My daughter is experiencing a sore throat, but she says it is deep and dry and raw. Her jaw is sore and so are her teeth. She has chills down her left arm but not her right arm. She has burning eyes -- not watery, just burning -- and an extremely stuffy nose. I'm concerned. This doesn't sound like the common cold. She is 20 years old.

M.

I would agree: This does not sound like the common cold. She probably has an infection, but she will have to see her doctor to pin this problem down with any certainty.

My hunch is that she has acute maxillary sinusitis, which is a bacterial infection of the sinus within the cheekbone. She may have a more generalized infection involving all of the sinuses (pansinusitis). Acute sinusitis commonly causes pain in the involved bone, and the cheekbones, upper jaw and teeth will ache. Even gentle tapping on these structures will result in severe pain.

In addition to pain, acute sinusitis commonly "spills over," leading to inflammation and/or pain of adjacent structures. Thus, nasal inflammation is another common sign of sinusitis. Inflammation of the tear ducts will cause watering or burning of the eyes. If your daughter is having even a small amount of pus draining from her sinuses down the back of her throat, then throat pain, cough and even hoarseness may result. She may or may not be conscious of this postnasal drainage, depending on the volume of material that is draining.

What about the chills? Chills are a common sign of any serious infection. However, I find it bizarre that she notes chills involving only her left arm -- I really don't know what to make of this symptom.

She MUST see a doctor. It is essential to obtain a real diagnosis -- not a "let's take a stab at it" diagnosis from an online doc. Also, if my hunch is correct and she does have acute sinusitis, she needs prompt treatment to limit the risk of serious, even life-threatening, complications.

Unlike the common cold, which an otherwise healthy 20-year-old could easily recover from without a doctor's assistance, acute sinusitis is an entirely different animal. Here is a partial list of the devastating problems that may occur if acute bacterial sinusitis is left untreated:

1. If the infection spreads to the space around the eye, double vision or even blindness may result.
   
2. Chronic infection of the facial bones (osteomyelitis) can be painful, disfiguring and difficult to eradicate.
   
3. Spread of infection to the tissues that surround the brain can result in bacterial meningitis, which in turn can cause blindness, deafness or even death.
   
4. The infection can also spread to the brain, causing a brain abscess. As with bacterial meningitis, a brain abscess can cause permanent neurologic damage and may be deadly.
   

These complications are far less common than they used to be, in the pre-antibiotic era. Obviously, antibiotics are cold comfort if they are sitting on the pharmacist's shelf while the infection rages on.