Sinusitis: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate acute sinusitis (sinusitis/inflammation of the mucosa of the paranasal sinuses) or acute rhinosinusitis (ARS; simultaneous inflammation of the nasal mucosa (“rhinitis”) and inflammation of the mucosa of the paranasal sinuses (“sinusitis”); or an episode of recent ARS):

  • Anterior and/or posterior secretion (discharge of secretions via the pharynx and/or from the nose) or purulent rhinorrhea (discharge of secretions from the nose; discolored secretions).
  • Nasal obstruction (obstruction of nasal breathing).
  • Facial pain or pain or feeling of pressure in the area of the affected sinus.
  • Dysosmia (olfactory disorder)

Possible accompanying symptoms

  • Fever – in about 50% of cases.
  • Cephalgia (in this case: frontal pain or headache; rather rare; about 10% of cases); these may increase during bending over or blowing the nose

Chronic sinusitis may be accompanied by anosmia (loss of smell) and a permanent feeling of pressure in the sinus area. Other symptoms include obstructed nasal breathing and secretion discharge, especially in the morning. However, a symptomless course is also possible!

Chronic sinusitis ethmoidalis (ethmoidal cell inflammation) can be accompanied by the following clinical picture: Difficulty breathing through the nose; eyelid swelling and eye pain; fever. The strongest predictor (“predictor”) of chronic rhinosinusitis (CRS) is rhinorrhea (heavy secretion of thin to mucous nasal secretions).

Note: Because the symptoms of CRS are less characteristic, they must be confirmed by pathologic findings on rhinoscopy (nasal endoscopy)/nasal endoscopy or imaging.

Diagnostic criteria of the Academy of Ototlaryngology – Head and Neck Surgery 1996

Main criteria Secondary criteria
  • Facial pain or facial/head pressure.
  • Congestion feeling
  • Nasal obstruction (stuffy nose; obstructed nasal breathing).
  • Purulent nasal secretion
  • Hyp- or anosmia
  • Fever (in acute sinusitis)
  • Headache
  • Fatigue or exhaustion
  • Halitosis (Foetor)
  • Toothache
  • Cough
  • Ear pressure
  • Fever

Assessment: for the diagnosis of chronic rhinosinusitis (CRS)/sinusitis, at least 2 major or 1 major and 2 minor criteria must be present or met for a period of more than 12 weeks.

Warning signs (red flags) of complicated rhinosinusitis

  • Persistent fever
  • Biphasic course of the disease
  • Severe pain
  • Facial swelling
  • Lethargy
  • Neurological symptoms (e.g., meningismus/painful neck stiffness).

Behind this may be the following dangerous clinical pictures:

The above risks occur with:

  • Adults: almost exclusively only in acute episodes of chronic rhinosinusitis.
  • Children: in acute pansinusitis (involvement of all sinuses) or sinusitis frontalis.