Infection of the frontal sinuses, which are the hollow spaces located in the center of the forehead directly above the orbital bone.

Sinusitis may occur secondary to a bacterial or viral infection, or an allergy. Chronic sinusitis may follow persistent, bacterial infection which is usually caused by two or more organisms (polymicrobial). Anaerobic organisms which may cause the condition are anaerobic Streptococci and Bacteroides species. Anaerobes are also significant in chronic sinusitis in that they predominate in brain abscesses associated with sinus infections. Several factors predispose a person to chronic sinusitis including: long-term impairment of mucous clearance, sinus drainage, allergies, and asthma. Vasomotor rhinitis may also be a cause. (See Diagnostic Code: 6522 Allergic or vasomotor rhinitis)

Signs and symptoms related to chronic frontal sinusitis include: frontal headaches, pain and tenderness over the eyebrows, and purulent drainage from the middle meatus of the nasal turbinates. Other signs and symptoms associated with chronic sinusitis include nasal congestion and purulent discharge. Headaches may be mild or absent, and fever is uncommon. A poor response to decongestants is also observed, and bone erosion may be present.

Sinus x-rays reveal cloudiness in the affected sinus, air-fluid levels, or thickened mucosal lining. Sinus cavity puncture promotes drainage and removal of pus, which may also provide a specimen for culture and sensitivity. Transillumination allows inspection of the sinus cavities by shining a light through them; pus will prevent passage of light. Computed tomography (CT) scans provide more information than the traditional sinus x-rays, and may be necessary to determine if an abscess around the eyes is present, or if a brain abscess coexists.

Antihistamines, antibiotics, and a steroid nasal spray may relieve pain and congestion. Surgery may be required if irrigation or cleaning (curettage) does not relieve symptoms. Endoscopic sinus surgery may be performed if the person does not respond to medical management.

Chronic sinusitis may lead to intracranial suppuration, orbital cellulitis, or meningitis. These conditions are considered to be medical emergencies. Any of the signs and symptoms noted previously might also recur, but the prognosis is good with vigorous medical management.

• Since most cases of sinusitis can be effectively treated and therefore are not ratable make sure that the condition is chronic and not acute and transitory. A solid diagnosis with a good description of symptoms is required.

• Consider entitlement to service connection based on presumed exposure to fine particulate matter under 38 CFR 3.320

• An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician.