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Acute sinusitis - Symptoms
Last reviewed: 06.07.2025
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Acute sinusitis is not only a local lesion, but a disease of the entire body with a reaction of many systems and organs. Manifestations of a general reaction to inflammation of the paranasal sinuses, in particular, are a feverish state and typical changes in the blood (in acute and exacerbations of chronic sinusitis), as well as general malaise, weakness, headaches. Since these symptoms also accompany other focal infections, local manifestations of inflammation acquire primary importance in the diagnosis of sinusitis.
The most common complaints with inflammation of the paranasal sinuses are: headaches, difficulty breathing through the nose, abnormal discharge from the nose and nasopharynx, and olfactory disorders.
Headaches are considered one of the leading symptoms of acute and exacerbation of chronic sinusitis. Their occurrence is explained by the effect of the inflammatory process on the membranes of the brain due to the anatomical proximity of the paranasal sinuses to the cranial cavity, the presence of wide connections between the vascular, lymphatic and nervous systems of the nasal cavity, paranasal sinuses and meninges. However, despite purulent inflammation of one or more sinuses, complaints of headache are sometimes absent, especially if there is a good outflow of exudate through natural fistulas. Headache with sinusitis is usually diffuse. However, with more pronounced inflammation in one of the sinuses, the headache can be local, characteristic of the lesion of this sinus.
Impaired nasal breathing in sinusitis can be either periodic or permanent, be unilateral or bilateral, and result from obstruction of the nasal passages caused by edema or hyperplasia of the mucous membrane, polyps, or pathological secretions. In unilateral sinusitis, difficulty in nasal breathing usually corresponds to the affected side. In allergic and vasomotor sinusitis, alternating blockage of one or the other half of the nose is often noted.
Pathological nasal discharge, as well as difficulty in nasal breathing, can be temporary and permanent, unilateral and bilateral. Usually, an increase in the amount of discharge coincides with an exacerbation of the inflammatory process in the sinuses, but if the outflow from the cavity is impaired, such a correspondence may not occur. Often, patients indicate the flow of discharge into the nasopharynx, which usually occurs with diseases of the sphenoid sinus and posterior cells of the ethmoid labyrinth,
During external examination, swelling of the soft tissues of the face in the projection of one or another sinus can be noted, which occurs with severe acute sinusitis or exacerbation of chronic sinusitis as a result of the involvement of the periosteum in the process. In some cases, the development of periostitis is manifested only by pain when palpating the anterior walls of the paranasal sinuses.
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