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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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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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