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Signs and Symptoms of Rhinosinusitis

Woman blowing nose

There are many symptoms suggestive of Rhinosinusitis. To help with making a diagnosis of sinusitis, the symptoms are divided into “major symptoms” and “minor symptoms.”

"Major" Symptoms

  • Nasal obstruction
  • Facial congestion or fullness
  • Facial pain or pressure
  • Thick & discolored drainage
  • Change in taste or smell

"Minor" Symptoms

  • Fever
  • Fatigue
  • Bad breath
  • Headache
  • Tooth pain
  • Cough
  • Ear pressure

One of the following combinations is required for a diagnosis of sinusitis:

  • At least two of the major symptoms
  • One major symptom and two minor symptoms

The diagnosis of chronic sinusitis should be confirmed with nasal endoscopy and/or a CT scan. On nasal endoscopy, purulent (infected) discharge and swelling of the sinus drainage pathways indicates sinusitis. The diagnosis is also confirmed if the CT scan reveals sinuses filled with thick mucus or sinuses that are lined by thickened mucous membranes.

The duration of the condition further characterizes sinusitis.

  • Acute Sinusitis: < 4 weeks
  • Sub-acute Sinusitis: 4-12 weeks
  • Chronic Sinusitis: > 12 weeks

Intense facial symptoms usually characterize acute sinusitis. The sinus inflammation usually results from viral or bacterial infection. Sometimes a viral infection precedes acute bacterial sinusitis. Viral sinusitis usually accompanies a cold and patients may have “flu-like” symptoms. Upper respiratory viral infections usually resolve in less than one week with treatments including rest, hydration, acetaminophen, nasal or oral decongestants, and nasal saline rinses. Bacterial acute sinusitis usually presents with fever, facial pain, colored discharge from the nose, and nasal obstruction. Antibiotics and supportive care help reduce the severity and duration of acute sinusitis. A vicious cycle may begin of mucous build-up, infection of mucous, mucous membrane inflammation and swelling, sinus outflow obstruction resulting in more mucous build-up, etc…. The cycle is broken by opening the sinus outflow tract and thinning the mucus so the infected material can drain.

© Benjamin Liess, MD, FACS