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
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
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.
Go to next page: "How is