Acute frontal sinusitis

See also Acute maxillary sinusitis (Acute maxillary sinusitis).

Essentials

  • Frontal sinusitis should be suspected in patients with symptoms of infection and facial pain particularly in the frontal sinus area.
  • Treatment is mainly the same as in maxillary sinusitis.
  • Patients with severe symptoms should be treated by an ENT specialist.

Aetiology

  • Acute frontal sinusitis usually follows a viral respiratory infection.
  • A large share of patients also have maxillary sinusitis at the same time (Acute maxillary sinusitis).
  • The narrow duct from the anterior ethmoidal sinuses to the frontal sinus is easily obstructed by infection, allergy or other mucosal irritation.
  • The nasofrontal duct is more sensitive than other sinuses to changes in atmospheric pressure. Frontal sinusitis may therefore occur in association with diving or flying.
  • Causative agents and their frequencies are the same as for maxillary sinusitis.
  • This is a disease of adolescents and adults; separate frontal sinuses are only formed after the age of 8 to 10 years. It is also possible that frontal sinuses are not formed at all (picture (Missing frontal sinus in sinus x-ray)).

Symptoms and diagnosis

  • Acute frontal sinusitis should be suspected if a patient with respiratory infection has headache in the frontal sinus area.
    • Frontal headache may be preceded by rhinitis and other upper respiratory tract symptoms.
    • There may also be a history of diving or air travel.
  • If the symptoms are uncharacteristic or prolonged, sinus x-ray may additionally be used in the diagnostics. A fluid level detected in the frontal sinus is a clear sign of frontal sinusitis (pictures (Left frontal sinusitis) (Fluid level in the frontal sinus)).
  • Symptoms
    • Facial pain particularly on the forehead
    • Purulent nasal discharge or postnasal drip
    • Impaired sense of smell
    • Cough
    • Concurrent maxillary sinusitis may also manifest as toothache in upper canine or molar teeth or as facial pain.
  • Examination of the patient
    • Tenderness to percussion over the frontal sinus
    • Mucosal oedema and erythema visible in the nose
    • Purulent discharge visible in the middle nasal meatus, posterior pharyngeal wall or nasopharynx
  • Symptoms and signs suggestive of complications include compromised general condition, intensive pain, palpable mass on the forehead, eyelid oedema, double vision or pain on eye movement, neurological symptoms (such as confusion, lowered level of consciousness, meningism)

Treatment

  • The frontonasal duct is narrow and, consequently, use of decongestant nasal drops or spray and/or a peroral decongestant in the treatment is recommended.
  • Glucocorticoid drops or sprays and pain medication are also recommended.
  • The first-line antibacterial agents for the treatment of acute frontal sinusitis as well as their dosage are the same as in the treatment of maxillary sinusitis(Acute maxillary sinusitis)

Indications for referral

  • Emergency referral
    • Suspected complication
    • Severe symptoms (frontal pain)
  • Referral for appointment
    • Symptoms of frontal sinusitis persisting despite appropriate medication
    • Recurrent episodes of frontal sinusitis

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