Clinical Manifestations Most cases of acute sinusitis present after or in conjunction with a viral URI, and it can be difficult to discriminate the clinical features of one from the other. A large proportion of patients with colds have sinus inflammation, although bacterial sinusitis complicates only –2% of these viral infections. Common presenting symptoms of sinusitis include nasal drainage and congestion, facial pain or pressure, and headache. Thick, purulent or discolored nasal discharge is often thought to indicate bacterial sinusitis but also occurs early in viral infections such as the common cold and is not specific to bacterial infection | Chapter 031. Pharyngitis Sinusitis Otitis and Other Upper Respiratory Tract Infections Part 3 Clinical Manifestations Most cases of acute sinusitis present after or in conjunction with a viral URI and it can be difficult to discriminate the clinical features of one from the other. A large proportion of patients with colds have sinus inflammation although bacterial sinusitis complicates only of these viral infections. Common presenting symptoms of sinusitis include nasal drainage and congestion facial pain or pressure and headache. Thick purulent or discolored nasal discharge is often thought to indicate bacterial sinusitis but also occurs early in viral infections such as the common cold and is not specific to bacterial infection. Other nonspecific manifestations include cough sneezing and fever. Tooth pain most often involving the upper molars is associated with bacterial sinusitis as is halitosis. In acute sinusitis sinus pain or pressure often localizes to the involved sinus particularly the maxillary sinus and can be worse when the patient bends over or is supine. Although rare manifestations of advanced sphenoid or ethmoid sinus infection can be profound including severe frontal or retroorbital pain radiating to the occiput thrombosis of the cavernous sinus and signs of orbital cellulitis. Acute focal sinusitis is uncommon but should be considered in the patient with severe symptoms over the maxillary sinus and fever regardless of illness duration. Similarly advanced frontal sinusitis can present with a condition known as Pott s puffy tumor with soft tissue swelling and pitting edema over the frontal bone from a communicating subperiosteal abscess. Life-threatening complications include meningitis epidural abscess and cerebral abscess. Patients with acute fungal sinusitis such as mucormycosis often present with symptoms related to pressure effects particularly when the infection has spread to the orbits and cavernous sinus. Signs such as orbital swelling
