Sinus infections are incredibly common, and for many people, symptoms clear up within a few weeks with little or no medical treatment. However, for millions of patients, sinusitis becomes a chronic problem that requires evaluation and treatment by a sinus specialist. Dr. David Santos, an ENT at Sinusitis In Seattle can pinpoint where your sinusitis is located and identify what is driving your symptoms.
Two of the most frequently involved areas are the maxillary sinuses (behind the cheeks) and the frontal sinuses (behind the forehead). Understanding the differences between maxillary and frontal sinusitis can help you recognize patterns in your symptoms and know when it may be time to see a sinus specialist.
Where Are the Maxillary and Frontal Sinuses?
The maxillary sinuses are the largest of the sinus cavities. They are pyramid‑shaped spaces located behind the cheekbones, close to the back molars and the sides of the nose. They are the only pair of sinuses located below the nose, which makes it easy for infections from other sinus cavities to spread to them. Over half of acute and chronic sinusitis cases involve the maxillary sinuses.
The frontal sinuses are hollow, air‑filled cavities located just behind the brow bone and the eyes. The septum divides them into right and left sides. Like other sinus cavities, they help lighten the skull and connect with the rest of the sinus system. Because they sit close to sensitive structures like the brain, frontal sinus infections are often treated more aggressively and frequently contribute to sinus headaches.
All of the sinuses work together to produce mucus that keeps the nose moist and helps trap pollutants and germs. When the system works properly, mucus drains gradually down the throat and is swallowed without you noticing it.
What Is Maxillary Sinusitis?
Maxillary sinusitis refers to a sinus infection located in the maxillary sinuses. These cavities are especially prone to infection because of their size, their connection to the other sinuses, and their proximity to the upper teeth. Infections may involve one side or both sides of the maxillary sinuses.
When the maxillary sinuses become inflamed and clogged, either because they are not draining properly or because of an outside infection, typical symptoms can include:
- Pain or tenderness in the cheek area
- Pain or tenderness in the teeth or mouth
- Runny nose and postnasal drip
- Sore throat
- Fatigue
- Fever (more common in acute infections)
- Pain that worsens when bending forward
- Swelling of the cheek or face (less common in early or isolated infections)
- Headache
The way maxillary sinusitis shows up can vary depending on whether it is acute or chronic. Acute maxillary sinusitis is more likely to cause facial pain but usually does not cause much facial swelling. Chronic maxillary sinusitis often produces duller, longer‑lasting symptoms that do not improve with time or basic treatment.
Chronic maxillary sinusitis is often linked to allergies or a larger upper respiratory infection, and bronchitis is a fairly common cause of subacute maxillary sinusitis.
What Is Frontal Sinusitis?
Frontal sinusitis involves inflammation and infection in the frontal sinuses. Like other forms of sinusitis, it begins when the sinus lining becomes inflamed and drainage is blocked, which causes mucus to build up. This can make breathing through the nose difficult and may lead to:
- Pain and pressure across the forehead
- Pain behind the eyes
- Runny nose and postnasal drip
- Congestion and generalized facial pressure
When other sinus cavities are involved along with the frontal sinuses, symptoms can be more widespread throughout the face. Because of the frontal sinuses’ location close to the brain, bacterial infections in this region are taken seriously and treated promptly to prevent them from spreading.
As with maxillary sinusitis, frontal sinusitis can present as acute, subacute, or chronic, depending on how long symptoms last and how they respond to treatment.
Symptoms: Maxillary vs. Frontal Sinusitis
Although both conditions share typical sinus symptoms like congestion, runny nose, and postnasal drip, there are some common patterns as follows:
Maxillary sinusitis symptoms often include:
- Cheek pain or tenderness, sometimes worse when leaning or lying down
- Tooth pain, jaw pain, or pain in the upper teeth
- Occasional numbness or tingling in the cheek
- Headache and fatigue
- Facial swelling, especially with chronic disease
- Bad breath in long‑standing cases
Frontal sinusitis symptoms often include:
- Pressure and aching across the forehead
- Pain behind the eyes
- Sinus headaches or migraine‑like pain
- Congestion and a runny nose
- Postnasal drip and difficulty breathing through the nose
In general, acute sinusitis symptoms, whether maxillary or frontal, tend to be more intense but short‑lived. Chronic sinusitis symptoms may be less severe day‑to‑day but can significantly affect quality of life over time.
Types of Sinusitis in the Maxillary and Frontal Sinuses
Both the maxillary and frontal sinuses can be affected by the three main types of sinusitis, which are generally defined by the duration of symptoms:
- Acute sinusitis – Most often associated with a typical sinus infection, commonly caused by a cold virus. With acute viral sinusitis, symptoms usually begin to improve within five to seven days and resolve within about two weeks. If they persist beyond that or get worse, a bacterial infection may be present that needs antibiotics.
- Subacute sinusitis – Symptoms last longer than four weeks and do not show significant improvement. This pattern can be related to allergies, a polluted environment, a deviated septum, or conditions like bronchitis that prolong sinus symptoms.
