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An in-depth report on the causes, diagnosis, treatment, and prevention of sinusitis.

Alternative Names

Antibiotics; Decongestants; Nasal Congestion


Symptoms Indicating a Bacterial Infection. Sinus symptoms are very common during a cold or flu, but in most of these 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. With true acute bacterial sinusitis, the signs and symptoms typically have the following course:

  • Nasal congestion and discharge that is typically thick and contains pus that is yellowish to yellow-green.
  • Pain in the teeth, which is increased by bending over. Symptoms may vary, however, depending on the sinuses involved.
  • Symptoms continue for 10 days or more after the start of a cold or flu, or
  • They worsen after five to seven days, or they return after initial improvement in a cold (called double sickening).

Other symptoms of acute sinusitis that usually occur in adults include the following:

  • Severe headache and pain or pressure in specific areas in the face. For example, eyes may be red, bulging or painful eyes if the sinus infection occurs around the eyes. In some cases, patients may also have double vision and even temporary vision loss.
  • A persistent cough (particularly during the day).
  • Fever (may be present).
  • Fatigue (from lack of good rest).
  • Lack of response to decongestants or antihistamines.

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 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 the following:

  • Persistent nasal discharge (of any type) and day time cough for more than 10 days, or
  • Severe symptoms that last for at least three or four days in a row and include thick, greenish nasal discharge plus a fever of at least 102 degrees F.

General Symptoms of Recurrent Acute and Chronic Sinusitis

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

  • Symptoms are more vague and generalized than acute sinusitis.
  • They last longer than four weeks. (Subacute sinusitis lasts longer than four weeks but less than three months. Chronic sinusitis lasts three months or more.)
  • They occur throughout the year, even during nonallergy seasons.

Specifically symptoms may include:

  • Nasal congestion and obstruction.
  • Chronic cough (day and night).
  • Bad breath.
  • Postnasal drip (which can cause repeated throat clearing).
  • Facial tenderness or pressure may be present. Sufferers do not usually experience facial pain unless the infection is in the frontal sinuses, which usually results in a dull, constant ache.

Site-Specific Symptoms

Specific symptoms depend on the location of the infection:

  • Frontal sinusitis causes pain across the lower forehead.
  • The pain in maxillary sinusitis occurs over the cheeks and may travel to the teeth, and the hard palate in the mouth sometimes becomes swollen.
  • Ethmoid sinusitis causes pain behind the eyes and sometimes redness and tenderness in the area across the top of the nose.
  • Sphenoid sinusitis rarely occurs by itself; when it does, the pain may be experienced behind the eyes, across the forehead, or in the face.

Symptoms of Sinusitis by Specific Site


Acute Symptoms

Chronic Symptoms


Ethmoid sinuses are located between the eyes. They resemble a honeycomb and are vulnerable to obstruction. This is a common location for sinusitis in children.

Nasal congestion.

Nasal discharge or postnasal drip.

Pain or pressure around the inner corner of the eye or down one side of the nose.

Headache in the temple or surrounding the eye.

Symptoms worse when coughing, straining, or lying on the back and better when the head is upright.


Symptoms of maxillary sinusitis often occur.

Symptoms indicating medical emergency:

Increasing severity of symptoms.

Fever, swelling and drooping eyelid, loss of eye movement (possible orbital infection, which is in the eye socket).

Fever, vision changes, pupil fixed or dilated. Symptoms spreading to both sides of face (may indicate blood clot).

Chronic nasal discharge, obstruction, and low-grade discomfort usually across the bridge of the nose.

Symptoms worse in the late morning or when wearing glasses.

Chronic sore throat and bad breath.

Sinusitis also can recur in other sites.


Maxillary sinuses are located behind the cheek bones. They are present at birth and continue to develop as long as teeth erupt. Tooth roots, in some cases, can penetrate the floor of these sinuses.

Pain across the cheekbone, under or around the eye, or around the upper teeth; may occur on one or both sides of the face.

Area over the cheekbone is tender and may be red or swollen.

Possibly tooth pain.

Symptoms are worse when the head is upright and improve when patient reclines.

Nasal discharge or postnasal drip.


Discomfort or pressure below the eye.

Chronic toothache.

Symptoms become worse with colds, flu, or allergies.

Discomfort increases during the day.

Coughing increases at night.


Frontal sinuses are located on both sides of the forehead. These sinuses are late in developing, so infection here is uncommon in children.

Severe headache in the forehead.

Fever (common but not always present).

Symptoms are worse when lying on the back and when pressing against the area over the eye on the side closest to the nose.

Symptoms are better when the head is upright.

Nasal discharge or postnasal drip.

Symptoms indicating medical emergency:

Increasing severity of symptoms, particularly severe headache, altered vision, mild personality or mental changes (may indicate spread of infection to brain).

Fever, vision changes, fixed or dilated pupil. Symptoms spreading to both sides of face (may indicate blood clot).

Headache, fever, along with a soft swelling over the bone (may indicate bone infection).

Persistent, low-grade headache in the forehead.

History of physical injury or other damage to the sinus area.


Sphenoid sinuses are located behind the eyes. They usually are present by age 3 and are fully developed by age 12.

Deep headache with pain in many places, including the back and top of the head, across the forehead, and behind the eye.


Symptoms are worse when lying on the back or bending forward.

Nasal discharge or postnasal drip.

Symptoms indicating medical emergency:

Increasing severity of symptoms, particularly severe headache, altered vision, mild personality or mental changes (may indicate spread of infection to brain).

Low grade, general headache (although not always present).

(Adapted from: Sinus Disease: Guide to First-line Management. D. Kennedy, ed. 1994 Health Communications, Inc. Adrian, CT.)


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