Sinus infections are not the same as allergies or bronchitis, but people often confuse the terms and think they are the same. They do have something in common as they involve the respiratory system. But the sinuses are very specific structures we need to understand before studying sinus infection symptoms.
The paranasal sinuses are cavities carved in the skull bones. They are filled with air and lined in a particular type of mucosa made up of ciliated epithelium. The mucosa in the sinuses can produce mucus through small glands, which creates a liquid on the surface that covers the epithelial lining.
We have three groups of paranasal sinuses. They are the ethmoid sinuses, the maxillary sinuses, and the sphenoid sinuses. The ethmoid group is located on either side of the nose. The sphenoid sinuses are found in front of the pituitary gland and behind the ethmoid, in the forehead. The maxillary sinuses are located in the maxillary bone below your eyes.
These compartments are linked to each other and to the main airways. Thus, they also communicate with the outside air and are prone to infections. An infection in the sinuses causes inflammation, known as sinusitis. In this article, we will cover the signs and symptoms associated with the infection of these compartments. We will break down the symptoms into acute and chronic sinusitis according to the timeline of the disease.
Acute bacterial or viral sinusitis
As noted above, sinusitis is the inflammation of the paranasal sinuses, which happens for different reasons, including an infection. The nasal mucosa is also usually involved because it is connected to the paranasal sinuses. Thus, it is usually referred to as rhinosinusitis.
Acute sinusitis is an episodic presentation of inflammation of the paranasal sinuses. It has more distinct signs and symptoms and is sometimes associated with other acute respiratory tract infections. When sinus infections are recurrent and happen more than twice a year, it will be considered acute sinusitis if the symptoms are separated by a minimum of 8 weeks of no symptoms.
The most important signs and symptoms of acute sinus infection include:
1. Pain in the frontal region or cheeks
This is perhaps one of the most important and noticeable symptoms. Other symptoms are common in most or all respiratory tract infections. This one is more specific for sinusitis. Patients feel a sensation of pressure or dull pain in different face regions, especially in the forehead, below the eyes, or on either side of the nose.
2. Maxillary dental pain
Sinus-related pain can also be located in the dental department. Sinusitis can sometimes cause a toothache because the maxillary sinuses are close to the teeth, and the inflammation can affect their nerves, triggering the sensation. This is more likely when the sinuses are filled with mucus and the pressure in these compartments increases.
3. Ear pressure or sensation of fullness
Ear doctors also specialize in the throat and the nose because these compartments are all linked to one another. Thus, the close proximity and communication between the infected sinuses and the ears also trigger alterations in these structures. When this happens, you can feel a sensation of fullness or ear pressure, and sometimes pain as fluid becomes trapped in your ear and behind the eardrum.
4. Redness of the nose, eyelids, or cheeks
One of the signs of inflammation is redness of the affected area, which is also true in the case of sinusitis. The adjacent skin area to the affected sinuses becomes reddened. This reddened area can be located in your cheeks, in the eyelids, or around the nose. Since frontal sinuses are not so close to the skin, the chance of having a reddened forehead is not very high.
5. Tenderness on the affected sinus
In patients with sinus infections, one of the physical exam findings doctors will look for is tenderness on the affected sinus. When you apply some pressure on the frontal sinus area, the cheeks, or on either side of the nose, you feel very uncomfortable pressure or dull pain. In more severe cases, the area can become very painful when a little pressure is applied.
6. Temple pain
This symptom is also important, especially when the frontal sinuses are involved in the disease. The inflammation of the area triggers pain receptors and reaches the brain. However, the brain interprets the signals as if they came from the temples, and patients start experiencing temple pain. This is called referred pain because the problem is not precisely in the temples but in the frontal sinuses instead.
7. Nasal discharge
As noted above, sinus infections are usually paired with nasal infections. Thus, not only the sinuses produce mucus but also the nasal mucosa. The nasal discharge can be fluid or thick, but it is usually purulent in case of bacterial infections. Still, the nature of the nasal discharge is not necessarily a sign of bacterial infection.