- Chronic sinusitis – Symptoms continue beyond three months and do not get better with standard treatment. Chronic sinusitis may follow untreated acute infections or be driven by other sinus problems; in some cases, an exact cause cannot be identified.
In the maxillary sinuses, chronic disease often presents with ongoing congestion, postnasal drip, facial swelling, fatigue, and changes in smell or taste. In the frontal sinuses, chronic sinusitis frequently shows up as persistent sinus headaches and migraines that interfere with everyday life.
Causes of Maxillary vs. Frontal Sinusitis
Maxillary sinusitis causes
Several factors make the maxillary sinuses especially vulnerable. Their position below the other sinuses means infections in other cavities can easily move down into them. Around 10–12% of maxillary sinus infections begin as a dental infection, where an untreated tooth problem spreads into the sinus. Chronic maxillary sinusitis is often linked to allergies or larger upper respiratory infections, and bronchitis is a fairly common cause of subacute maxillary sinusitis.
Frontal sinusitis causes
Sinusitis can have many contributing factors, such as a deviated septum, environmental pollution, allergies, and a compromised immune system. On a biological level, three categories of organisms can trigger frontal sinus inflammation: viruses, bacteria, and fungi.
- Viruses – Viral infections are the most frequent cause of sinusitis, including frontal sinusitis. Rhinoviruses and influenza viruses are particularly common, and an acute sinus infection can develop after a cold or sometimes even when you did not notice cold symptoms. Most viral sinusitis resolves within one to two weeks.
- Bacteria – Bacterial sinusitis accounts for under 2% of sinusitis cases each year. It typically does not clear without antibiotics. If symptoms fail to improve after about two weeks or worsen, doctors may prescribe antibiotics, and bacterial sinusitis usually resolves once treatment begins. In rare situations, bacterial sinusitis can become subacute or chronic, especially when viral and bacterial infections overlap.
- Fungi – Fungi are often present in the sinuses of patients with sinus issues, but a true fungal sinus infection is relatively rare. Most fungal sinusitis is non‑invasive and treated similarly to other forms of sinusitis. Invasive fungal sinusitis is uncommon but can be serious and requires prompt surgical care; fortunately, these cases are exceedingly rare in the United States.
Treatments and Sinus Surgery at Sinusitis In Seattle
For both maxillary sinusitis and frontal sinusitis, treatment depends on the cause, severity, and duration of symptoms. Viral infections often improve with time and home remedies. When bacterial infection is suspected, such as symptoms lasting beyond two weeks or getting worse, antibiotics may be prescribed.
When symptoms persist beyond several weeks and do not get better with standard medical therapies, or when sinusitis becomes chronic, sinus surgery may be recommended. These are the key point about surgical treatment for maxillary and frontal sinusitis:
- Maxillary sinusitis generally becomes chronic when it lasts longer than eight to twelve weeks and does not respond to initial treatments.
- Chronic frontal sinusitis is often resistant to many therapies, making it important to see an ENT specialist.
- Sinus surgery may be an option for people with chronic or recurrent sinusitis.
At Sinusitis In Seattle, Dr. David Santos, can determine whether sinus surgery is appropriate and which approach is likely to provide the most benefit. The three most common procedures described on the site are endoscopic sinus surgery, balloon sinus surgery, and stealth sinus surgery. All are designed to remove infection and inflammation, improve drainage, and may help prevent future sinus infections.
For maxillary sinusitis surgery, Dr. Santos uses small instruments inserted through the nostril. Imaging technology, such as an endoscope or CT‑based guidance, helps him direct instruments into the maxillary sinuses to manually drain them, remove infected tissue, and relieve inflammation. In balloon sinuplasty, the sinus openings are gently widened to reduce the risk of future blockage. Sinus surgery is usually performed as an outpatient procedure that often takes about an hour, with more complex cases sometimes taking longer.
After surgery, it is normal to experience temporary congestion and some bloody discharge from the nose. Dr. Santos provides detailed instructions that may include nasal irrigation to promote healing and reduce discomfort, avoiding heavy lifting and vigorous exercise for a period of time, not blowing the nose for about two weeks, and using pain relievers that do not thin the blood unless otherwise advised.
Frontal sinus surgery follows similar pathways through the nostrils but is technically more challenging because the frontal sinuses are the most difficult to reach using endoscopic techniques. Modern advances have made non‑invasive frontal sinus surgery possible and increasingly standard. Frontal sinusitis surgery is considered complex and is best performed by a surgeon highly skilled and experienced in sinus surgery, particularly frontal sinus procedures.
When to See a Sinusitis Specialist?
We suggest that long‑lasting or recurrent sinus symptoms, whether in the maxillary or frontal sinuses, should be evaluated by an ENT with expertise in sinusitis. If your symptoms last longer than four weeks, do not improve with basic treatment, or continue beyond three months, you may be dealing with subacute or chronic sinusitis that needs specialized care.
Dr. David Santos has decades of experience treating sinusitis in all sinus cavities and offers consultation, medical therapy, and advanced sinus surgery in the Seattle area. For more information, visit our website or call us at (206) 242-3696.
