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 |
|
|
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:
- Orbital phlegmon (bacterial inflammation of the eye socket).
- Frontal bone osteomyelitis (frontal bone osteomyelitis).
- Intracerebral abscess (brain abscess) – encapsulated collection of pus in the brain.
- Meningitis (meningitis)
- Sinus cavernosus thrombosis (blood clot formation in brain vessels; in the context of sinusitis frontalis (sinusitis) or sinusitis sphenoidalis/sphenoid sinusitis).
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.