8. Postnasal drip
This is also an important symptom of acute sinusitis and is very uncomfortable for patients. They feel a constant fluid running in the back of the nose. This often causes itchiness, sneezing, and other symptoms.
9. Nasal congestion and blocked nose
When mucus production is abundant, patients will have not only nasal discharge but also nasal congestion. There’s so much mucus in the nose that it can’t be properly managed or eliminated from the nasal cavity. It tends to dry out after a few hours and blocks the nose.
10. Persistent coughing with or without pharyngeal irritation
This symptom is common in almost all respiratory infections. In this case, the cough is held throughout the day and sometimes worsens at night. It can be productive or not, depending on the nature and the extent of the infection.
11. Hyposmia or anosmia
Nasal infections can also change the way we perceive odors, which is known as hyposmia or anosmia. Hyposmia refers to a decreased sensation of smell. Anosmia is a complete absence of this sensation. Hyposmia is more common, but sometimes, more severe infection and some infectious agents affect the olfactory bulb or cause a severe blockage that leads to anosmia.
12. Periorbital edema
This mainly happens in the case of acute ethmoiditis. In other words, when the disease takes the ethmoid sinuses. It is more common in young children and infants. The fluid accumulates in the area, and it looks swollen. The overlying skin may also infect, causing periorbital cellulitis, which is a more severe complication of the disease.
13. Fever
This is also an important symptom in the case of infection, and it helps guide the diagnosis because fever usually shows up in infectious diseases and not in allergies. It can be a high fever in case of severe infection, mainly when spreading to other parts of the respiratory tract.
14. Fatigue
This is a constitutional symptom and does not have predictive value. In other words, it won’t guide the diagnosis and will probably not tell you how severe the disease really is. But most patients constantly feel tired and sometimes lethargic. This can be due to a reduction in oxygenation paired with the chronic inflammation of the respiratory tissue, making the immune system consume extra energy to fight off the disease.
15. Chronic bacterial or viral sinusitis
Chronic sinus infections can also persist for several weeks in some people. In such cases, we call this entity chronic sinusitis. The signs and symptoms are similar, but most of them have important variations that differentiate chronic and acute diseases.
Symptoms of chronic sinusitis are maintained for 12 weeks or more. The patients can experience an episodic worsening of the disease with symptoms similar to acute sinusitis. But when the condition apparently resolves, patients continue experiencing mild symptoms every once in a while before another recrudescence happens.
Chronic sinusitis can happen in three forms, two of which can be associated with bacterial infections. They are chronic sinusitis with nasal polyps and chronic sinusitis without nasal polyps. For doctors, it is crucial to determine if the patient has nasal polyps or not because this fact will guide the treatment.
The signs and symptoms have variations with the acute disease and include the following:
16. Acute sinusitis that does not resolve
First of all, chronic sinusitis can be detected as acute sinusitis that does not fully resolve. The symptoms still linger for a while until a new episode comes through. The minimum of 8 weeks without symptoms is not met, and patients experience mild manifestations of the disease and may even get used to them.
17. Low-grade fever or no fever
You can also have an increase in body temperature in chronic sinusitis, but it is very different from acute disease. In this case, fever is not always present. When it is, the temperature barely rises and is sometimes not detected by patients. It is what we know as low-grade fever.
18. Nasal congestion
Patients with chronic sinus infections live with mild or moderate nasal congestion. They constantly need decongestants to control their symptoms and get used to having a blocked nose, especially at night. Difficult breathing can be more severe in patients with nasal polyps.
19. Nasal discharge
Chronic infections will also cause significant nasal discharge, which blocks the nose at night, as mentioned above. The character of the nasal discharge can be very thin or very thick. It can be clear, transparent, or purulent. The diagnosis of chronic sinusitis requires the presence of several symptoms, and one of them is nasal discharge with or without nasal obstruction. Thus, it is an important feature of the disease.
20. Postnasal drip
This uncomfortable symptom is maintained in patients with chronic disease. In this case, the postnasal drip is purulent and discolored. It has a foul taste and contributes to bad breath, as we will mention below.
