Symptoms:

Symptoms Suggesting a Bacterial Infection

Sinus symptoms are very common during a cold or the flu, but in most cases they are due to the effects of the infecting virus and resolve when the infection does. It is important to differentiate between inflamed sinuses associated with cold or flu virus and sinusitis caused by bacteria.

The signs and symptoms that are associated with the diagnosis of sinusitis include one to two of the following:

• Nasal congestion and discharge that typically is thick and becomes yellowish to yellow-green
• Facial pain, pressure, congestion, or fullness (that is also accompanied by other symptoms of sinusitis)
• Symptoms that continue for 10 days or more after the start of a cold or flu
• Symptoms worsen after 5 - 7 days, or return after initial improvement in a cold (called double sickening)
• Reduced or absent sense of smell
• Fever, although should also be accompanied by other symptoms of sinusitis

Other symptoms of sinusitis that usually occur in adults include one to two of the following:

• Eyes may be red, bulging, or painful if the sinus infection occurs around the eyes
• A persistent cough (particularly during the day)
• Ear pain, pressure, or fullness
• Halitosis (bad breath)
• Dental pain
• Fatigue

However, many studies have shown that symptoms used to diagnose sinusitis often do not predict prognosis or response to antibiotic treatment.

Sneezing, sore throat, and muscle aches may be present, but they are rarely caused by sinusitis itself. Muscle aches may be caused by fever, sore throat by post-nasal drip, and sneezing from cold or allergies.

Rare complications of sinusitis can produce additional symptoms, which may be severe or even life threatening.

Symptoms Indicating Medical Emergency

• Increasing severity of symptoms
• Swelling and drooping eyelid
• Loss of eye movement (possible orbital infection, which is in the eye socket)
• Vision changes
• Pupil fixed or dilated
• Symptoms spreading to both sides of face (may indicate blood clot)
• Development of severe headache, altered vision
• Mild personality or mental changes (may indicate spread of infection to brain)
• A soft swelling over the bone (may indicate bone infection)

Symptoms in Children

Children are most likely to develop infection in the ethmoid sinuses, located between the eyes. Children with sinusitis are also less likely to experience facial pain over the affected sinus and headache, which are the primary signs in adults. Symptoms of bacterial sinusitis may be less specific than in adults and include:

• Persistent nasal discharge (of any type) and day time cough for more than 10 days, or
• Severe symptoms last for at least 3 - 4 days in a row and include thick, greenish nasal discharge plus a fever of at least 102° F

Other symptoms in children may include:

• Irritability
• Vomiting
• Gagging on mucus
• Cough

Chronic Sinusitis

Recurrent acute and chronic sinusitis tend to take the following course:

• Any of the sinusitis symptoms listed previously may be present
• Symptoms are more vague and generalized than acute sinusitis
• Fever may be absent or just low grade
• Symptoms of sinusitis last 12 weeks or longer
• Symptoms occur throughout the year, even during nonallergy seasons

Site-Specific Symptoms

Specific symptoms may indicate which sinus is involved.

Frontal sinusitis causes:

• Pain across the lower forehead.
• Symptoms are worse when lying on the back

Maxillary sinusitis causes:

• Pain over the cheeks that may travel to the teeth
• Hard palate in the mouth sometimes becomes swollen
• Symptoms are worse when head is upright

Ethmoid sinusitis causes:

• Pain behind the eyes and sometimes redness and tenderness in the area across the top of the nose
• Symptoms are worse when coughing, straining, or lying on the back

Sphenoid sinusitis:

• Rarely occurs by itself; when it does, the pain may be felt behind the eyes, across the forehead, or in the face
• Symptoms are worse when lying on the back or bending forward

Other Causes of Sinusitis Symptoms

It is often difficult to tell when a viral infection converts to a bacterial infection. Studies have found that 40 - 85% of patients with the common cold show signs of inflamed sinuses on x-rays or CT scans. A cold, however, unlike sinusitis, typically clears up without treatment within a week. (Only about 0.5 - 2% of adults with viral colds or flus actually develop bacterial infections.)

Allergies. Symptoms of both sinusitis and allergic rhinitis include nasal obstruction and congestion. The conditions often occur together. People with allergies and no sinus infection may have:

• Thin, clear, and runny nasal discharge
• Itchy nose, eyes, or throat (do not occur with bacterial sinusitis)
• Recurrent sneezing
• Symptoms of allergies appear only during exposure to allergens

Migraine and Other Headaches. Many primary headaches, particularly migraine or cluster, may closely resemble sinus headache. Migraine and sinus headaches may even coexist in many cases. Sinus headaches are usually more generalized than migraines, but it is often difficult to tell them apart, particularly if headache is the only symptom of sinusitis.

Trigeminal Neuralgia. In some cases, headache that persists after successful treatment of chronic sinusitis may be due to neuralgia (nerve-related pain) in the face. This condition requires specific drugs, such as tricyclic antidepressants or carbamazepine. Trials using such drugs may identify patients with neuralgia and help avoid unnecessary invasive treatments for chronic sinusitis.

Other Conditions. A number of other conditions can mimic sinusitis. They include:

• Dental problems
• A foreign object in the nasal passage
• Temporal arteritis (headache caused by inflamed arteries in the head)
• Persistent upper respiratory tract infections
• Temporomandibular disorders (problems in the joints and muscles of the jaw hinges)
• Vasomotor rhinitis, a condition in which the nasal passages become congested in response to irritants or stress. It often occurs in pregnant women.