The symptoms of sinus disease are similar to the symptoms of nasal disease. Fever, malaise, cough, nasal congestion, maxillary toothache, purulent nasal discharge, headache, and little improvement of symptoms with decongestants increase the likelihood of sinus disease. Pain, often made worse by bending forward, is an important symptom. Pain from localized sinus disease is usually present in the area overlying the involved sinus. The only exception is sphenoid sinus disease, which is felt diffusely. Maxillary sinus pain is felt behind the eye and near the second premolar and first and second molar teeth. Frontal sinus pain is localized to above the eye. Ethmoid sinus pain is usually periorbital. Sometimes sinus pain can be referred to another area. In addition to pain, ocular abnormalities may also be present with diseases of the sinuses.
The accuracy of the symptoms and signs of sinusitis has been evaluated. Colored nasal discharge, cough, and sneezing were the symptoms with the highest sensitivities (72%, 70%, and 70%, respectively);these symptoms, however, were not very specific. Maxillary toothache was the symptom most specific for sinusitis, with a specificity of 93%;however, only 11% of patients reported this symptom. This symptom had the highest positive likelihood ratio, of 2.5. The conclusion was that the combination of maxillary toothache, poor response to decongestants, colored nasal discharge, and abnormality on sinus transillumination (discussed later in this chapter) was the strongest predictor of sinusitis in primary care populations. If all these symptoms were present in one patient, the positive likelihood ratio was 6.4, and the patient probably had sinusitis;if none were present, sinusitis was ruled out.
Table 11-2 summarizes the location of pain associated with sinus disease. Table 11-3 lists other clinical signs and symptoms associated with sinus disease.
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