Atopic history, seasonal, eye itching, sneezing, nasal polyps, eosinophilia, or occupational related symptoms are present. Fever, periorbital edema, facial tenderness and swelling, purulent discharge, malodorous breath, leukocytosis, positive x-rays support the diagnosis. Ethmoiditis usually does not occur before age six months, maxillary before one year, and frontal before age 10 years because of delay in sinus development. Pain is behind the eyes with ethmoid, in teeth or zygomatic bone with maxillary, and above the eye with frontal involvement. Symptoms similar to allergic but more related to weather changes, physical stimuli, emotion.
Patient lacks atopic history or eosinophilia.
History of frequent use of nasal sprays, decongestants, and antihistaminesis present. Nasal congestion seen with oral contraceptives, reserpine, aldomet, beta blockers, aspirin and non-steroidal antiinflammatory drugs if patient is sensitive. Most common, history of dry heat, may be seasonal, irritants may precipitate. History of recent trauma, nose picking, or nose blowing is present. Sinus tumors may present with pain, congestion, or bleeding.