Sandbox:Dima

• Maxillary sinusitis - can cause pain or pressure in the maxillary (cheek) area (e.g., toothache, headache)
• Frontal sinusitis - can cause pain or pressure in the frontal sinus cavity (located behind/above eyes), headache
• Ethmoid sinusitis - can cause pain or pressure pain between and/or behind eyes, headache
• Sphenoid sinusitis - can cause pain or pressure behind the eyes, but often refers to the vertex of the head
• Pansinusitis - can present with a combination of any of the above symptoms

The importance of normal sinus ventilation for maintenance of a healthy sinus is stressed. It is concluded that granulocytes in the sinus secretion play an important role in the defence of the mucosa against potentially invading bacteria, but that the granulocytes in purulent secretions release proteases in high concentrations causing heavy inflammatory response in the mucosa. It is also concluded that although bacteria only rarely and not invariably invade the mucosa, bacteria in the secretion activate the humoral and cellular defence systems. When the stimuli are strong, the release of granulocyte protease in tissues and secretion can surpass the capacity of the locally available protease inhibitors and tissue destruction will ensue.

In order to maintain a healthy sinus, it has to be well-aereated. A precipitating factor, such as an URI, causes swelling of the nasal mucosa. This results in blockage of the ostea of the paranasal sinuses, which provides a medium for an inflammatory response to ensue. Inflammation is mediated by protease in granulocytes and if the amount of protease overwhelms the amount of protease inhibitors available, tissue destruction will take place.

the incidence of acute sinusitis ranges from 15 to 40 episodes per 1000 patients per year, depending on the setting.