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Maxillary Sinusitis – Causes, Symptoms and Treatment

Maxillary sinusitis is an inflammation of the mucous membrane lining the maxillary sinuses. It causes facial pain, nasal congestion, and pressure behind the cheeks.

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Things worth knowing about "Maxillary Sinusitis"

Maxillary sinusitis is an inflammation of the mucous membrane lining the maxillary sinuses. It causes facial pain, nasal congestion, and pressure behind the cheeks.

What is Maxillary Sinusitis?

Maxillary sinusitis is an inflammation of the mucous membrane lining the maxillary sinuses – the air-filled cavities located in the cheekbones on either side of the nose. It is one of the most common forms of sinusitis and can occur as an acute or chronic condition. Acute maxillary sinusitis typically resolves within four weeks, while the chronic form persists for more than twelve weeks. It is a very frequent reason for visits to general practitioners and ENT (ear, nose, and throat) specialists.

Causes

Maxillary sinusitis most commonly develops as a complication of a cold or upper respiratory tract infection. Common causes include:

Viral infections: The most frequent trigger, often following a common cold.
Bacterial infections: Bacteria such as Streptococcus pneumoniae or Haemophilus influenzae can cause secondary infections after a viral illness.
Allergies: Allergic rhinitis can cause swelling of the nasal passages, blocking the sinus openings.
Dental infections: Infections at the roots of upper teeth can spread into the maxillary sinuses (odontogenic sinusitis).
Anatomical factors: A deviated nasal septum or nasal polyps can obstruct sinus drainage.
Fungal infections: Rare, but can occur particularly in immunocompromised individuals.

Symptoms

Symptoms of maxillary sinusitis may vary in severity and duration. Common complaints include:

Pressure and pain in the cheeks and below the eyes, worsening when bending forward
Blocked or runny nose with yellow-green discharge
Reduced or lost sense of smell
Toothache in the upper jaw area
Headache, particularly in the forehead and cheek area
Fever (especially with bacterial infection)
General feeling of illness and fatigue
Postnasal drip causing a cough or sore throat

Diagnosis

Maxillary sinusitis is typically diagnosed by a general practitioner or an ENT specialist based on the following assessments:

Medical history and physical examination: Review of symptoms and their onset, palpation of the cheeks for tenderness.
Nasal endoscopy (rhinoscopy): Direct examination of the nasal passages and sinus openings using a small camera.
Imaging: In chronic or complicated cases, a computed tomography (CT) scan of the sinuses may be performed.
Swab culture: To identify the causative organism, especially if bacterial infection is suspected or treatment has failed.

Treatment

Conservative Measures

For viral maxillary sinusitis, treatment focuses on relieving symptoms:

Decongestant nasal sprays or drops to improve sinus ventilation
Nasal irrigation with isotonic saline solution
Steam inhalation
Pain relief and fever reduction with medications such as ibuprofen or paracetamol
Adequate hydration and rest

Medication

For bacterial infections or complicated cases, a doctor may recommend:

Antibiotics: Such as amoxicillin, sometimes combined with clavulanic acid, typically for 5 to 10 days.
Corticosteroid nasal sprays: To reduce mucosal swelling, especially in allergic cases.
Antihistamines: For allergy-related maxillary sinusitis.

Surgical Treatment

For chronic sinusitis or when polyps or anatomical obstructions are present, surgery may be necessary. Functional endoscopic sinus surgery (FESS) is the most common procedure, widening the sinus openings to improve drainage and ventilation.

Prevention

Several steps can help reduce the risk of developing maxillary sinusitis:

Regular handwashing and good hygiene to prevent colds
Proper management of allergies
Regular dental check-ups to detect and treat tooth infections early
Adequate humidification of indoor air in dry environments
Avoiding smoking, as tobacco smoke irritates the mucous membranes

References

Fokkens WJ et al. - European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020. Rhinology. 2020;58(Suppl S29):1-464.
Rosenfeld RM et al. - Clinical Practice Guideline: Adult Sinusitis. Otolaryngology-Head and Neck Surgery. 2015;152(2 Suppl):S1-S39.
Chow AW et al. - IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clinical Infectious Diseases. 2012;54(8):e72-e112.

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