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[ What are sinuses? ] [ What is sinusitis? ] [ How is sinusitis diiagnosed? ] [ How is sinusitis treated? ] [ Functional Endoscopic Sinus Surgery ]

How is sinusitis diagnosed?

Because the symptoms of sinusitis can mimic other diseases, a careful history of the problem is important. While facial pain and discolored nasal discharge or mucus is most often associated with sinusitis, other more subtle symptoms like cough, malaise, or fatigue should also be sought out. Questions about each specific symptom, including its duration and severity, and about the success or failure of past interventions can help to shed light on the nature of the problem. In order to be thorough and complete, we use a questionnaire to gather information about a patient's symptoms. The patient's responses then form a basis for a more thorough discussion of the history of the illness.

An equally thorough physical examination then compliments the history of the illness. Because symptoms within the nose and sinuses can be associated with findings within the ears, throat, and neck, a complete otolaryngological (ENT) examination is warranted.

Often a more thorough examination of the nose, called a "diagnostic nasal endoscopy" is performed. This procedure involves passing a fiber-optic telescope, or "endoscope," into the nose and examining the interior of the nasal cavity. In this manner, the condition of the mucosal lining surrounding the sinus openings can be examined. Nasal endoscopy has greatly advanced the diagnosis and treatment of sinusitis. By providing superb illumination and magnification, it gives physicians the ability to closely examine conditions deep within the nose. It allows precise identification and targeting of problem areas and gives physicians an increased ability to monitor a patient's response to therapy.

Despite the great advances brought about by nasal endoscopy, this procedure can only give information about the openings of the sinuses. Unless a patient has had previous sinus surgery, the examiner cannot see the interior of the sinuses. Even in patients who have had sinus surgery, scarring can obscure the view into the previously opened sinuses. For this reason, another tool is used to visualize the sinus interior: computerized tomography, also known as a CT scan. (Previously the procedure was also referred to as a CAT scan, for computerized axial tomography). The CT scan provides information about swelling within the sinuses and also provides a road map of sinus anatomy should surgery be necessary.

CT scanning can be a powerful tool in diagnosing sinusitis but must be performed under the right conditions. In patients with "chronic sinusitis," the procedure should be performed when the patient is at his/her best. Patients should have received appropriate medical therapy and the scan should be performed no sooner than four weeks after the last flare-up. Otherwise, residual acute (short-term) inflammation will show up on the CT scan and give a false impression about the severity of the disease. If a patient undergoes a scan during an acute flare of sinusitis - or even during an episode of the common cold - the scan may show inflammation that will completely resolve. Such inflammation does not necessitate long-term medications and especially does not require surgery. In contrast, patients with "recurrent acute sinusitis," a less common variation of sinus problems, sometimes have CT scanning performed during the acute exacerbation in order to demonstrate that sinusitis is truly occurring and which sinuses are affected.

"Recurrent acute sinusitis" is much less common than "chronic sinusitis" but the difference shows the importance of a thorough evaluation. All components of each patient's assessment - history, general otolaryngological examination, nasal endoscopy, and CT scanning - must be considered before embarking upon a course of treatment. Trying to use just one without the others can lead to errors in diagnosis and delays in instituting the correct therapy.


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