The many faces of atypical sinusitis.

The physician must be alert to the possibility of unsuspected sinusitis when evaluating a patient with chronic cough, sore throat, fever of unknown origin, supraglottitis, pneumonia, or headache. This article presents four cases in which atypical or asymptomatic sinusitis was discovered that could have caused significant or potentially life-threatening complications. In each case, the sinusitis was initially unsuspected. A complete nasal evaluation is warranted following decongestion of the nasal cavity when conditions are present. A screening sinus computed tomography scan may be indicated when sinusitis is strongly suspected even in the absence of typical clinical symptoms. Exact identification of the organism causing the infection may require sinus aspirate or tissue culture.