Sinusitis presents as a blocked nose with postnasal discharge, headache, pain behind the eyes, in the cheeks, jaw and sometimes teeth, redness of the eyes and nose, watery eyes and sore throat with cough. There may be hyposmia and a feeling of pressure behind the face, particularly when bending forward. Sometimes the patient may also have a fever, muscular pain and halitosis (foul smelling breath).

• Fever

  Hay fever treatment, including antihistamine nasal spray or tablets, is recommended when allergic rhinitis is contributing to sinusitis. Immunotherapy for ongoing hay fever is another treatment option. [mydr.com.au]

  "Headache and fever" is a common presentation to the urgent care and emergency department setting and can have many etiologies. [ncbi.nlm.nih.gov]

  Blocked sinuses can be caused by the common cold, hay fever or nasal polyps (small lumps inside the nose). [who.int]

  Allergies such as hay fever. Inflammation that occurs with allergies can block your sinuses. [mayoclinic.com]

  Fever can be a symptom of a sinus infection or a cold. Simple nasal congestion with a low-grade fever and a runny nose probably indicates a cold and may not call for medications or antibiotics. [emedicinehealth.com]

• Fatigue

  […] symptoms: Chronic sinus headaches /facial pressure in the forehead, eyes or cheeks Nasal congestion and/or difficulty breathing through the nose Runny nose or dripping from the back of the nose into the throat Loss of sense of smell or taste Chronic Fatigue [sinusinstituteatlanta.com]

  The signs and symptoms of chronic sinusitis last longer and often cause more fatigue. Fever isn't a common sign of chronic sinusitis, but you might have one with acute sinusitis. [mayoclinic.com]

  […] include: 1 Sinus pressure and congestion Sinus Headache Facial pain Tenderness and swelling around the eyes, cheeks, nose and forehead Difficulty breathing through the nose Loss of the sense of smell or taste Yellow or green mucus from the nose Teeth pain Fatigue [balloonsinuplasty.com]

  Very often, people report fatigue. Rare Symptoms Acute sinusitis is usually caused by a virus, but bacteria can get trapped in the congested sinus and produce a bacterial infection. Only about 2%f acute sinus infections are bacterial. [verywellhealth.com]

• Pathologist

  Fungal infections are usually diagnosed by such biopsy procedures and tissue removed by a surgeon, or by fungal culture and microscopic identification by a microbiologist or pathologist trained to identify fungi. [medicinenet.com]

• Fever of Unknown Origin

  Nosocomial bacterial rhinosinusitis is an acute sinusitis that can affect patients in intensive care units (ICUs), typically presenting as fever of unknown origin. [cancertherapyadvisor.com]

  Hospital-acquired sinusitis is a common cause of fever of unknown origin in orotracheally intubated critically ill patients. Crit Care 2005 ;9: R583 –R590. Crossref, Medline, Google Scholar 117. Kronberg FG, Goodwin WJ. [atsjournals.org]

• Cough

  Boodman, chicagotribune.com, "The girl who couldn't stop coughing," 5 Apr. 2018 But a sinus CT scan performed after Mimi had taken medications for two months still showed persistent sinusitis. — Sandra G. [merriam-webster.com]

  Sneezing and coughing do not generate sufficient pressure to propel viscous fluid into the sinus. Contrast medium from the nasopharynx appeared in >/=1 sinuses in 4 of 4 subjects after a nose blow but not after sneezing or coughing. [ncbi.nlm.nih.gov]

  Nose blowing (both nostrils open or 1 occluded) and coughing were initiated voluntarily. [doi.org]

• Rhinitis

  CONCLUSION: Allergic rhinitis is common in childhood asthama, but sinusitis is rare. [ncbi.nlm.nih.gov]

  Allergic rhinitis and sinusitis are linked to each other, because allergic rhinitis causes your nose to become blocked, and in turn blocks the sinuses. Causes Allergic rhinitis is triggered by allergens. [who.int]

  Sinusitis versus rhinitis Although many symptoms are similar, sinusitis should not be mistaken for rhinitis. Rhinitis is an inflammation of the mucus membrane of the nose, not the sinuses. [allergy.org.au]

• Common Cold

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

  It May Start as a Cold Most cases of sinusitis start off with the inflammation from a virus such as the common cold. This inflammation can lead to bacterial colonization and cause a bacterial sinus infection. [onhealth.com]

