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. Pain is often referred to the teeth, and the hard palate may be edematous in severe cases.
Purulent drainage is present in the middle meatus.
Patients with ethmoidal sinusitis complain of retroorbital pain and may have pain, tenderness, and even erythema over the upper lateral aspect of the nose. The anterior ethmoidal cells drain through the middle meatus, whereas the posterior cells drain through the superior meatus. Photophobia and tearing may be present. Purulent drainage is present in the superior meatus. In addition to chronic or inadequately treated bacterial infections, factors that predispose to chronic sinusitis include long-term impairment of mucociliary clearance, obstruction of sinus drainage, and allergies and asthma.