Editing Sinusitis (section)

==Signs and symptoms==
Acute sinusitis can present as facial pain and tenderness that may worsen on standing up or bending over, headache, cough, bad breath, nasal congestion, ear pain, ear pressure or [[Rhinorrhea|nasal discharge]] that is usually green in color, and may contain [[pus]] or blood.<ref>{{Cite web |date=2025-03-12 |title=What Is a Sinus Infection? Symptoms, Causes, Diagnosis, Treatment, and Prevention |url=https://www.everydayhealth.com/sinus-infection/guide/ |access-date=2025-03-18 |website=EverydayHealth.com |language=en}}</ref>Dental pain can also occur. A way to distinguish between toothache and sinusitis is that sinusitis-related pain is usually worsened by tilting the head forward or performing the [[Valsalva maneuver]].<ref name="pmid24861778">{{cite journal |vauthors=Ferguson M |date=September 2014 |title=Rhinosinusitis in oral medicine and dentistry |journal=Australian Dental Journal |volume=59 |issue=3 |pages=289–95 |doi=10.1111/adj.12193 |pmid=24861778 |doi-access=free}}</ref>

Chronic sinusitis presents with more subtle symptoms of nasal obstruction, with less fever and pain complaints.<ref>{{Cite book |last=Pasha |first=Raza |title=Otolaryngology-Head and Neck Surgery: Clinical Reference Guide |publisher=Plural Publishing Inc. |year=2013 |isbn=978-1597565325 |edition=4th}}</ref> Symptoms include facial pain, [[headache]], night-time coughing, an increase in previously minor or controlled asthma symptoms, general [[malaise]], thick green or yellow nasal [[Rhinorrhea|discharge]], feeling of facial fullness or tightness that may worsen when bending over, dizziness, aching teeth, and [[Halitosis|bad breath]].<ref name="Radojicic2">{{cite web |last=Radojicic |first=Christine |title=Sinusitis |url=http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/ |url-status=live |archive-url=https://web.archive.org/web/20121114060719/http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/ |archive-date=November 14, 2012 |access-date=November 26, 2012 |work=Disease Management Project |publisher=[[Cleveland Clinic]]}}</ref> Often, chronic sinusitis can lead to [[anosmia]], the loss of the sense of [[Olfaction|smell]].<ref name="Radojicic2" />

A 2005 review suggested that most "sinus headaches" are migraines.<ref>{{cite journal |vauthors=Mehle ME, Schreiber CP |date=October 2005 |title=Sinus headache, migraine, and the otolaryngologist |journal=Otolaryngology–Head and Neck Surgery |volume=133 |issue=4 |pages=489–96 |doi=10.1016/j.otohns.2005.05.659 |pmid=16213917 |s2cid=40427174}}</ref> The confusion occurs in part because migraine involves activation of the [[trigeminal nerves]], which innervate both the sinus region and the [[meninges]] surrounding the brain. As a result, accurately determining the site from which the pain originates is difficult. People with migraines do not typically have the thick nasal discharge that is a common symptom of a sinus infection.<ref>{{cite journal |author1=Headache Classification Subcommittee of the International Headache Society |year=2004 |title=The International Classification of Headache Disorders: 2nd edition |journal=Cephalalgia |volume=24 |issue=Suppl 1 |pages=9–160 |doi=10.1111/j.1468-2982.2004.00653.x |pmid=14979299 |doi-access=free}}</ref>

===By location===
The four paired [[paranasal sinuses]] are the frontal, ethmoidal, maxillary, and sphenoidal sinuses. The [[Ethmoid sinus|ethmoidal sinuses]] are further subdivided into anterior and posterior ethmoid sinuses, the division of which is defined as the [[Ethmoid sinus#Groups of sinuses|basal lamella]] of the [[middle nasal concha]]. In addition to the severity of [[disease]], discussed below, sinusitis can be classified by the sinus cavity it affects:

* [[Maxillary sinus|Maxillary]] – may cause pain or pressure in the maxillary (cheek) region, often experienced as toothache or headache.<ref name="pmid248617783">{{cite journal |vauthors=Ferguson M |date=September 2014 |title=Rhinosinusitis in oral medicine and dentistry |journal=Australian Dental Journal |volume=59 |issue=3 |pages=289–95 |doi=10.1111/adj.12193 |pmid=24861778 |doi-access=free}}</ref>
* [[Frontal sinus|Frontal]] – may cause pain or pressure in the frontal sinus cavity (above the eyes), often experienced as headache, particularly in the forehead area.
* [[Ethmoid sinus|Ethmoidal]] – may cause pain or pressure pain between or behind the eyes,  along the sides of the upper nose ([[Canthus|medial canthi]]), and headaches.<ref name="Terézhalmy-20093">{{cite book |url=https://archive.org/details/physicalevaluati00tere |title=Physical evaluation in dental practice |vauthors=Terézhalmy GT, Huber MA, Jones AC, Noujeim M, Sankar V |publisher=Wiley-Blackwell |year=2009 |isbn=978-0-8138-2131-3 |location=Ames, Iowa |page=[https://archive.org/details/physicalevaluati00tere/page/n37 27] |url-access=limited}}</ref>
* [[Sphenoid sinus|Sphenoidal]] – may cause pain or pressure behind the eyes, though it is often felt at [[Vertex (anatomy)|top of the head]], over the [[Mastoid process|mastoid processes]], or the back of the head.<ref name="Terézhalmy-20093" />