  How can I tell if I have a sinus infection, cold, or nasal allergy? It can be difficult to tell the difference between a cold, allergies, and a sinus infection. The common cold typically builds, peaks, and slowly disappears. [my.clevelandclinic.org]

  Common Colds and Sinus Infections A viral infection associated with the common cold is the most common cause of sinus infections (also known as viral sinusitis, in this case). ( 10 ) Learn More About Cold and Flu 101: What You Need to Know This virus [everydayhealth.com]

• Nasal Congestion

  Sinusitis Symptoms of sinusitis can include nasal congestion, discolored nasal drainage, sinus pressure, headache, and fever. The two most common types of sinusitis are viral and bacterial. [allergytampa.com]

  Decongestants These medicines, available as tablet, syrup or nasal spray, may help unblock the openings of the sinuses and temporarily reduce symptoms of nasal congestion. [nationaljewish.org]

  Symptoms include: nasal congestion facial discomfort nasal discharge headache fatigue Types of Sinusitis There are two main categories of sinusitis: acute and chronic. [americansinus.com]

• Sneezing

  Sneezing. The general procedure for instilling contrast into the nasopharynx for sneezing was the same as above; however, contrast was only instilled once because repeated episodes of sneezing could not be elicited. [doi.org]

  Sneezing and coughing do not generate sufficient pressure to propel viscous fluid into the sinus. Contrast medium from the nasopharynx appeared in >/=1 sinuses in 4 of 4 subjects after a nose blow but not after sneezing or coughing. [ncbi.nlm.nih.gov]

• Thrombosis

  Intracranial complications included subdural empyema, frontal lobe abscesses, intrahemispheric abscesses, cavernous and superior sagittal sinus thrombosis, and osteomyelitis. [ncbi.nlm.nih.gov]

  Pott's puffy tumor can be associated with cortical vein thrombosis, epidural abscess, subdural empyema, and brain abscess. [en.wikipedia.org]

  Complications erosion through bone subperiosteal abscess frontal sinus superficially ( Pott puffy tumor ) frontal or ethmoidal sinuses into the orbit ( subperiosteal abscess of the orbit ) dural venous sinus thrombosis intracranial extension meningitis [radiopaedia.org]

• Halitosis

  Often it is stated that rhinosinusitis may contribute to a halitosis complaint, and widely used diagnostic protocols for rhinosinusitis sometimes list halitosis as a minor criterion. [ncbi.nlm.nih.gov]

  Sometimes the patient may also have a fever, muscular pain and halitosis (foul smelling breath). [symptoma.com]

  […] symptoms of sinusitis include: pain or pressure in your cheeks, forehead, and nose, or between your eyes headache nasal congestion fever coughing, which may be worse at night drainage in your throat reduced sense of smell and taste bad breath (called halitosis [familydoctor.org]

• Dental Abscess

  Occasionally, a periapical dental abscess of a maxillary tooth spreads to the overlying sinus. [msdmanuals.com]

  Dental abscesses or procedures that result in communication between the oral cavity and sinus can produce sinusitis by this mechanism. Additionally, ciliary action can be affected after certain viral infections. [emedicine.medscape.com]

• Jaw Pain

  Not yet well publicized in the general or medical communities, many chronic symptoms such as sinusitis, dizziness (or vertigo), ear pain, jaw pain, nasal blockage/stuffiness, facial pain/pressure, eye pain/pressure, tinnitus, abnormal or bad taste or [youtube.com]

  […] may include tooth and jaw pain, ear pain, bad breath, and a cough that gets worse at night. [verywellhealth.com]

  Infection in the maxillary sinuses can cause upper jaw pain and tooth sensitivity, with the malar areas tender to the touch. [clevelandclinicmeded.com]

  Hence, pathology here may be felt as upper jaw pain, toothache or pain in the skin of the cheek. This article will give you an overview of rhinosinusitis. [patient.info]

• Myalgia

  Symptoms include sneezing, rhinorrhea, nasal congestion and postnasal drip, aural fullness, facial pressure and headache, sore throat, cough and fever, and myalgias. [atsu.edu]

  If fever is present at all in uncomplicated viral infections of the upper respiratory tract, it tends to be present early in the illness, usually accompanied by other constitutional symptoms such as headache and myalgias. 24 Generally, the constitutional [pediatrics.aappublications.org]

