Sinusitis

Diagnosis

Your doctor will take a history and conduct a physical exam, looking for signs of sinusitis. You doctor will ask if you have had persistent cold symptoms (lasting longer than five to seven days) and a poor response to over-the-counter decongestants, as both these things suggest a sinus infection.

During the physical exam, your doctor will tap briskly on your cheeks and forehead to see if you have any tenderness overlying the sinuses. In addition, the doctor will check the back of your throat for post-nasal drip and redness.

To confirm acute sinusitis, your doctor will shine a flashlight through your sinuses in a dark room (a procedure called trans-illumination), and may take an x-ray. Trans-illumination can identify sinusitis in some patients because blocked sinuses will be opaque to the light. However, this test is not useful for patients with chronic sinusitis, or other conditions that increase the thickness of the sinus bones. Four-view x-rays of the sinuses are also helpful.

More highly technical diagnostic techniques are reserved for patients with chronic sinusitis, hospitalized patients, or those with complicated acute sinusitis. In chronic sinusitis, the physician must determine whether the patient has allergies or immune deficiency, and rule out the possibility that a tumor or growth called a granulomatous process is blocking the sinuses.

Patients with suspected chronic sinusitis should always have computerized tomography, or CT scanning. This imaging technique produces precise images of structures within the skull, and will confirm or rule out the diagnosis of chronic sinusitis and pinpoint the affected sinuses. An ear, nose, and throat doctor may use nasal endoscopy in these patients. In this procedure, a flexible, lighted scope is inserted into the nose, and is passed down the nasal passages to the larynx. As the scope is inserted and then withdrawn, the doctor views the sinus openings, checks for blockage, and determines whether surgical widening of the ostia may be necessary. The patient receives local anesthesia to suppress the gag reflex, and may be sedated. During this procedure the doctor can also collect sinus secretions. Collection is important for complicated and chronic cases of sinusitis because it allows the doctor to determine the most appropriate antibiotic to give the patient for the infection.

Prevention and Screening

If you smoke, you should quit to protect yourself against sinusitis. Cigarette smoking impairs the function of the cilia, making the body less able to clear contaminants from the sinuses. Some smokers, for example, develop sinusitis every time they get a cold. Quitting allows the cilia to heal, and more effectively remove the bacteria, mucus, and foreign objects that can lead to sinusitis. In addition, if you stop smoking, you will no longer be introducing foreign material into the respiratory system that can cause inflammation of the nasal passages and interefere with normal muco-ciliary function. Vaccinations against certain bacteria, such as pneumoccal pneumonia, can help prevent sinusitis infections caused by those bacteria.

Taking preventive measures when diving or traveling by air can prevent sinusitis caused by barotrauma. Holding the nose when jumping into water feet-first will prevent water from being forced into the nose, which can lead to sinusitis. When traveling in an airplane, chew gum or swallow frequently during takeoff and landing to equalize the pressure inside and outside the skull.