=== Complications ===
{| class="wikitable" style="float: right; margin-left:15px; text-align:center"
|+Chandler Classification
|-
!scope="col"| Stage
!scope="col"| Description
|-
!scope="row" style="text-align:left; font-weight:normal;"| I
| Preseptal cellulitis
|-
!scope="row" style="text-align:left; font-weight:normal;"| II
| Orbital cellulitis
|-
!scope="row" style="text-align:left; font-weight:normal;"| III
| Subperiosteal abscess
|-
!scope="row" style="text-align:left; font-weight:normal;"| IV
| Orbital abscess
|-
!scope="row" style="text-align:left; font-weight:normal;"| V
| Cavernous sinus septic thrombosis
|}
Complications are thought to be rare (1 case per 10,000).<ref name="pmid18206715"/> Infectious complications of acute bacterial sinusitis include [[Orbit (anatomy)|eye]], [[Cranial cavity|brain]] and [[Osseous|bone]] complications.<ref name=":0">{{Cite book |last1=Scholes |first1=Melissa A. |title=ENT secrets |last2=Ramakrishnan |first2=Vijay R. |date=May 9, 2022 |publisher=Elsevier Health Sciences |isbn=9780323733588 |edition=5th |pages=155–160}}</ref>

==== Orbital complications ====
The Chandler Classification is used to group orbital complications into five stages according to their severity.<ref>{{cite journal|vauthors=Chandler JR, Langenbrunner DJ, Stevens ER|date=September 1970|title=The pathogenesis of orbital complications in acute sinusitis|journal=The Laryngoscope|volume=80|issue=9|pages=1414–28|doi=10.1288/00005537-197009000-00007|pmid=5470225|s2cid=32773653}}</ref> Stage I, known as preseptal cellulitis, occurs when an infection develops in front of the [[orbital septum]].<ref name=":1">{{Citation|last1=Bae|first1=Crystal|title=Periorbital Cellulitis|date=2024|work=StatPearls|url=https://www.ncbi.nlm.nih.gov/books/NBK470408/|access-date=2024-11-13|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=29261970|last2=Bourget|first2=Daniele}}</ref> It is thought to result from restricted [[Venous|venous drainage]] from the sinuses and affects the soft tissue of the eyelids and other superficial structures.<ref name=":1"/> Stage II, known as orbital cellulitis, occurs when infection develops behind the orbital septum and affects the [[Orbit (anatomy)|orbits]].<ref name=":1"/> This can result in [[Ophthalmoparesis|impaired eye movement]], [[Exophthalmos|protrusion of the eye]], and [[Chemosis|eye swelling]].<ref name=":1"/> Stage III, known as subperiosteal abscess, occurs when [[pus]] collects between walls of the orbit and the surrounding periosteal structures.<ref name=":1"/> This can result in impaired eye movement and acuity.<ref name=":1"/> Stage IV, known as orbital abscess, occurs when an abscess forms within the orbital tissue.<ref name=":1"/> This can result in severe vision impairment.<ref name=":1"/> Stage V, known as cavernous sinus thrombosis, is considered an intracranial complication. It can occur as bacterial spread progresses, triggering blood clots that become trapped within the cavernous sinus.<ref>{{Citation|last1=Plewa|first1=Michael C.|title=Cavernous Sinus Thrombosis|date=2024 |work=StatPearls|url=https://pubmed.ncbi.nlm.nih.gov/28846357/|access-date=2024-11-13|place=Treasure Island (FL) |publisher=StatPearls Publishing|pmid=28846357|last2=Tadi|first2=Prasanna|last3=Gupta|first3=Mohit}}</ref> This can result in previously described symptoms within the opposite eye and in severe cases, meningitis.<ref name=":1"/>

