Viral: adeno, rhino, influenza, para-influenza, other
Bacterial: strep, h flu, moraxella, other
Fungal: mucor or aspergillous; overall uncommon
Allergic: response to allergen
Risk Factors
For fungal: Diabetic (in particular if poorly controlled), elderly and/or otherwise compromised hosts (e.g. chemotherapy, immune-modulating treatments)
Symptoms
Viral: acute onset; sometimes fever; cough, facial fullness/pain, colored d/c; typicallyself limited, resolving by 7-10d
Bacterial: acute, cough, persistent and progressive; colored d/c; sometimes fever; tooth or facial pain; lasting > 10d, or sx that improve initially and then worsen
Fungal: persistent and progressive facial pain; sometimes fever; congestion; numbness, local neurological signs (e.g. if cavernous sinus involvement/thrombosis); high mortality as these organisms are rapidly invasive and hosts typically compromised
Allergic: chronic nasal congestion, d/c, post nasal drip; chronic need to clear throat, cough
Physical Exam Findings
Nasal mucosa red, edematous, covered with d/c; pain upon percussion of sinuses
Post nasal drip evident on pharynx
Impaired transillumination of maxillary sinus (if affected)
Sometimes tooth pain (if tap on them and seated in the sinus)
Invasive Fungal or Bacterial: May be quite ill; sinus area pain; Sometimes evidence palatal or external necrosis over sinus; Neurological symptoms and findings are very worrisome and can include: Facial numbness, dilated pupil, impaired extra-occular movements, red eye--> involvement cavernous sinus