Sinusitis Symptoms and Diagnosis

Mostly patients of sinusitis can be diagnosed without much investigation as diagnosis is mainly based on clinical criteria in patient who presents with persistent or severe upper respiratory symptoms.

Nasal endoscopy for proper visualization of nose and sinuses and CT scan of sinuses is important for appropriate management.

How Sinusitis Develops

Acute sinusitis usually follows an upper respiratory tract infection.

Upper respiratory infection causes– over production of mucus and– impaires mucocilliary clearance (small hair like structure, cilia helps propel mucus out).

This compounded with blockage of opening of sinuses (osteomeatal area or key area) by mucosal edema and associated structural deformity of nose (like DNS, spur) leads to stagnation of secretion.

Blockage of sinus opening also impedes with ventilation of sinus cavity.

Certain factors predisposes for sinusitis -allergy, structural defects like deviated nasal septum, spur, low immunity like in HIV, defects of ciliary mechanism like cystic fibrosis, kartagenar’s syndrome, and immotile cilia syndrome.

Diagnosis of Sinusitis

Diagnosis is usually based on proper history of symptoms and thorough physical examination.

Nasal endoscopy for proper visualization of nose and sinuses is important for appropriate management.

Symptoms of Sinusitis

  • Purulent discharge from nose

  • Pain/pressure sensation over face more on leaning forward.

  • Headache

  • Nasal blockage

  • Changes in taste/smell

  • Poor response to decongestant

  • Toothache

  • Pressure sensation in the ear.

Sinus Questionnaire helps your clinician to reach to the diagnosis.

Examination

Nose is inspected thoroughly with nasal speculum (a small metal instrument), with a good source of light focused inside nose. Any discharge coming from sinuses opening or any structural deformity is looked for.

Nasal Endoscopy: E.N.T. Specialist use nasal endoscope attached to camera and monitor to see the nose and nasopharynx. Procedure called Nasal Endoscopy. At the same time accurate pus-swab can be obtained for bacteriological examination.

The patient should be assessed for the following conditions:

  • Septal deviation

  • Turbinate hypertrophy

  • Nasal polyps

  • Nasal airway problems

  • Ostiomeatal complex

  • Adenoidal hypertrophy

Palpation: Clinically tenderness over specific point of sinuses is assessed.

Laboratory Test

Not of much value in acute sinusitis.

In cases not responding to treatment it may be done.

  • Immune status of patient-HIV/chemotherapy

  • Allergy testing

  • Nasal cytology

  • Sweat chloride test for cystic fibrosis

  • Cilliary function test

In refractory cases one should always think possibility of fungal sinusitis.

Radiology

X-Rays of sinuses are not helpful in making diagnosis.

CT scan– CT scan are generally not advised routinely. It is advised by otolaryngologist if surgery is anticipated (to evaluate the extent of sinusitis and guiding during surgery), infection is severe or there is risk of complication.

MRI– MRI is not as effective as CT scan in evaluating sinusitis and is more costly. But may be advised for:

  • Suspected fungal sinusitis

  • To differentiate sinusitis from tumor

  • For intracranial complications

Determination of Causative Organism

It requires puncture, aspiration of mucopus and culture, but usually it is not done initially as it is invasive procedure. It is reserved for cases refractory to primary line of management.


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