The antecedent history of viral URI likely contributes to the specificity of these symptoms for ABRS, but the extent to which this is true has not been quantified. Similarly, although the differential diagnosis of isolated nasal obstruction or facial pain is broad (and beyond the scope of this guideline), the specificity for ABRS increases when coupled with concurrent purulent nasal discharge (Table 5). For example, migraine headaches, tension headaches, and dental abscess can mimic rhinosinusitis pain, but the absence of purulent nasal discharge excludes this diagnosis based on our definition. Additional signs and symptoms of ABRS include fe- ver, cough, fatigue (malaise), hyposomia, anosmia, max- illary dental pain, and ear fullness or.
