From the Guidelines
Acute maxillary sinusitis typically presents with facial pain or pressure over the cheek area, which often worsens when bending forward or lying down, accompanied by nasal congestion, purulent nasal discharge, and decreased sense of smell, as noted in the clinical practice guideline on adult sinusitis 1. The clinical presentation of acute maxillary sinusitis can be summarized as follows:
- Facial pain or pressure over the cheek area, worsening with bending forward or lying down
- Nasal congestion and obstruction
- Purulent nasal discharge
- Decreased sense of smell
- Fever, fatigue, dental pain in the upper teeth, and halitosis may also occur
- Symptoms usually develop following a viral upper respiratory infection and persist beyond 10 days, or worsen after initial improvement (double worsening) 1 On examination, there may be:
- Tenderness over the maxillary sinuses
- Purulent discharge visible in the nasal passages
- Occasionally periorbital edema
- Transillumination of the sinuses may reveal decreased light transmission on the affected side Diagnosis is primarily clinical, though imaging may be considered in complicated cases, as radiologic findings have a sensitivity of 90% in detecting a bacterial cause, but a specificity of only 61% 1. Treatment typically includes:
- Analgesics for pain relief
- Saline nasal irrigation
- Intranasal corticosteroids
- Antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) are indicated when bacterial infection is suspected based on severe symptoms, prolonged duration beyond 10 days, or worsening after initial improvement 1 Decongestants may provide symptomatic relief but should be limited to 3-5 days to avoid rebound congestion. Patients should be advised to maintain adequate hydration and avoid air travel if possible until symptoms resolve, as pressure changes can exacerbate pain.
From the FDA Drug Label
1.3 Sinusitis – caused by beta-lactamase–producing isolates of H. influenzae and M. catarrhalis. The clinical presentation of acute maxillary sinusitis is not directly described in the drug label. Key points:
- The drug label mentions sinusitis as an indication for amoxicillin-clavulanate, but does not provide information on the clinical presentation.
- The label only discusses the causative bacteria and the use of the drug in treating the infection. 2
From the Research
Clinical Presentation of Acute Maxillary Sinusitis
The clinical presentation of acute maxillary sinusitis can be identified through various signs and symptoms. According to 3, the most helpful clinical signs and symptoms in the diagnosis of maxillary sinusitis include:
- Presence of a maxillary toothache
- Lack of improvement with decongestants
- Purulent nasal discharge
- Cough
- Purulent secretions observed on nasal examination
- Abnormal transillumination
- Sinus tenderness
Causes of Acute Maxillary Sinusitis
Acute maxillary sinusitis is most commonly caused by sinus ostia obstruction associated with the common cold or allergies 3. The most common pathogens responsible for acute maxillary sinusitis in adults are Streptococcus pneumoniae and Hemophilus influenzae, while Moroxella catarrhalis is common in children 3.
Diagnosis of Acute Maxillary Sinusitis
The diagnosis of acute maxillary sinusitis can be confirmed through various methods, including:
- Plain film radiographs, although they do not adequately visualize the anterior ethmoid sinuses 3
- Computed tomography, which provides superior visualization but is costly for routine cases 3
- Clinical diagnosis based on symptoms and physical examination 4, 5, 6
Treatment of Acute Maxillary Sinusitis
The treatment of acute maxillary sinusitis typically involves the use of antibiotics. According to 7, 4, 5, 6, antibiotics such as penicillin or amoxicillin can be effective in treating acute maxillary sinusitis, although the benefits must be weighed against the potential for adverse effects. The choice of antibiotic and duration of treatment depend on various factors, including the severity of symptoms and the presence of any underlying conditions.