Although infections of the paranasal sinuses are common, they are greatly overdiagnosed by patient and physician. Acute purulent sinusitis is characterized by nasal congestion, purulent nasal discharge, fetid breath, facial pain that typically increases when the patient stoops forward, and, often, fever and other systemic symptoms. Viral, allergic, or vasomotor rhinitis is frequently an antecedent event. Nasal polyps, deviation of the nasal septum, or hypertrophied adenoids may predispose to purulent sinusitis by obstructing sinus drainage. Cigarette smoke and overuse of topical decongestants impair ciliary action and alter the mucous blanket, predisposing to sinusitis.
Nosocomial sinusitis occurs as a complication of nasotracheal intubation.
Unexplained fever may be the presenting symptom, and computed tomography scanning is often required for diagnosis if the patient cannot localize the pain. Immunosuppression increases the frequency and severity of sinusitis. Sinusitis is common in patients with AIDS and is often severe and refractory to treatment. Frontal sinusitis produces pain and tenderness over the lower forehead and purulent drainage from the middle meatus of the nasal turbinates. Maxillary sinusitis produces pain and tenderness over the cheeks.