In sinusitis, whether acute or chronic, the accumulation of pus in the nasal tract is one of the most important signs, i.e., a runny nose is the main symptom. The location of pus accumulation in the nasal tract varies because of the different openings of each sinus. The maxillary sinus, frontal sinus and anterior septal sinus all open in the middle nasal tract, so the secretions from the anterior sinus can flow into the nasal cavity and be easily blown forward, and some of them can also flow to the back of the nose. The opening of the pterygoid sinus is located in the pterygoid sieve fossa, and the sieve sinus of the posterior group opens in the upper nasal passage or the uppermost nasal passage.
Local examination of the nasal cavity reveals the location of the pus, which is of some value in diagnosing a particular sinus inflammation. Not only should the anterior rhinoscopy be done, but also the posterior rhinoscopy and, if necessary, nasal endoscopy should be done to clarify the diagnosis. Sometimes, the examination does not find pus, but also must be positioned to drain or repeatedly examined. Sinus radiographs or sinus CT examinations can also be taken to help with the diagnosis.
The amount of discharge from sinusitis varies, and is usually more in acute sinusitis. It is viscous, mucopurulent or purely purulent, depending on the severity of the lesion. Nasal secretions are an important cause of nasal obstruction, and nasal ventilation can be improved momentarily when the secretions are removed. When the maxillary sinus is punctured and flushed, the pus of acute inflammation is more likely to be mixed in the flushing fluid; the pus of chronic inflammation is in clumps. When sinusitis is accompanied by atrophic rhinitis, pus crusts can be blown out of the nose, and the secretions are mostly foul-smelling. Pus from odontogenic maxillary sinusitis often has a foul odor.
Patients with sinusitis can suffer from inflammation of the pharynx, larynx, and tracheobronchi due to secretions flowing down the posterior nostrils. Clinically, it is also common to see bronchiectasis often accompanied by chronic sinusitis. The secretions swallowed can cause gastrointestinal lesions, such as stomach pain, diarrhea, constipation, etc.