• Eye Pain

  […] stuffiness, nasal congestion, runny nose, rhinorrhea, facial pain, cheek pain, eye pressure, eye pain, facial pressure, difficulty driving, spinning, mal de debarquement, aphasia, allodynia, light sensitivity, auditory processing disorder, depression [youtube.com]

  Pain and swelling are also common symptoms, especially under the eyes. Pain is usually worse on one side of the face. [raisingchildren.net.au]

  Additional symptoms may include: facial tenderness; fever; tiredness; bad breath; headache; swelling around the eyes; pain in the upper jaw and/or teeth; cough; and nausea. [mydr.com.au]

  The following are all common symptoms of sinusitis: A cold that lasts more than 10 days and is not getting better A headache with a feeling of pressure Pain and tenderness near your eyes and cheekbones, sometimes with swelling around your eyes Pain in [youngmenshealthsite.org]

• Visual Impairment

  Although odontogenic sinusitis rarely results in abscess formation of the visual pathways, early recognition and immediate treatment is imperative to decrease the risk of profound and permanent visual impairment. [ncbi.nlm.nih.gov]

  Periorbital edema in a child requires prompt assessment for orbital cellulitis and possible surgical intervention to prevent visual impairment and intracranial infection. [msdmanuals.com]

  Masayuki Karaki, Kousuke Akiyama, Masafumi Yonezaki and Nozomu Mori, Invasive Mycosis of the Posterior Paranasal Sinuses that Caused Visual Impairment: Report of three cases, Nihon Bika Gakkai Kaishi (Japanese Journal of Rhinology), 51, 1, (15), (2012 [doi.org]

• Excessive Tearing

  The tear duct or nasolacrimal duct drains tears from the eyes into the nose where it enters beneath the inferior turbinate. Blockage of this duct from injury or disease causes excess tearing of the eye, or epiphora. [hopkinsmedicine.org]

• Flushing

  flushing their nares with saline. [web.stanford.edu]

  (…patients can flush with a buffered saline solution they make themselves…) Anecdotally, some patients get relief of their sinus symptoms by flushing their nares with saline. [med.stanford.edu]

  Home remedies for sinus infection consist of inhalation of steam, saline nasal flushes and hot compresses placed on the forehead and facial region. [sinusinfectionhelp.com]

• Angioedema

  Battal Tahsin Somuk, Göksel Göktas, Samet Özer, Emrah Sapmaz and Yalcın Bas, Hereditary angioedema type 2 presented as an orbital complication of acute rhinosinusitis, International Journal of Pediatric Otorhinolaryngology, 82, (16), (2016). M. [doi.org]

• Otalgia

  Minor factors (diagnostically significant only with one or more major factors) include a headache, halitosis, fatigue, malaise, dental pain, cough, and otalgia. A physical exam is best performed after a topical decongestant. [ncbi.nlm.nih.gov]

  Not declared Not declared 12% (6/49) 3/6 in treatment group Tano 2004 108 0.9% saline spray versus no treatment Not declared Not declared 36% Only 60% compliance for most Tomooka 2000 211 Hypertonic irrigation 24% Nasal irritation, nasal discomfort, otalgia [doi.org]

• Withdrawn

  This was the case for gatifloxacin, which has been withdrawn from the market because of its association with disturbances in glucose control. [cmaj.ca]

• Sinus Pain

  Over-the-counter pain relievers such as acetaminophen and ibuprofen can help ease headache and sinus pain. In the case of very severe sinusitis, and if it is caused by bacteria, an antibiotic may be prescribed for 10 to 14 days. [nuh.com.sg]

  Before turning to antibiotics, try these sinus pain remedies to help ease achiness and nasal congestion. [everydayhealth.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]

• Facial Swelling

  Symptoms are similar to a sinus infection — congestion, facial pain and swelling, and discharge — but you may be severely ill with these symptoms. [upmc.com]

  A diagnosis of acute bacterial rhinosinusitis is likely when an adult patient has moderate symptoms of rhinosinusitis that persists beyond 7 days or severe symptoms of any duration including unilateral/focal facial swelling or tooth pain. [atsu.edu]

  The early symptoms of sinusitis include Runny or stuffy nose, postnasal drip, earache, pain or pressure around the eyes or cheekbones, facial swelling, dizziness, headache, sore throat, fever, bad breath, tooth pain or sensitive, fatigue, cough, loss [emedicinehealth.com]

• Neck Swelling

  Tell your doctor if you develop bleeding from the nose, a stiff neck, swelling, or problems with your vision. [healthdirect.gov.au]

