4 weeks. [ncbi.nlm.nih.gov]

• Headache

  When asked about sinusitis, the patient mentioned occasional episodes of pus taste and intermittent crises of headache lasting for one week. The patient has been edentulous for 20 years. [ncbi.nlm.nih.gov]

  Topics range from the standard diagnosis and treatment of acute sinusitis in children and adults to state-of-the-art discussions of imaging techniques, unique material on smell disorders, the role of allergies in sinus disease, sinus headaches, and the [books.google.com]

  Follow-up appointments in the facial pain/headache clinic found “some features of migraine, but it is unclear whether headaches represent primary or secondary headaches with migraine features”. [f1000research.com]

• Neglect

  As a consequence a detailed investigation of BRONJ of the maxilla and in particular of involvement of the maxillary sinus has largely so far been neglected. [ncbi.nlm.nih.gov]

Although sinusitis is a common entity in practice, its diagnosis may be difficult to attain due to the nonspecific signs and symptoms that are seen in a myriad of illnesses and infections. But because of its rather high frequency, a clinical suspicion must be present in all patients with unexplained rhinorrhea, fever, and facial pain, especially if a chronic course is reported. Physicians should inquire about the onset and duration of symptoms, after which a complete physical examination, with an emphasis on the ENT exam, is necessary. Identification of areas sensitive to pain is an important part of the exam, but it is not uncommon for sinusitis to be misdiagnosed as tension or migraine headaches, as both can cause tenderness and pain in the sinonasal area [4]. For this reason, detection of pus in the middle nasal meatus on anterior rhinoscopy is considered as a key sign of acute bacterial maxillary sinusitis [1] [4]. Once clinical findings suggest sinusitis as the probable diagnosis, imaging studies could be employed. Plain radiography of the sinuses can show an air-fluid level but computed tomography (CT) could be necessary in difficult cases [7] [9]. Ultrasonography has been evaluated as a possible method in the assessment of this infection and seems to be superior to plain X-rays [5]. A panoramic X-ray is recommended if an odontogenic source is suspected [4] [8]. In addition to clinical and imaging studies, a microbiological investigation is an important step as well. But because swab cultures or cultivation of nasal secretions often provide inadequate results, this part of workup is reserved only for individuals who do not respond to therapy or those at risk for a more severe form of infection (eg. immunocompromised patients) [1] [2].

• Penicillium

  The Penicillium genera, encompassing about 225 different species of fungi, are naturally present in the environment. These genera are poorly linked to human disease, except for Penicillium marneffei causing septicemia in immunocompromised hosts. [ncbi.nlm.nih.gov]

• Gram-Positive Bacteria

  Overall, 22 % of Staphylococcus aureus isolates were oxacillin-resistant, and 75 % of Streptococcus pneumoniae isolates were penicillin-resistant and/or erythromycin-resistant; 21 % of anaerobic Gram-positive bacteria were penicillin-resistant, and 44 [ncbi.nlm.nih.gov]

1. Yehouessi-Vignikin B, Vodouhe SJ. Maxillary sinusitis: 1752 cases at the ear-nose-throat department of a teaching hospital in Cotonou, Benin. Eur Ann Otorhinolaryngol Head Neck Dis. 2013;130(4):183-187.
2. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011
3. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
4. Bell GW, Joshi BB, Macleod RI. Maxillary sinus disease: diagnosis and treatment. Br Dent J. 2011;210(3):113-118.
5. Fufezan O, Asavoaie C, Cherecheş Panta P, et al. The role of ultrasonography in the evaluation of maxillary sinusitis in pediatrics. Med Ultrason. 2010;12(1):4-11.
6. Mehra P, Murad H. Maxillary sinus disease of odontogenic origin. Otolaryngol Clin North Am. 2004;37(2):347-364.
7. Patel NA, Ferguson BJ. Odontogenic sinusitis: an ancient but under-appreciated cause of maxillary sinusitis. Curr Opin Otolaryngol Head Neck Surg. 2012;20(1):24-28.
8. Simuntis R, Kubilius R, Vaitkus S. Odontogenic maxillary sinusitis: a review. Stomatologija. 2014;16(2):39-43.
9. Guerra-Pereira I, Vaz P, Faria-Almeida R, Braga A-C, Felino A. CT maxillary sinus evaluation-A retrospective cohort study. Med Oral Patol Oral Cir Bucal. 2015;20(4):e419-e426.