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. The diagnosis of sinusitis can usually be established on clinical grounds. Poor response to decongestants, maxillary toothache, and purulent nasal discharge are useful criteria. The diagnosis can be confirmed by the finding of opacity when the frontal or maxillary sinuses are transilluminated or by radiographic findings such as mucosal thickening, sinus opacification, or air-fluid levels. Bone erosion may be present in chronic sinusitis.