21. Headache
Temple pain transforms into a headache in chronic disease. The headache can be felt simply as discomfort. In some cases, patients with migraines can experience more frequent and severe episodes. The headaches are particularly common in patients with chronic sinusitis and nasal polyps. They are considered minor factors, such as fever and facial pain, but they are essential to diagnosing the disease.
22. Facial discomfort
This symptom is similar to the one reported in acute sinusitis. It is sometimes reported as facial fullness and is also more common in patients with nasal polyps. It is a sensation of pressure in the forehead or below the eyes. Facial pain is a major factor of the disease, meaning that it is found in almost all instances of the disease.
23. Chronic coughing
This symptom is particularly prevalent in children, and the type of coughing is unproductive. In other words, you won’t cough up mucus. Dry coughing is more common at night; these patients are more likely to snore and experience a blocked nose. These nocturnal symptoms are triggered by postnasal drip, which becomes more severe in patients with an infection and allergies.
24. Sneezing
Another consequence of postnasal drip is sneezing. This symptom is also common in patients with allergies. Infectious sinusitis does not rule out allergies. Quite the opposite because allergies and chronic infectious sinusitis are often found in the same patients.
25. Hyposmia or anosmia
This is a reduction or a total absence of the sensation of smell. Hyposmia and anosmia are major symptoms of the disease, and it is more common and severe in cases of nasal polyps.
26. Sore throat
Patients with a chronic disease often experience irritation of the pharynx, which is also associated with the constant postnasal drip. Sore throat is a common symptom, especially in episodic recrudescences of the disease.
27. Bad breath
This symptom is distinctive of chronic sinusitis because it is not always found in acute disease. Postnasal drip has a foul taste and is usually made up of purulent secretions, which contribute to the bad breath.
28. Unpleasant taste
Patients with chronic sinusitis often have taste changes, including loss of taste or an unpleasant taste. This is partly a consequence of anosmia and hyposmia. Smell is an important part of the sensation of taste, and losing your smell will also affect your taste. Additionally, the unpleasant taste is made worse by the purulent nature of the nasal secretions.
29. Anorexia
Loss of appetite or anorexia comes as a consequence of the taste and smell changes patients experience. It can also lead to weight loss and other alterations.
30. Worsening of asthma symptoms
Chronic sinusitis may lead to an increase in the frequency and severity of asthma attacks. At the same time, asthma makes it more likely to suffer from chronic sinusitis. Thus, there is a strong association between these conditions, and you could say they feed each other.
31. Visual disturbances
In some cases, a severe and sustained sinus infection is spread into the eye socket and starts causing visual disturbances. Visual problems include blurred vision, reduced visual acuity, and sometimes vision loss can be permanent in case of severe infections.
Conclusion
Sinus infections can cause severe inflammation, known as sinusitis. Depending on how long your symptoms last, they can be acute or chronic. However, acute and chronic symptoms are also different in some key elements. For example, acute sinusitis fever is usually moderate or high, depending on the severity of the disease. In chronic sinusitis, it is a low-grade fever, and sometimes there’s no rise in body temperature.
Treatment of sinus infections depends on the nature of the microorganism. In the case of viral infections, symptomatic treatment is required to provide some relief as the body handles the infection. It is usually a self-limited disease and resolves by itself. Antibiotics and symptomatic treatment are needed in bacterial infections to help the organism get rid of the bacteria.
Some patients may also benefit from surgical treatment if they are not responsive to medical treatment. Surgery is reserved for patients with anatomic obstructions of the sinuses, which increase the likelihood of an infection or inflammation. The goal is to expand sinus ventilation and improve the functioning of the mucus clearance system.
Allergies often accompany acute and chronic sinusitis, and chronic sinusitis is associated with asthma. Thus, in treating the disease, it is essential to identify comorbidities or related disorders that complicate the patient’s condition.
Thus, a doctor should evaluate sinusitis in order to receive proper treatment according to not only one but different conditions contributing to your symptoms. Therefore, if the symptoms laid down in this article make you suspect sinusitis in yourself or others, do not hesitate to inform your doctor to get a complete physical exam and a treatment according to what you need.