Clinical features

The 3 cardinal symptoms that are most sensitive and specific for acute sinusitis are purulent nasal drainage accompanied by either nasal obstruction or facial pain, pressure, or fullness.

Major symptoms:

• Purulent anterior nasal discharge
• Purulent or discoloured posterior nasal discharge
• Nasal congestion or obstruction
• Facial congestion or fullness
• Facial pain or pressure
• Hyposmia or anosmia
• Fever (for acute sinusitis only)

Minor symptoms:

• Headache
• Ear pain, pressure, or fullness
• Halitosis
• Dental pain
• Cough
• Fever (for subacute or chronic sinusitis)
• Fatigue

Conventional diagnostic criteria for rhinosinusitis in adults require the patient to have at least 2 major symptoms or 1 major plus 2 or more minor symptoms. The criteria for children are similar, but there is greater emphasis on nasal discharge rather than nasal obstruction.

Reference

1. Rosenfeld RM et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1-S39.