A 2 year old presents with pain over the bridge of the nose, medial and deep to the eye. It was aggravated by movements of eyeballs. Patient also complains of nasal discharge. Examination reveals oedema of both eyelids and swelling of the middle turbinate. Involvement of which of the following para-nasal sinus is suspected.

Ethmoid Sinus sinusitis Major factors Minor factors Facial pain or pressure Headache Facial congestion or fullness Fever (in chronic sinusitis) Nasal obstruction or blockage Halitosis Nasal discharge , purulence, or discolored postnasal drainage Fatigue Hyposmia or anosmia Dental pain Purulence in nasal cavity Cough Fever (in acute rhinosinusitis only Ear pain, pressure, or fullness The presence of 2 major factor and 1 minor Factor, or 1 major factor and 2 minor factor, is strongly Suggested o sinusitis. ACUTE FRONTAL SINUSITIS ACUTE MAXILLARY SINUSITIS Clinical features Clinical features Frontal headache 1. Constitutional symptoms 2. Headache 3. Nasal discharge 4. Postural test 5. Postal nasal discharge It shows characteristic periodicity, i.e. come upon waking gradually increases reaches its peak by about midday and then stas subsiding. It is also called office headache tenderness Oedema of upper eye lid Tenderness ACUTE SPHENOID SINUSITIS ACUTE ETHMOID SINUSITIS Clinical features Pain over bridge of the nose Headache: usually localized to the occiput or veex. Oedema of both lids Swelling of middle Postnasal discharge Turbinate