Risk factors for acute sphenoid sinusitis:
(1) chronic steroid therapy
(2) immunosuppression
(3) diabetes mellitus
(4) recent viral infection
(5) barotraumas
(6) dental infection of the maxilla
(7) intranasal cocaine use
(8) anatomic obstruction of the sphenoid ostium (foreign body, trauma, tumor, etc)
(9) history of sinusitis
Clinical features:
(1) sudden onset of headache that is not relieved by over-the-counter analgesics
(2) sudden onset of facial pain
(3) worsening of headache and/or facial pain with head movement
(4) variable photophobia, diplopia, or blurred vision
(5) variable chemosis or proptosis
(6) variable disorder of smell
(7) variable meningeal signs or seizures
(8) relief of symptoms after sphenoidotomy
Features that may make diagnosis difficult:
(1) isolated sphenoid sinusitis
(2) absence of fever (fever present in only 8%)
(3) absence of leukocytosis
(4) failure to take imaging studies of the sphenoid sinus
(5) vague or few clinical findings
Complications:
(1) cavernous sinus thrombosis
(2) bacterial meningitis
(3) subdural abscess
(4) pituitary insufficiency
(5) osteomyelitis