  Notify your doctor promptly if your sinusitis gets worse with one or more of these warning symptoms: High fever Severe headache Mental confusion or stiff neck Swelling of the cheek, forehead, or roof of the mouth A swollen, red, painful eye Impaired vision [health.harvard.edu]

• Facial Edema

  The subject has complications of sinusitis (facial edema, cellulitis, or orbital, meningeal or cerebral signs). The subject is thought to require intravenous antibiotics or hospital admission. The subject is pregnant. [clinicaltrials.gov]

• Headache

  It includes painkillers for headache and facial pain, hot steam to open clogged up ostia and increased intake of warm fluids. [symptoma.com]

  Eighty-eight percent of the participants were found to be having migraine headache and not sinus headache. Strict criteria from the International Classification of Headache Disorders were used to tell the difference between headache types. [americanmigrainefoundation.org]

  "Headache and fever" is a common presentation to the urgent care and emergency department setting and can have many etiologies. [ncbi.nlm.nih.gov]

  and these symptoms distinguish a sinus-related headache from other types of headaches, such as tension and migraine headaches. [en.wikipedia.org]

• Hyposmia - Anosmia

  Symptoms of acute bacterial rhinosinusitis include the following: Facial pain or pressure (especially unilateral) Hyposmia/anosmia Nasal congestion Nasal drainage Postnasal drip Fever Cough Fatigue Maxillary dental pain Ear fullness/pressure The diagnosis [emedicine.medscape.com]

  anosmia, malaise, fever; clinical signs: purulent secretion in the nasal cavity, discharge in the pharynx and tenderness in sinus tapping) Days 14‐16 7 (4.7%) Frequency of recovery at follow‐up, according to the telephone interview (executed by the [doi.org]

• Trigeminal Neuralgia

  Those somethings could be trigeminal migraines, trigeminal neuralgia, sluder's neuralgia, tension headaches, allergies, cold, etc. Assuming it is not neurologic, allergies are a common culprit. [fauquierent.net]

  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]

  Yen‐Wen Lin, Shinn‐Kuang Lin and I‐Hsin Weng, Fatal Paranasal Sinusitis Presenting as Trigeminal Neuralgia, Headache: The Journal of Head and Face Pain, 46, 1, (174-178), (2006). Jonathan S. Glickstein, Rakesh K. Chandra and Jerome W. [doi.org]

• Somnolence

  We report the case of a 17-year-old boy who presented in a state of somnolence due to interhemispheric and infratentorial subdural empyema with preseptal cellulitis secondary to pansinusitis. [ncbi.nlm.nih.gov]

  Somnolence, irritability, insomnia, rhinitis medicamentosa, prolonged middle ear effusion and death have been associated with the use of these medications ( CDC 2007 ; Chonmaitree 2003 ; Shefrin 2009 ). [doi.org]

Acute sinusitis is diagnosed clinically but its evaluation may include the following tests [7]:

• Biopsy of paranasal sinuses
• Nasal cytology
• Testing for ciliary dysfunction
• Complete blood count
• ESR

Imaging 

Imaging studies are not required to diagnose sinusitis. In complicated cases, a CT scan and nasal endoscopy may be conducted.

Test results

Typically tests results are not awaited to confirm the diagnosis and start treatment because sinusitis is a clinical diagnosis. Nasal cytology may help identify the causative organism as viral or bacterial so that appropriate antibiotics or antivirals, respectively, may be prescribed.

AVRS typically resolves within 10 days and ABRS may also resolve spontaneously within the first 10 days of infection, so patients who present with fewer than 10 days of symptoms in general should be managed with supportive care only [8]. It includes painkillers for headache and facial pain, hot steam to open clogged up ostia and increased intake of warm fluids. Antihistamines cause the sinuses to dry up but sometimes cause excessive drying, as well as have other side effects like drowsiness and xerostomia, so their use for the treatment of acute sinusitis is generally not recommended [9].

If the infection persists for more than a week or is very severe, mechanical irrigation with buffered hypertonic saline solution may help reduce the need for analgesics and improve overall patient comfort [10]. Irrigation is recommended for people suffering from frequent sinus infections.

Sinusitis has an excellent prognosis. Studies suggest that 40% to 69% of patients suffering from ABRS may clear their infection spontaneously [6]. Whatever the underlying cause, acute sinusitis persists for 3 to 10 days only and then resolves on its own. In some rare cases, it may progress to chronic sinusitis, which also has an excellent prognosis and is easily and effectively treated with antibiotics or antiviral drugs.

