Often there is a sensation of facial congestion and stuffiness. Children with sinusitis often present with cough and fetid breath.
Fever is only present in half of patients with acute infection and is usually low grade.
A high fever usually indicates a serious complication such as meningitis or another diagnosis altogether. Stuffy ears and impaired hearing are common because of associated serous otitis media and eustachian tube dysfunction. Examine the nose for purulent drainage before and after shrinking the nasal mucosa with topical vasoconstrictor. First-line antibiotic therapy is amoxicillin, or, for patients with penicillin allergy, Bactrim or Sulfa. If the patient has been recently treated with these medications or if the infection appears to be serious, then treat with a second-line drug like Ceftin or Augmentin.