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Unilateral Sinusitis – Causes, Symptoms & Treatment
Unilateral sinusitis affects only one of the two maxillary sinuses, causing one-sided facial pain, pressure, and nasal discharge. It often has a specific local cause.
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Unilateral sinusitis affects only one of the two maxillary sinuses, causing one-sided facial pain, pressure, and nasal discharge. It often has a specific local cause.
What is Unilateral Sinusitis?
Unilateral sinusitis, also known as one-sided maxillary sinusitis, is an inflammation of the mucous membrane lining one of the two maxillary sinuses. The maxillary sinuses are air-filled cavities located within the cheekbones on either side of the nose. Unlike bilateral sinusitis, the one-sided form often points to a specific, localized cause that requires targeted diagnosis and treatment.
Causes
Several conditions can lead to unilateral sinusitis:
- Dental (odontogenic) causes: One of the most common reasons for one-sided sinusitis is a dental infection originating from an upper molar or wisdom tooth. The roots of these teeth lie very close to the sinus floor, allowing bacteria to spread directly into the sinus cavity.
- Viral infections: Common colds or influenza can cause swelling of the sinus lining, blocking drainage on one side and leading to infection.
- Bacterial infections: A secondary bacterial infection often follows a viral illness. Common bacteria involved include Streptococcus pneumoniae and Haemophilus influenzae.
- Anatomical factors: A deviated nasal septum or nasal polyps can obstruct drainage on one side, predisposing that sinus to inflammation.
- Foreign bodies or cysts: Retained root fragments, dental implant complications, or sinus cysts may trigger one-sided inflammation.
- Fungal infections: Rare but serious, especially in immunocompromised individuals.
Symptoms
Symptoms of unilateral sinusitis are typically restricted to one side of the face:
- Pain and pressure in the cheek, below the eye, or in the upper jaw on the affected side
- Headache that worsens when bending forward
- Thick, discolored nasal discharge from one nostril (yellow or green)
- Nasal congestion on one side
- Toothache in the upper jaw, particularly when a dental cause is present
- General malaise and possibly fever
- Reduced sense of smell (hyposmia)
- Bad breath or unpleasant odor from the nose, especially in bacterial or dental-related cases
Diagnosis
Diagnosis is usually established through clinical examination combined with imaging:
- ENT examination: An ear, nose, and throat (ENT) specialist examines the nasal passages using rhinoscopy or nasal endoscopy to assess the sinus openings and mucosa.
- X-ray: A sinus X-ray may reveal opacification or fluid levels in the affected sinus.
- CT scan (Computed Tomography): Provides detailed images of the sinus anatomy and is used in complex or treatment-resistant cases.
- Dental assessment: When an odontogenic cause is suspected, dental X-rays (such as panoramic radiography, OPG) help identify infected tooth roots near the sinus floor.
- Nasal swab and culture: Helps identify the causative organism and guides antibiotic selection.
Treatment
Conservative Treatment
Mild to moderate cases are usually managed with the following measures:
- Decongestant nasal sprays or drops (e.g., xylometazoline) to improve sinus drainage -- for short-term use only
- Saline nasal rinses to cleanse the nasal passages and reduce mucus buildup
- Pain relief with ibuprofen or paracetamol (acetaminophen) to manage pain and fever
- Warm compresses applied to the face to promote circulation and relieve pressure
- Antibiotics: Prescribed for confirmed bacterial infections or severe presentations (e.g., amoxicillin or amoxicillin-clavulanate)
Surgical Treatment
If conservative treatment fails or a structural or dental cause is identified, surgical intervention may be necessary:
- Sinus irrigation: Performed by an ENT specialist to flush out infected secretions from the sinus
- Functional Endoscopic Sinus Surgery (FESS): A minimally invasive procedure to widen the sinus opening and remove polyps or damaged tissue
- Dental treatment or extraction: When the cause is dental, the affected tooth, root remnants, or implant must be treated or removed by a dentist or oral surgeon
When to See a Doctor
Medical evaluation is strongly recommended if:
- symptoms persist for more than 10 days or worsen after initial improvement
- high fever develops
- severe headache, visual disturbances, or facial swelling occur
- nasal discharge is purulent or foul-smelling
- upper jaw toothache accompanies the sinus symptoms
References
- Fokkens WJ et al. - European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020). Rhinology. 2020;58(Suppl S29):1-464.
- Brook I. - Sinusitis of odontogenic origin. Otolaryngol Head Neck Surg. 2006;135(3):349-355.
- Rosenfeld RM et al. - Clinical Practice Guideline (Update): Adult Sinusitis. Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1-S39.
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