==== Intracranial complications ====
The close proximity of the sinuses to the brain makes brain infections one of the most dangerous complication of acute bacterial sinusitis, especially when the frontal and sphenoid sinuses are involved. These infections can result from invasion of [[Anaerobic organisms|anaerobic bacteria]] through the bones or blood vessels. [[Abscesses]], [[meningitis]], and other life-threatening conditions may occur. In rare cases, mild personality changes, headache, altered consciousness, visual problems, seizures, [[coma]], and even death may occur.<ref name="Patient Education2">{{cite web |title=Sinusitus Complications |url=http://www.umm.edu/patiented/articles/what_symptoms_of_sinusitis_000062_4.htm |url-status=live |archive-url=https://web.archive.org/web/20100222004055/http://www.umm.edu/patiented/articles/what_symptoms_of_sinusitis_000062_4.htm |archive-date=2010-02-22 |work=Patient Education |publisher=University of Maryland}}</ref>

==== Osseous complications ====
A rare complication of acute sinusitis is a bone infection, known as [[osteomyelitis]], which affects the [[Frontal bone|frontal]] and other [[Facial skeleton|facial bones]].<ref name=":02">{{Cite journal |last1=Wadhwa |first1=Smriti |last2=Jain |first2=Shraddha |last3=Gupta |first3=Jaya |last4=Dobariya |first4=Harshil |last5=Pantbalekundri |first5=Nikhil |last6=Wadhwa |first6=Smriti |last7=Jain |first7=Shraddha |last8=Gupta |first8=Jaya |last9=Dobariya |first9=Harshil |last10=Pantbalekundri |first10=Nikhil |date=2024-02-13 |title=Osteomyelitis of Frontal Sinus: A Rare Sequelae of Acute Bacterial Sinusitis Associated With Anatomical Variations in the Frontal Sinus Drainage Pathway |journal=Cureus |language=en |volume=16 |issue=2 |pages=e54158 |doi=10.7759/cureus.54158 |doi-access=free |issn=2168-8184 |pmc=10940872 |pmid=38496067}}</ref> Specifically, the combination of frontal sinusitis, osteomyelitis and subperiosteal abscess formation is referred to as [[Pott's puffy tumor]].<ref name="Patient Education3">{{cite web |title=Sinusitus Complications |url=http://www.umm.edu/patiented/articles/what_symptoms_of_sinusitis_000062_4.htm |url-status=live |archive-url=https://web.archive.org/web/20100222004055/http://www.umm.edu/patiented/articles/what_symptoms_of_sinusitis_000062_4.htm |archive-date=2010-02-22 |work=Patient Education |publisher=University of Maryland}}</ref><ref name=":02" />

'''Other complications'''

When an infection originating from a tooth or dental procedure affects the maxillary sinus it can lead to [[odontogenic sinusitis]] (ODS).<ref>{{cite journal |last1=Craig |first1=John R. |last2=Poetker |first2=David M. |last3=Aksoy |first3=Umut |last4=Allevi |first4=Fabiana |last5=Biglioli |first5=Federico |last6=Cha |first6=Bruce Y. |last7=Chiapasco |first7=Matteo |last8=Lechien |first8=Jerome R. |last9=Safadi |first9=Ahmad |last10=Simuntis |first10=Regimantas |last11=Tataryn |first11=Roderick |date=2021-02-14 |title=Diagnosing odontogenic sinusitis: An international multidisciplinary consensus statement |journal=International Forum of Allergy & Rhinology |language=en |volume=11 |issue=8 |pages=1235–1248 |doi=10.1002/alr.22777 |issn=2042-6976 |pmid=33583151 |doi-access=free |hdl-access=free |hdl=2027.42/168522}}</ref> Odontogenic sinusitis can often spread to nearby sinuses including the ethmoid, frontal, sphenoid sinuses, and the contralateral nasal cavity.<ref>{{cite journal |last1=Saibene |first1=Alberto Maria |last2=Pipolo |first2=Giorgia Carlotta |last3=Lozza |first3=Paolo |last4=Maccari |first4=Alberto |last5=Portaleone |first5=Sara Maria |last6=Scotti |first6=Alberto |last7=Borloni |first7=Roberto |last8=Messina |first8=Francesco |last9=Di Pasquale |first9=Daniele |last10=Felisati |first10=Giovanni |date=December 2014 |title=Redefining boundaries in odontogenic sinusitis: a retrospective evaluation of extramaxillary involvement in 315 patients: Odontogenic sinusitis extramaxillary involvement |url=http://doi.wiley.com/10.1002/alr.21400 |url-status=live |journal=International Forum of Allergy & Rhinology |language=en |volume=4 |issue=12 |pages=1020–1023 |doi=10.1002/alr.21400 |pmid=25196643 |s2cid=28835025 |archive-url=https://web.archive.org/web/20240225034048/https://onlinelibrary.wiley.com/doi/abs/10.1002/alr.21400 |archive-date=2024-02-25 |access-date=2021-03-27}}</ref> In rare instances, these infections may spread to the [[Orbit (anatomy)|orbit]], leading to orbital [[cellulitis]].