Sinusitis may be due to a viral infection, such as infection from Rhinovirus, Adenovirus, Influenza virus A and B, Parainfluenza virus, Coronavirus or Respiratory syncytial virus resulting in acute viral rhinosinusitis (AVRS). It may also be caused by a bacterial infection, such as from Staphylococcus aureus, Staphylococcus pneumoniae, Haemophilus influenzae or Pseudomonas aeruginosa causing acute bacterial rhinosinusitis (ABRS). Acute viral upper respiratory tract infections are considered to be the most important risk factor for the development of ABRS [1].

Some fungi have also been implicated in the etiology of sinusitis but fungal sinusitis is a rare condition. Whatever the causative factor may be, the infection can be primary, affecting the paranasal sinuses directly, or it may be secondary, a result of an upper respiratory tract infection. The blocked sinuses have a negative sinus pressure and a reduced partial pressure of oxygen which makes the cavity ideal for the microorganisms to settle and multiply.

Chronic rhinosinusitis (CRS) is defined as an inflammatory condition involving the lining epithelium of the paranasal sinuses, which persists for at least 12 weeks or longer [2]. It is characterized by persistent nasal discharge or nasal blockage, headache and facial pain.

Incidence

Sinusitis is an extremely common condition with an incidence of over 24 million cases every year in the United States [3].

Age

Sinusitis affects young and old alike. It does not have a predisposition to any particular age group.

Sex

It occurs equally in both sexes but infectious sinusitis is more common in females because they are more prone to close contact with children having infections.

The paranasal sinuses develop as outpouchings of the nasal cavity, with the first sinuses appearing between the 3rd and 4th months of gestaton [4]. They are air-filled cavities extending from the skull to the alveolar process and are lined by pseudostratified ciliated columnar epithelium having mucus producing goblet cells. They include the frontal sinus, anterior and posterior ethmoid sinus, maxillary sinus and sphenoid sinus. All sinuses drain into the nasal cavity via openings called ostia. Ciliary activity is necessary for drainage of secretions from the sinuses into the nose, particularly from the maxillary sinus because the ostia are located high up on the medial walls of this sinus [5].

If any one or more of these paranasal sinuses become blocked and congested, the normally sterile mucus is prevented from draining into the nasal cavity via the ostia. The filling up of the sinuses with mucus results in negative sinus pressure which promotes the development of an infection. The viral, bacterial or fungal pathogens inhabit the congested sinuses and sinusitis develops. Some allergins such as pollen grains or animal fur may cause the sinuses to become irritated resulting in excessive mucus production which then blocks up the cavities causing sinusitis.

Sinusitis may be prevented by intake of appropriate fluids and good oral hygiene. Upper respiratory tract infections should be promptly and properly treated

Sinusitis, or more appropriately rhinosinusitis, is the inflammation of the mucosa of the paranasal sinuses which presents as features similar to influenza. It is a common household occurrence and affects people of all ages, races and ethnicity. Paranasal sinues are hollow bony cavities that help reduce the weight of the skull as well as humidify air during respiration. If any of these sinuses become blocked, the mucus produced by the goblet cells present in these sinuses is unable to drain out, the nasal cavity becomes congested and sinusitis ensues. Commonly, the condition is due to external pathogens, as discussed below.

Definition

Sinusitis is a condition in which the lining membrane of paranasal sinuses, which are hollow air-filled cavities present in the skull, become infected and congested with mucus.

Cause

Sinusitis may be viral, bacterial or fungal or it may be due to an upper respiratory tract infection. Sometimes allergens like pollen grains and animal fur may cause overproduction of mucus which may become infected resulting in sinusitis.

Signs and symptoms

It presents with a blocked and congested nose, thick, postnasal discharge, headache, pain behind the eyes, in the jaws and teeth, red watery eyes and fever. There may also be sore throat and cough.

Diagnosis

Diagnosis of sinusitis is purely clinical. Laboratory tests may help in identifying the causative agent.

Treatment

Treatment is mainly supportive as most cases of sinusitis resolve by themselves. However, it may be treated with antibiotics or antiviral drugs.

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3. Anon JB. Upper respiratory infections. Am. J. Med, Apr 2010. 123 (4 Suppl): S16–25. 
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